CPAP Causing High Central Apneas

[CM Apnea]

Hi everyone -- happy to have found this place, been learning a lot. At the start of the year, I was officially diagnosed with mild obstructive sleep apnea, with an AHI of 6.2. I was told my options were CPAP therapy or sleeping on my side would also help to treat it after my sleep study. I'll attach it here, but as far as I know and can tell, I wasn't experiencing any central apneas. For reference, I'm a 28year old, 5'10 male about 155-165lbs give or take, I'm definitely not overweight, although I know my father also had a history of apnea (but he was much heavier than me, but unfortunately he passed so I can't determine if it's genetic or not).

So I purchased the Resmed AirSense 10 Autoset, as all the research pointed me to it being the best. I also purchased the Nasal Pillows P10. Because I've been worried about congestion and the hose potentially being why I'm not sleeping well, I've also experimented with the n30i, but my head is large so it doesn't fit super well, but I can't say my results have been better. Anyways, we went through the early phase, although I had already started tweaking it because I wasn't sleeping well on the 4-20 range. Got lectured from my doctor, but eventually we settled on a range of 7 to 11, with EPR set to 3 as that's what my CPAP was adjusting itself to. I've been attempting to consistently use it for months, but it has been causing me to have severe central apneas instead. When I sat down with my sleep doctor, he wanted to do an oxygen test on me to determine if my oxygen was fine, and we determined that I'm not having any problems with my O2 levels and we didn't need supplemental oxygen. No changes otherwise. He advised me to use it for 30 days as we "need more data." I got fed up after the fact and stopped using it and have been racking my brain on what to do. I've since been experimenting with decreasing EPR to turning it off, since I've read EPR can cause central apneas I try it some nights thinking "okay I need to just rip this bandaid off and get it done" -- but 30 days of data is TORTURE when I can just not use my CPAP, sleep kind of sh**ty, but at least make it through the day vs having a sh**ty night rest on my CPAP and then waking up and ripping it off at 2-3AM and then trying to go back to sleep. I have a job and responsibilities, I can't just fall sleep at my desk all day because nobody knows what's going on.  The entire interaction kind of left me frustrated and wanting a second opinion, but maybe this practice is standard? I don't have a lot of good options for sleep doctors in my area without driving to another city, so getting a second opinion is hard. The crazy thing is I've seen a few nights where I got down to 5 AHI as well and I slept "okay" 

Anyways, I'm attaching 

• My sleep study report
  
• a few screenshots of my CPAP therapy from OSCAR
  
• Details where I can on some of the events
  

I'm hoping somebody could guide me to whether I need to really just dig in and use it consistently and see if these "go away," I need to go back to the doctor and demand something else, or I need to really seek out a second opinion. Any advice here is greatly appreciated. Thank you so much!

---

April Screenshots since limited to attachments

[KeepSmiling]

Hi CM Apnea,

On the report,

Apnea Index showed
Central as 1.3

Unclassified as 0.2 (Do not know what those are.)

At the very bottom of the paper it shows CSR [0.5]. I assume are Cheyne-Stokes respiration events..

With oxygen saturation going down to 88%, it is an issue. Not good for you.

The fact that "hypoapneas were only scored if there was a valid oximetry data" I have an issue with that, because what if they arouse you. That would not be healthy for your body.

Others will be able to give more info on the OSCAR data and the centrals. You may be having issues with how you sleep.

I understand you just about had it. Be gentle with yourself. If need be take notes on each mask. Pros/cons, where it leaked, what position where you in. What does each setting feel like. If you take off EPR can you breath, etc. What about the humidity level, everything plays a role.

Do you get more congested on your machine?

Yes, I would dig in and use the machine. May not be the right machine etc, but you will be gaining knowledge, to guide you yo your best setup for good sleep and good health.

[Gideon]

IMHO the CA event you show in the expanded view are the result of arousal and by the irregular breathing pattern most likely just you holding your breath while tossing. They shouldn't be considered in your AHI.
I do not see why you are having this irregular breathing that is typical of awake breathing.

[clownbell]

CM - your charths indicate you are using EPR of 2. People with lots of centrals are encouraged to turn EPR off entirely. That may be an experiment worth trying. One or two nights do not make a trend. I'd give it a week.

You're not gonna want to hear it, but I tend to agree with your doc. More data needed. This is a corollary to "one night is not a trend." Tough it out and get it done.

[ethereal]

What is it about EPR that causes (does it cause?) centrals? 

And is it fine to just go from 3 EPR > 0 EPR or should you step down?

[Gideon]

The use of a CPAP, the use of higher pressures, the use of differential pressure always improves your breathing efficiency and can and does, in some cases, cause TECA by flushing too much CO2 being purged, meaning to below your apneic threshold, which will then result in a central apnea. The detailed charts you have previously provided do not show this pa[tern.

[Lucid]

Hi, CM Apnea,

I have a few questions after looking at your original post and the attachments.

1.  Have you tried anything to keep from rolling over on your back?

2.  What is it about using CPAP that makes it feel like torture, specifically?  E.g., does the mask hurt your face, is the air pressure uncomfortable, is it the unpredictability, do you get air in your mouth, or what?  Does using CPAP make it hard to fall asleep?  What is it about it that wakes you up?

There were so many different things I had to address to finally get comfortable with CPAP, in addition to the pressure settings.

One thing that GREAT about your charts is no leaks!  That's a big challenge for many/most users, and you have that solved already.

[CM Apnea]

Hello everyone -- thank you for the responses. Haven't been able to respond until today.

