3 Weeks In and Lots of Central Events

[RER9372]

I'll try this again since I have a better handle on OSCAR and the proper way of taking screenshots. 

I'm about 3 weeks into therapy after having an AHI around 40 in a sleep study. I was given a ResMed 10 AutoSet with P10 nasal pillows. So far I find the equipment pretty comfortable, but seem to be subconsciously taking the mask off in the middle of the night - last night was the best night in terms of keeping the mask on. The OSA seems to be mostly taken care of with the CPAP, but I can't seem to get the CA and Hypo apneas under control. I also live at altitude (about 5400 feet) which may contribute to the CA. When I was visiting family recently at sea level the CA numbers were much lower which I found interesting. I just recently turned off EPR, turned off ramp, and bumped the minimum pressure from 5 to 6. Attached is my OSCAR report from last night and my initial sleep study numbers. I appreciate everything in advance!

[SFLGuy]

I also started a few months ago and am having CA events when I didn't during my sleep study.

[Jay51]

Welcome to apnea board RER9372.  2 major things jump out at me.  

1.  Your new machine could be over ventilating you (causing too much CO2 washout) and causing the CA's.  But you had a high amount of CA's on your sleep study though.  

1.  Your CA's could be related to your living at a high altitude.  High altitude can both cause and worsen CA from the research I have done.  Some people have used supplemental oxygen successfully to combat this particular problem.  

2.  You may have the wrong machine.  This machine will not do anything to treat CA's.  A ventilating - type machine like an ASV, ST, or ST (A)  or even volume assured algorithm machines can treat CA's (the volume assure machine have a programmable back up rate).  A back up rate is a timed function of the machine to deliver a breath when you fail to take one due to CA's.  Your current machine does not have this back up rate function.  

Possibly the only way to rule out altitude is to use your machine at sea level, etc. and see if you have significant changes (can take machine on next vacation to a lower altitude to test this out).  

If you are still having high CA's after using it for about 3 weeks then that most likely rules out treatment emergent CA's also - CA's that occur early in treatment to some people, but go away after a few weeks as their bodies adapt to the better ventilation of pap therapy.  

*With your AHI being as high as it is, that is a good thing.  I will explain.  Since yours is over the 5 AHI point (the gold standard for AHI treatment), it should be easier for you to convince your Dr.'s that your therapy is inadequate and get more help from them.  I would recommend making an appointment with your Sleep Dr. or PCP and show them this OSCAR data (and the Resmed Myair app data - which they should already be getting from your machine).  

Any other questions just ask.

[RER9372]

Welcome to apnea board RER9372.  2 major things jump out at me.  

1.  Your new machine could be over ventilating you (causing too much CO2 washout) and causing the CA's.  But you had a high amount of CA's on your sleep study though.  

1.  Your CA's could be related to your living at a high altitude.  High altitude can both cause and worsen CA from the research I have done.  Some people have used supplemental oxygen successfully to combat this particular problem.  

2.  You may have the wrong machine.  This machine will not do anything to treat CA's.  A ventilating - type machine like an ASV, ST, or ST (A)  or even volume assured algorithm machines can treat CA's (the volume assure machine have a programmable back up rate).  A back up rate is a timed function of the machine to deliver a breath when you fail to take one due to CA's.  Your current machine does not have this back up rate function.  

Possibly the only way to rule out altitude is to use your machine at sea level, etc. and see if you have significant changes (can take machine on next vacation to a lower altitude to test this out).  

If you are still having high CA's after using it for about 3 weeks then that most likely rules out treatment emergent CA's also - CA's that occur early in treatment to some people, but go away after a few weeks as their bodies adapt to the better ventilation of pap therapy.  

*With your AHI being as high as it is, that is a good thing.  I will explain.  Since yours is over the 5 AHI point (the gold standard for AHI treatment), it should be easier for you to convince your Dr.'s that your therapy is inadequate and get more help from them.  I would recommend making an appointment with your Sleep Dr. or PCP and show them this OSCAR data (and the Resmed Myair app data - which they should already be getting from your machine).  

Any other questions just ask.

Thank you so much for the welcome and detailed response! I did notice at lower altitude when traveling my AHI was around and sometimes below. I will be traveling again soon and will keep a close eye on it.

Is there anything else I can do from a settings perspective to reduce the CA? I've already turned off the ramp and EPR. I was also concerned about the crazy ups and downs of pressure and wondering if I should fine tune that a bit.

[Jay51]

I think the pressure increases are purely to combat obstructive apneas (and maybe hypopneas also).  I am not super familiar with your particular machine, but I do know that is does not have a back up rate so it cannot treat central apneas.  

