Centrals coming back

[Gperry]

My AHI number have been creeping up lately. I know these don't look too bad but the centrals when I try to go back to sleep ruin my day. I cant take a nap later due to fear of the centrals (they ramp my anxiety up bad). I recently switched to an air-sense 10 form an 11 due to a provider change. I switched back to the 11 halfway through last night but my anxiety prevented me from falling back to sleep to see if it made any difference.  I am at a pressure of 13 with no ramp and no EPR on.

 I am desperate because I have to work tomorrow but if this keeps up I won't be able to stay awake.

Any help would be appreciated.

   

   

[PeaceLoveAndPizza]

The CA’s are one problem and combined with the flow limitations are possibly what is causing your poor sleep quality. Things look good until around 02:00, then it goes south quickly and you terminate the session. When you restart you likely never really fell asleep and had a lot of sleep-wake junk. It must have been positively frustrating.

My issue with CPAP mode is at a fixed common IPAP/EPAP pressure there is no way to deal with flow limitations. For some they do not have a lot of FL’s. If you add a bit of EPR, that may deal with enough of the flow limitations to give a better nights sleep. Consider trying EPR 2 as you can always go up or down 1 from there. 

I went through your therapy thread and flow limitations seem to be a problem there as well. I know you have tried all sorts of combinations, so wondering how you ended up with what you are currently using. I tried to make a fixed single IPAP/EPAP pressure work and had the same problems. When I added EPR things settled down nicely, though it did take some time to find the right IPAP/EPAP pressure differential.

[Gperry]

Thank you so much for the response. I"ill explain how I got to 13 quickly and then I have a couple questions if you don't mind. 

I started at a 9.4 to 12.4 but was having the centrals problem. I then went to 11.4 (at the time this was my average) to 14 range. During that time I solved the centrals problem by turning off EPR all together via help from this board (the advice was to go to 2, but I went to zero out of fear). After some time I was having issues with waking up a lot, and my average was 13, so I talked with my doctor and we went to a 13-14 setting and that was good for a time. At 14 it was causing some Aerophagia and it was ramping to 14 when I first put it on due to me breathing very heavily (something I have solved). So I went to just 13 which was basically my average still. I was waking up much less after going to 13-14 and then to 13.

So that's the quick and dirty of how I got to that. Would going back to a range help with the flow limits? I would rather wake up than have the centrals, they are the worst thing to me. I only ask because turning off EPR (it was at 3) stopped the centrals for some time, but this issue crept up again over time with not being able to go back to sleep without centrals, even with with the ranges.

Again thank you for you time, all the help is appreciated.



[url=https://en.wikipedia.org/wiki/Aerophagia][/url]

[PeaceLoveAndPizza]

You can try adding a bit of EPR to your fixed pressure to see how it goes. I reckon trying a narrow range of pressure with EPR, back to where you were before, may be a workable solution with patience. 

Consider a 12-14 range with EPR 1 or 2, or possible a 13-15 range with EPR 2. That should tell us quite a bit. The EPR will help with flow limitations and you have a bit of range for pressure to increase if needed. 

You have to find that comfy balance point between pressure, EPR, flow limitations, and sleep quality. The folks here can help.

[staceyburke]

You only had a few central apnea, all at the end of the night. To begin with centrals are ver inconsistent where one night there are some and then the next night none. Many centrals are just a person holding their breath. You might do it when turning over or pulling up covers. 

I don’t think ther is a problem there. Everyone has some central apnea every once in a while - you need to monitor but your sleep looks good.

[SarcasticDave94]

I could be proven to be wrong, not the first time either, I think the flow limits would have been more the issue than Central AHI 0.92 to .93 versus FL at .26-.49. Max, except FL are otherwise fairly low. A few blips, short duration.

I look at FL numbers as a percentage, so this range to me reads 26-49% limited, but only within the max 99.5% column. Both charts also show median of 0.00.

According to the numbers on these 2 charts, neither should be the issue.

Leaks are minimal so it's not that either.

How is your general sleep hygiene? Bed at a regular time and length? Etc...

I'm inclined to think straight 13 isn't as helpful as you might need. It lacks EPR as well. I know you say you have to avoid CA, but this is well below AHI 5. Sorry to sound doctor like, but by the numbers, CA isn't the issue. You don't want to eliminate all events, you will be robbed of any comfort.

To contrast with a person that has big issues with CA, myself, because mine is of the predominant idiopathic CA. If on your machine, my CA would be around C-AHI 20. At that level, yes it's an issue.

[Gperry]

Thank you so much for the response.

The centrals give me a jolt of fear that last for hours when I wake up from them. Yes some of the nightly ones aren't even real centrals. But those final ones are killers, and it doesn't flag all of them. I can have any other form of AHI with mostly no problem, but the centrals bring back my anxiety every time. If I don't have centrals I don't get anxiety.

I know it looks like nothing on the charts but those last few on there are rough. Last night I had a run of 5+ back to back and it has ruined my day. I didnt have the card in for last night or I would have included it.
I
 could just get up for the day, when I wake up at night and have no anxiety, but I am super tired after a few nights of doing that.

All this is to say that for anyone who may read this thread, PeaceLoveAndPizza is 100% right. and most of my flagged centrals at night aren't real or have no effect. But the ones before I wake up after restarting therapy are demons for my mental health.

[Gperry]

Please see my response to PeaceLoveAndPizza for more on why the limited centrals are a problem. 

I got to bed at the same time every night and wake up at the same time every morning. I don't sleep in more that 30 minutes and I am almost never late to bed. I am in bed for around 9.5 hours and usually sleep 7 to 8 hours in that time.

I am not sure of the cause of my centrals, but they really suck.

Thank you for the response and your time.

---

I will go back to the 13-14 range tonight as I seemed to be pretty good with that setting. I will introduce EPR if I am getting centrals tonight.

Thank you again.

[Gperry]

Massive improvement, Thanks all of you who responded!

I changed to a range of 12 to 14 and an EPR of 1 and am getting very good quality sleep now. 2 nights in a row I have gotten 8 plus hours. Below is last nights report.

I feel amazing and I can't thank you guys enough!

   

[SarcasticDave94]

If it's good and working well, run with this setup. Congrats