Hi CM Apnea,
On the report,
Apnea Index showed
Central as 1.3
Unclassified as 0.2 (Do not know what those are.)
At the very bottom of the paper it shows CSR [0.5]. I assume are Cheyne-Stokes respiration events..
With oxygen saturation going down to 88%, it is an issue. Not good for you.
The fact that "hypoapneas were only scored if there was a valid oximetry data" I have an issue with that, because what if they arouse you. That would not be healthy for your body.
Others will be able to give more info on the OSCAR data and the centrals. You may be having issues with how you sleep.
I understand you just about had it. Be gentle with yourself. If need be take notes on each mask. Pros/cons, where it leaked, what position where you in. What does each setting feel like. If you take off EPR can you breath, etc. What about the humidity level, everything plays a role.
Do you get more congested on your machine?
Yes, I would dig in and use the machine. May not be the right machine etc, but you will be gaining knowledge, to guide you yo your best setup for good sleep and good health.

I feel like my sleep study was quite weird compared to what I'm experiencing otherwise. A lot of the numbers floating around there just flat don't make sense to me from what I'm seeing. As mentioned, my oxygen saturation has been tested so I'm fine there, so this may have just been an anomaly. I do get more congested on my machine but there may be some other factors there outside of my control, so I may have to experiment with that and get back. Thank you for your response, based on everyone elses response I think I do need to dig back in.

IMHO the CA event you show in the expanded view are the result of arousal and by the irregular breathing pattern most likely just you holding your breath while tossing. They shouldn't be considered in your AHI.
I do not see why you are having this irregular breathing that is typical of awake breathing.

Would be hard for m to figure out what I was looking for I suppose. Something that bugged me is my doc seemed to have just printed out the "summary page" looked at it, and then nothing else. Perhaps I'm just a heavily data driven person, but seems my only choice regardless is to dig back in

CM - your charths indicate you are using EPR of 2. People with lots of centrals are encouraged to turn EPR off entirely. That may be an experiment worth trying. One or two nights do not make a trend. I'd give it a week.

You're not gonna want to hear it, but I tend to agree with your doc. More data needed. This is a corollary to "one night is not a trend." Tough it out and get it done.

Will do -- I may have pulled an EPR 2 chart, but I have turned off EPR and had similar results. (Maybe a pinch better). Doc still was discouraging me from turning off EPR which I found irritating.

What is it about EPR that causes (does it cause?) centrals? 
And is it fine to just go from 3 EPR > 0 EPR or should you step down?

I've seen a few theories, but I think it basically comes down to what your body interprets as a signal to "breathe" because what causes your body to breathe isn't low oxygen but high CO2. So the body just goes "oh I guess I don't need to breathe" don't quote me on that. Some people are more sensitive than others.

The use of a CPAP, the use of higher pressures, the use of differential pressure always improves your breathing efficiency and can and does, in some cases, cause TECA by flushing too much CO2 being purged, meaning to below your apneic threshold, which will then result in a central apnea. The detailed charts you have previously provided do not show this pa[tern.

Then again sounds like I at least need to tough it out. Thank you!

Hi, CM Apnea,

I have a few questions after looking at your original post and the attachments.

1.  Have you tried anything to keep from rolling over on your back?

2.  What is it about using CPAP that makes it feel like torture, specifically?  E.g., does the mask hurt your face, is the air pressure uncomfortable, is it the unpredictability, do you get air in your mouth, or what?  Does using CPAP make it hard to fall asleep?  What is it about it that wakes you up?

There were so many different things I had to address to finally get comfortable with CPAP, in addition to the pressure settings.

One thing that GREAT about your charts is no leaks!  That's a big challenge for many/most users, and you have that solved already.

I've tried wearing a backpack to bed with some books -- not super comfortable though. Did it without my CPAP for a bit to see because I just wasn't able to sleep properly. My sleeping setup unfortunately isn't ideal right now but I have noticed these symptoms even in a nice comfortable bed.

For me -- nothing at all feels difficult about it apart from getting the mask adjusted right. Sometimes I feel a little starved of air when trying to get to sleep but that's gotten better (and hence why I feel congestion may have a hand in this) it's just that I wake up, rip it off my face , go back to sleep. Sometimes half conscience. I then wake up more tired than without it.


Anyways -- sounds like I at least need to tough it out for 2-3 weeks and just deal with being ridiculously tired somehow. Will probably talk to my boss and tell him what is up and hope he'll be sympathetic. Thank you everyone!

[Brazen]

CM -

Unfortunately, your sleep clinic experiences sound very standard. It's really difficult to find solid sleep help in the medical community. 
Thank goodness for this forum and the experts giving their time. 
You have to educate yourself and advocate for yourself.

My sleep quality 100% got subjectively worse when I first started using my cpap.  It made me angry.
Treating an issue shouldn't make you feel worse, right?!!

Well, until someone invents a less terrible method for treating disordered sleep breathing, it's what we have to deal with to avoid all the potential health problems that arise with untreated sleep apnea.

Embrace the suck.
Do what you can to make it tolerable. 

I wonder how much of your sleep quality issues are related to the cpap.
Yes, the discomfort of it can throw you over the threshold but you need to address whatever other issues are preventing quality sleep.
What can you do to improve sleep hygiene?
Dark, cool, quiet room, comfy bed, standard sleep times, limit electronics and big meals before bed... that sort of thing.

[clownbell]

CM - You mention congestion. Your profile indicates no humidifier although a humidifier is built into the machine. Congestion is a funny thing. Some users need more humidity than others -- because of the climate they live in or because of the preferences of their nasal mucosa. Some users prefer higher water temperature, others lower temperature. If you are not using the ClimatelineAir heated tubing, I suggest you consider it. Pretty inexpensive on that website that used to sell books only. Experimentation may be needed. Personally, I set the temperature I want and then set humidity to AUTO which lets the machine make the determination as to what amount of humidity is best. That approach works for some but not others. Some need to experiment with the humidity setting to see what works for them.