Sometimes turning down the pressure can decrease CA's.  But it is a fine balance because the pressure has to be high enough to combat the OA's.  A high epap can stent your airway open to stop obstructives.  You can try to turn down the pressure if you can on your machine and it might decrease your centrals.  But that move may also increase your obstructive apneas.  

Anyone more familiar with the Autoset may want to post here.

[Gideon]

Sorry I'm late to the party.
Your centrals may be due to altitude, especially if I understand you correctly in that the centrals basically disappear when you travel to lower altitude.

I'm going to assume that your sleep test was at the same approximate altitude that you live, please confirm this.
Based on that and the fact that during your sleep test you had more central apnea than obstructive apnea. And the fact that your AutoSet has already proven that it does not work for your apnea, not a surprise since it is set up to do nothing if central apnea is detected.

In short, you have the wrong machine. The proper machine for you is the ASV Adaptive Servo Ventilator. The ASV is specifically designed to treat Central and Mixed apnea.

Your sleep study deserves kudos for verbally stating your central and mixed apnea. I'd bet they didn't enter the HC codes that define you ailment to include anything but OSA.

Also their exemplary new, new math should receive the Nobel prize for showing how no (0) obstructive hypopneas + no (0) central hypopneas = 11 total hypopneas per hr. I just had to chuckle when I saw that

[RER9372]

Sorry I'm late to the party.
Your centrals may be due to altitude, especially if I understand you correctly in that the centrals basically disappear when you travel to lower altitude.

I'm going to assume that your sleep test was at the same approximate altitude that you live, please confirm this.
Based on that and the fact that during your sleep test you had more central apnea than obstructive apnea.  And the fact that your AutoSet has already proven that it does not work for your apnea, not a surprise since it is set up to do nothing if central apnea is detected.

In short, you have the wrong machine.  The proper machine for you is the ASV Adaptive Servo Ventilator.  The ASV is specifically designed to treat Central and Mixed apnea.

Your sleep study deserves kudos for verbally stating your central and mixed apnea.  I'd bet they didn't enter the HC codes that define you ailment to include anything but OSA.

Also their exemplary new, new math should receive the Nobel prize for showing how no (0) obstructive hypopneas + no (0) central hypopneas = 11 total hypopneas per hr.  I just had to chuckle when I saw that



Thanks for the reply and info above. I can confirm the test was done at altitude (same altitude I live at and per the screenshot with OSCAR data above). When I was at sea level I was hovering around 2-4 total AHI with CA around 1-3. I am looking to move to sea level in a few months coincidentally - If I can continue to obtain those same numbers at sea level should I still pursue the ASV? The sleep clinic mentioned the ASV would be more costly and may or may not provide additional symptomatic benefit. 

I am definitely frustrated with what I know now at what the sleep clinic recommended for me and just providing the APAP.

[Gideon]

Try this
https://www.apneaboard.com/wiki/index.ph...ace_(EERS)
It is a method of moving the mask vent further away from the mask resulting in rebreathing a slight amount of your exhaled air, the effect is to increase your CO2 levels and thus reduce your Central Apnea under the assumption that it is CO2 induced. It very likely is since you have centrals at altitude and not at sea level.

This is not applicable to everyone but in your case it should work

Basically you block the mask vents, add a length of hose to increase your CO2 levels, then add a new vent between that hose and your cu=ENT CPAP hose. The vent is very important and the mask is disabled from sea level/normal use because of the blocked vent. The article details this.

At sea level we may be able to slightly reduce your CA level but you are into the official ok range for there.

[RER9372]

Thanks so much, I'll definitely give that a shot!

I'm wondering if my OA continues to be at 0, should I continue lower my pressuring or moving it to something more fixed? I'm wondering if the wild ups and downs of the pressure ranges are creating CA events.

Last night I moved to minimum of 5 and maximum of 9 (down from 5 to 15 range) and had better results.

Also, I never put this together until now, but I have felt and looked very bloated since starting CPAP. I never connected it to CPAP until last night. Anything I can do to remedy this? I heard turning on EPR to 3 would help, but I fear that would raise CA more.

[Sleepy Quixote]

@RER9372 I had a problem with CA events early on too. Did some EERS as Gideon suggests, that helped, but still continued to have some CA events. After reducing the number of events it was easier to study the graphs for correlations, mine like yours showed concentrations of CA centered on extended leak periods, when I got the leaks under control my CA tally decreased dramatically. Now I'm down to a few sporadic instances, some false flags, some leak related and the occasional actual event.

Its always good to work on leak control in the mean time, but keep in mind Gideons advice about working toward an ASV.