BiPAP Induced Central Apneas for New User (help)?

[STB123]

Hi Crew,

New guy here and at Sleeprider's suggestion, I am starting a thread.  I'm sure it's been said infinitely, but this is an awesome resource and thanks in advance for any input.

I initially ordered a study on my own from singular sleep.  I've had ongoing bruxism, and although I have always eaten healthy and am in excellent shape, working out daily, I had an arterial calcium score of 17, which I should not have at age 39.  This plus restless sleep, brought me to singular.

I did a home test with a Philips testing device, and had an AHI of 10.4, 100% Hypopnea's, no Central Apneas.  O2 86%-96%, avg 91%. My waking O2 is 98+.  I was diagnosed primarily based on the idea of improving O2 (but I also live at 6,000 Feet ) and chose to go with the more advanced Dreamstation BiPAP.  I was excited to get started a week ago, but the results have been poor.  The Hypopnea's and Apnea's are no problem, but I am having around 15 Central Apnea's an hour.  I think I am actually lucid during these, as I am somewhat cognizant of struggling with "Am I breathing or is the machine breathing?" 

I got my data into sleepyhead today, and based on another amazing starter thread I read here, it seems to me like I am having waking events, and then clusters of CA's as I fall back to sleep.


BiPAP Range 4-25 (open)
PS 5
Humidified

I've already tried nasal mask, pillows, face mask.

I have insurance, but did this all solo.  I'm not looking forward to coming out-of-pocket $5k for an ASV when I started with an AHI of 10.4, all Hypopnea's, so the alternative to trying to sort this out on my own is to start all over with my GP.  I've already spent $2k out-of-pocket for the convenience of doing this outside the insurance system.

Please let me know your thoughts.  I feel like my Dr is accessible, and I have a follow up shortly.  

Do people adjust through this?

Does this seem to be a case of machine-induced CA?

Is the primary goal to improve overall oxygenation (other than feeling good)?  I have an oximeter on the way.

Is there any point treating these numbers?  I feel sort of OK, don't snore, and certainly can't hold a candle to a lot of people struggling with severe issues.  I am more just concerned with keeping and improving my health than any major sleep disturbance issues.  I definitely don't want to make things worse, but I went from 10.4, All Hypopnea's, to around 20, primarily CA's on the machine.  

Looking forward to any input!  


Example of CA Trend can't post links, put in a space.  Files over 200 kb, sorry.  Posted one smaller snap attachment. 
https://imgur.com/a/hWPiC

Sleep Study Snapshot:
https://imgur.com/U2AGCdu

[Walla Walla]

Others smarter than me will weigh in. But first thing you need to do is drop your (PS) pressure support to 3. A wide PS is one of the leading causes of CA's in people who don't normally have central apnea. High altitude also can increase CA's. It is important to keep O2 levels above 90 to 92% Below that and the lack of O2 over the long term can cause damage to your internal organs including your brain. Using a Bipap can help keep your O2 levels up.
Good luck with your treatment and welcome to the Board!

[Sleeprider]

Take your EPAP min to 5 and PS to 3 and see what happens. I think these are machine induced, and you would not be the first one on the forum to have altitude related centrals. I'm thinking this change will help quite a bit. Your Dreamstation is capable of variable PS, and using a range of 2-4 is another option.

[STB123]

Walla Walla and Sleeprider: Thank you very much for the advice! I made the changes last night but it was a bit of a throwaway, as I only wore the mask for a few hours and was awake for much of that. I'm going to give it another shot tonight and will report back.

[Sleeprider]

Good luck! Give it a fair chance to work and we're here for you to help interpret the results. The lower pressures should be more comfortable and help you to sleep. If you feel like something is happening at sleep transition that is awakening you, that may actually be an indicator of central apnea. Good luck.

[STB123]

I'm curious, in the absence of Oximeter results, do you think these CA's particularly concerning? They average 10 seconds each, and I can't imagine holding one's breath for 10 seconds is particularly dangerous.

Again, Thank you. And BTW, I've chosen to support the board already, the donation is nominal considering the value in terms of the medical expense and wasted treatment time saved.

[Sleeprider]

I don't think they are as serious as most OA in terms of health impact, and given you are just starting bilevel therapy, it's not alarming. While we don't know the cause, the sudden introduction to high pressure support is a strong suspect. Backing off on PS is an appropriate response, and we can get it all sorted out as you adapt more to the therapy.

[Mogy]

Hi STB123,
I too am one of those that get Centrals that are induced by CPAP therapy. They were the worst for the first week. After a month they we're manageable. From month 3 to month 8 they have averaged about 1 per hour.

[Sleeprider]

Another data point: http://www.apneaboard.com/forums/Thread-...#pid226859

[trish6hundred]

Hi STB123,
WELCOME! to the forum.!
Good luck with CPAP therapy.