Central Apneas

[Bubkis]

I'm one of those people who have struggled to get comfortable with PAP therapy. Diagnosed in 2021, I tried a variety of masks but could never sleep comfortably and never felt better for sleeping under treatment. I didn't get much support from my health care provider, so in 2023 I just stopped trying. Now that I am retired, I have a new set of doctors, and I'm refocusing on making this work. Dealing with leaks has been a big challenge. Like I said, I've tried different masks including two full face masks, three different chin straps, and taping my mouth, but I rarely sleep longer than 3 or 4 hours and frequently have large leaks of 25% or more. My machine settings seem to have obstructive apneas and hypopneas under control, but it reports a lot of central apneas. Since I haven't conquered the leaking issue yet, I didn't think I could put much faith in the success of these reports, but I have felt more rested recently after brief periods of being able to sleep for a few hours under treatment. Last night was one of the more successful nights. In the screen shot below, I wasn't asleep for the first two hours, but at about 3:00 AM I was able to finally fall asleep. Since it is one of the nights when I experienced few leaks, I want to know if I should be concerned about the central apneas, especially in the last fifteen minutes because I am confident I was actually asleep then. My next appointment with my doctor isn't until after the new year, so I have some time to get educated a bit better before I speak with him. I appreciate any insights you can offer.

   
   

[Jay51]

Your "trigger" setting is at medium.  You can try "high" and later try "very high" to help stop CA's. 

Increasing pressure support helps stop flow limitations, etc. but the drawback can include more CA's.  The "trigger" setting is the best tool you have to help stop CA's.  Trigger is simply how fast the VAuto will trigger an inhalation (how much effort you have to provide).

[Deborah K.]

Did you have a lot of CAs in your sleep study?  If you don't know please post a redacted copy of your study.  If you don't have a copy of the study ask your doctor's office to provide you a copy.  They must give it to you if you request it under US law.

Good luck at getting better and more comfortable sleep!  

[Bubkis]

Here are what seem like the relevant sections from the in-lab sleep study in 2021. Note -- I had a really hard time trying to sleep in the lab, with or without PAP therapy.

W/O CPAP RESPIRATORY ANALYSIS:  (index = #/hr)
Apnea/Hypopnea Index (AHI): 28.7
*AHI 4% or greater: 20.1
NREM AHI: 25.2
REM AHI: 56.3
Non-Supine AHI: 24.4
Supine AHI: 37.4
Respiratory Disturbance Index (RDI): 28.7
NREM RDI: 25.2
REM RDI: 56.3
Apneas (index, #): 7.3 (17)  
Obstructive Apneas (index, #): 1.3 (3)  
Mixed Apneas (index, #): 0.9 (2)  
Central Apneas (index, #): 5.1 (12)  
Hypopneas (index, #): 21.4 (50)  
RERAs (index, #): 0.0 (0)  
Mean Awake SpO2: 91%
Mean Sleep SpO2: 87%
Minimum Sleep SpO2: 74%
Sleep Time with SpO2 < 88% (min, % of TST): 42.0 (30.0%)
Cheyne Stokes breathing: No
Snoring: Yes


W/ CPAP RESPIRATORY ANALYSIS:  (index = #/hr)
Apnea/Hypopnea Index (AHI): 45.7
( *AHI 4% or greater: 20.1 )
NREM AHI: 43.4
REM AHI: 60.0
Non-Supine AHI: 32.7
Supine AHI: 56.6
Respiratory Disturbance Index (RDI): 45.7
NREM RDI: 43.4
REM RDI: 60.0
Apneas (index, #): 5.8 (19)  
Obstructive Apneas (index, #): 0.6 (2)  
Mixed Apneas (index, #): 0.0 (0)  
Central Apneas (index, #): 5.2 (17)  
Hypopneas (index, #): 39.9 (131)  
RERAs (index, #): 0.0 (0)  
Mean Awake SpO2: 94%
Mean Sleep SpO2: 92%
Minimum Sleep SpO2: 85%
Sleep Time with SpO2 < 88% (min, % of TST): 2.0 (1.0%)
Cheyne Stokes breathing: No

---

Thanks, I'll try an adjustment to the trigger setting and hope for another night without too many leaks.

[SarcasticDave94]

Obstructive Apnea 1.3 with 3 events
Central Apnea 5.1 with 12 events
Hypopnea 21.4 and 50 events

AHI 45.7

I'm inclined to think your Central Apnea could be concidered prior therapy as idiopathic cause. You may want to first try the High or Very High Trigger on the VAuto. If that doesn't work then you'll need to look into ResMed AirCurve ASV.

[Bubkis]

After increasing the sensitivity of the Trigger setting, my Centrals have improved, and last night I had probably my best night of sleep under PAP therapy yet, waking up without an alarm after 6 hours of use and feeling pretty rested. I'm wondering if I should still be concerned about the leaks I'm experiencing. Does this level of leaking call into question the accuracy of the rest of the data?

   

[Crimson Nape]

You are bumping up against your TiMax. I find this to very annoying and can cause an arousal. I would try increasing it to 2.8 seconds.
- Red

[SarcasticDave94]

Also, yes those leaks are a hindrance.

It may be needing a different sized cushion or different method for strap adjustment. Don't make it very tight or it'll surely get worse. You may want to review other masks to see what may be better for you.

I myself have done well with Fisher and Paykel masks. I've had the Simplus, Vitera, and Evora. The first 2 are standard full face, while the Evora full is hybrid.

[Bubkis]

Thanks for the advice! I'll give that a try.