CENTRAL APNOEA

[Geer1]

I am slightly confused reading through this.

If am understanding this correctly you were previously on medication that can cause centrals, you discontinued the medication and your central apnea went away.

Since then you have been using pillow style masks and your AHI was regularly below 5 but recently it increased to 10+ for an unknown reason, the majority of which you claim are central although in the examples you posted I see a mixture of both central and obstruction as well as a mess of other issues like leaks etc.

You tried switching to a full face mask and your AHI reduced back below 5 and you are trying to understand why that might be. Is that correct?

When answering this post up some recent, typical FFM OSCAR graphs so we can get an idea of what your current treatment looks like.

[Pedrx]

Me too. Confused. Very.


I suggest we drop the previous post which is about drug related Apnoea.

And I get the impression that contributors are not understanding the subject which is described in the the opening post. 

If, therefore, this is unclear I can try to clarify it.

Thank you for your input so far.

[Geer1]

So Pedrx my summary was correct?

As mentioned it is worthwhile to see one typical, recent FFM results before attempting to determine why the results are now different.

The main idea is likely a mouth breathing issue that has got worse for some reason.

[Pedrx]

       

Sorry for the delay. Difficult times. Ok now.

Two screen shots enclosed. Feb 16 shows the peak of the Cheynee Stokes events.

The following night switched from FFM to Pillows. There were no CS events but they steadily increased up to, as yet, last night's results, shown as Feb 22.

Am aware Cheynee Stokes indicates heart failure. A recent scan shows heart to be fine.

The numbers seem low but, nonetheless, I can feel exhausted during the day. Is that due to the duration of the events rather than the quantity perhaps?

So it looks like ''Treatment Emergent'' apnea and perhaps adaptive servo-ventilation.

Any advice, please, before I approach my NHS Sleep Lab... again?

[SarcasticDave94]

CSR will mean variable breathing as you state the heart is healthy.

Leaks are too high to allow acceptable therapy. If accurate, Central Apnea presented here will hinder well rested sleep, but the leaks may have hindered reporting accuracy. And flow limits add to the not good enough therapy.

Depending on what trends are ongoing will determine how to remedy this. I think leaks are first as they do hinder any action to address any of the events.

[Sleeprider]

Pedrx, I'd like to try something to verify the origin of the centrals is not obstructive. They occur in clusters and are associated with very high flow limitations. As far as I know, you have never tried EPR and your flow limits are chronically high which causes pressure increases. Let's turn on the EPR full-time at 3 and see what happens to these events. If you find that level of EPR uncomfortable or feel you can't properly breathe, the reduce the setting to a comfortable level. It's possible the central events are more related to arousal and flow limitation, and before moving forward I'd like to rule that out or see if EPR actually increases central apnea. Give us a night with EPR, then depending on the outcome, we may want to take other measures to stabilize your pressure.

With regard to CSR, that is the default flag title for periodic breathing with Resmed machines. It is usually not CSR, and we have seen both obstructive and central periodic breathing flagged with this. We would need to look at a much closer zoomed view of 3-4 minutes of the flow rate to actually see what is going on with the variable flow. Do not worry about heart failure.

[Pedrx]

Thank you. This gives me hope. If closer zoom required then for what times?


           

[Sleeprider]

While there is improvement in the data of 2/23, there are also signs that you are at your central apneic threshold as indicated by the periodic breathing at 04:30. It would be more comfortable and should improve therapy id we stabilize pressure by increasing the minimum pressure from 5.0 to 8.0. Other than that, we should reserve judgement until any improvement is demonstrated by more days of improvement.

[wr61]

I think the leaks are from positional apnea where the air pressure can't penetrate the obstruction and has nowhere to go but out through the mask seal and face. Stopped mine with a $ 10.00 Soft Cervical Collar, got rid of my OA Clusters lie you have too. Just my opinion.

[Pedrx]

I think the leaks are from positional apnea where the air pressure can't penetrate the obstruction and has nowhere to go but out through the mask seal and face. Stopped mine with a $ 10.00 Soft Cervical Collar, got rid of my OA Clusters lie you have too. Just my opinion.

Yes, wr61, you might be on to something there. Will definitely try the collar.

These 'clusters' still occur occasionally, where, though the max pressure is 14, the red line wants to go higher. 

It's no doubt also due to lying on my back. Perhaps you have some ideas about this?
(Other than gluing a golf ball to my spine).