Why are CAs increasing, and why is my HR spiking?

[UsuallyTired]

Now that I'm able to tolerate mildly higher settings on my CPAP, my CAs seem to be increasing. Is this significant or something to be concerned about? 

I believe EPR is known to increase CAs, so I turned that off. Is that correct? 

Also, I have numerous HR spikes. What's driving that? My flow limitations appear low and treated by pressure. 

[staceyburke]

Your pressure spikes are from Flow Limits.  FL are apnea just like O and H events but they are not long enough (must be 10 Seconds or longer to be counted) and are not counted in your AHI.  And yes in some people the use of EPR can cause more centrals but these are treatment emergent and go away as your body gets accustomed to the therapy.   Some times we suggest to slowly increase the EPR one step at  a time to allow the body to adjust BUT EPR does not effect everyone.


So I would suggest you do try EPR and I would try it at 2 and see how it works for you.

I would set 

Min 7
EPR full time
EPR 2

[SarcasticDave94]

Pertaining to the Central Apnea question: what did your sleep study report? If you are in a higher elevation like your user info states, this may be a contributing factor.

[ChadBSr]

Unless you're a small guy your tidal volume looks low.  Your charts look similar to what I had.  EPR, pressure too high, pressure changes, it all caused me to have CAs even after 2 months.  I fixed the CA, O2 drops, and ow tidal volume with EERS.

[UsuallyTired]

Your pressure spikes are from Flow Limits.  

@staceyburke, Thank you for the suggestions. You mentioned the pressure spikes are from flow limits, which makes total sense. However, I sometimes seem to have heart rate spikes that aren't always associated with flow limits or with high flow limits. I wonder if you have any insight into that. 

Pertaining to the Central Apnea question: what did your sleep study report? If you are in a higher elevation like your user info states, this may be a contributing factor.

@SarcasticDave94, my sleep studies seemed atypical. They showed very little to no CA. When they did the titration studies, to get me fully treated, they tried to increase my pressures, which induced a lot of CAs. Honestly, I wish I could be more specific, but all I can say is my studies and experience on my own with CPAP has been very atypical. It seems that every time I improve OSA, CA gets worse or vice-versa, and I'm plagued by constant arousals, fragmentation, and fatigue, no matter what I seem to do. 

I have been at the same elevation (˜5600 ft) for this duration and for all testing. Good question. 

Unless you're a small guy your tidal volume looks low.  Your charts look similar to what I had.  EPR, pressure too high, pressure changes, it all caused me to have CAs even after 2 months.  I fixed the CA, O2 drops, and ow tidal volume with EERS.

months.  I fixed the CA, O2 drops, and ow tidal volume with EERS.
@ChadBSr! YES. I keep saying and thinking that something looks very off with my TV (and also I'm convinced my rapid respiration rate cannot be healthy). I'm overweight now at ~220 pounds (I'm 5'8"), but even when slim, this TV would be considered far low range for my bodyweight and activity level. 

I had never heard of EERS until you mentioned it, and I feel like you're really on to something. Briefly googling, there seems to be a connection with high loop gain, which I had started suspecting. Though, I don't have a good sense of the legitimacy or treatment for it. My exposure has only been through Patrick McKeowan's work on breathing and the BOLT score. 

Can you buy EERS tubes/equipment anywhere, or do you really need to make your own? 

If you can recommend any resources or further insight on EERS, I would greatly appreciate it -- even if it's just hearing more about your own experience. I want to learn all about this. 

Do you understand the link between high loop gain and EERS? I'm confused b/c I understand high loop gain to be an oversensitivity to CO2. If that's the case, wouldn't increasing CO2 via EERS make things even worse? I must be misunderstanding things b/c I would think these would be opposite cases.  

Have you tried decreasing your own sensitivity, your own loop gain via any breathing exercises? 

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Thank you all. I really appreciate the responses.

[OpalRose]

UsuallyTired,

I have no personal knowledge on how EERS works, but this Wiki article may help.

https://www.apneaboard.com/wiki/index.ph...ace_(EERS)

[SarcasticDave94]

Hmmm, OK. The issue of Obstructive versus Central Apnea treatment is that there's what I'll call the teeter-totter effect. Placed on the left is your Central based Apnea and /or Hypopnea events, and on the other side everything else (Obstructive Apnea Hypopnea, flow limits).

If you defer to CA in your settings to push down these Centrals, like minimizing EPR to avoid them, then the Obstructive side of the teeter-totter will inevitably go up. And yes there's the vice versa, AKA the reverse card.

So, you probably need to chat with yourself without being crazy. Ask "are CA bad enough to treat?" Here in the AutoSet, and within the next one up bilevel like VAuto, you can only avoid CA, whereas a ResMed ASV will actually treat CA along with the rest of the events. Note the VAuto does have an adjustable Trigger, which will assist in avoiding more CA.

If not mentioned before, I will now. You need to have both the diagnostic sleep study and the Titration detailed reports. Do you have these? Yes, post them here redacted of your personal info. If no, get them both ASAP.

PS, yes ERRS can be another option for you.

[ChadBSr]

@UsuallyTired

Here is a link to my thread where I've been using EERS.

https://www.apneaboard.com/forums/Thread...-and-Trial

It is definitely about high loop gain. What you may be missing in understanding the working principle is the CPAP is washing out your CO2.

No CO2 = brain says we don't need to breathe.

As far as building it, its just some cheap tubing and a $25 vent.

I follow Patrick too and I do hope to eventually decrease my sensitivity and strengthen my diaphragm.  EERS was a quick solution and it has been fantastic for my health pretty much overnight.

YMMV