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This is my first post here, although I've been using a CPAP device for 6 years. I'm glad to have discovered you. I have a question about CA events.
My CPAP therapy seems to work well on giving me more restful sleep. I do wonder, however, about the CA events that it detects. As you can see from the attached OSCAR chart, it appears that I am breathing somewhat normally until my breathing becomes a bit ragged and then shuts down for up to 30 seconds. Sometimes the CA event is preceded by some mask leakage; other times it isn't. Could there be a causal link between mask leakage and my CA?
If I'm awake and relaxed, I find I can manually exhale, stop breathing, and feel comfortable for about 20 seconds before I feel the need to inhale.
I initially got my CPAP device because I was suffering from obstructive sleep apnea, which I'd guess was probably brought on by weight gain and age. Also, I was told by the therapist that I have a "small mouth" (he might have said it was a "5"). But with the CPAP system, the charts seem to indicate that there were central airway events occurring as well.
Are there any red flags here? I'd guess everything is okay, although it does seem unnatural for your breathing to stop and then start up again after a few seconds.
-- Wayne Farmer
This may not be the definitive and direct answer you seek, but it is possible the leaks setup a CA event in this way. If the leak is bad enough to make the machine jack up the pressure to compensate, it may cause an imbalance in the oxygen to carbon dioxide ratio called wash out. At least in theory it may be happening. With CA events, the thing to note and help correct when using a standard style CPAP is that pressure swings may initiate a CA event. You may first want to look at your machine settings and things like Ramp and EPR could be considered needing to be reduced or turned off and see if the CA diminishes.
Also of note is that time may change our apnea therapy needs. You are on an S9 I think. It may be time to evaluate getting a new ResMed. It may require a sleep study, but your therapy needs may have changed to adding in some CA events that might need a machine called ASV to address it. I can't predict anything of the sort about therapy needs and whether or not it did change, but it's possible that CA events were happening all along. I wouldn't know that for certain, but it's something to consider, given that most of these doctors become blind to CA events. The normal way doctors handle apnea: Oh you have apnea means it's always Obstructive and it only needs to have a CPAP. Here's your cookie cutter solution. You may have had that happen, as for me I am only guessing at possible scenarios.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
04-29-2020, 08:47 AM (This post was last modified: 04-29-2020, 08:48 AM by wdfarmer.)
RE: Central Apnea associated with mask leakage?
Thanks, Dave. I'll keep an eye on things. I looked through my OSCAR chart, and in many cases an increase in leak rate happened before the breathing cessation that seconds later got flagged as a CA. I also know that my S9 makes more noise than it used to, and I suspect it has an internal leak. A med supply store associated with our local hospital has said they could help me with getting it fixed or replaced if there's a problem, so I'll pursue that first.
OK I copy on the increased noise. Certainly explore every avenue available to see if your S9 is working properly. Best wishes on a quick and inexpensive fix.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I have had central apneas since 2001, and I don't buy the leaks or small mouth theory. I know that for some people CO2 is an issue, but I'm not strongly in that camp, especially for someone who has been on therapy for a long time and has what I would consider long centrals; 30 seconds. Also, I doubt that you will go half a minute not breathing when you turn over, plus you would probably take a deeper breath just prior to a position change.
I quickly "glanced" at my numbers and it seems that when my central apneas were better controlled my duration was in the teens, but those times when I started to be impacted with them the duration was higher. I didn't do scientific analysis, I just went back to different periods of time at looked at Resmed detail data.
If your are getting more now than before, or if your sleep in being impacted by them, you might have to think about going to a different therapy. If there is no impact to your sleep quality, then carry-on. I eventually agreed to an ASV titration as things got worse, and it has turned out to be great decision.
Machine: ResMed Airsense 10 Autoset for Her Mask Type: Full face mask Mask Make & Model: Resmed Airtouch F20 Humidifier: Resmed Airsense CPAP Pressure: APAP 11.8-16 CPAP Software: OSCAR
Other Comments: PAP use since September 2015--30.8 AHI untreated
If you are on Medicare and your machine you could probably get a new sleep test and a new machine. Some secondary insurances pick up a lot or all of the remaining cost. My husband's S9 was getting really noisy and occasionally not writing to the SD card properly. We checked the run hours and date of manufacture--the VA hasn't been able to find his original home sleep test--and I took him to my civilian sleep doctor as the machine was 6 years old. He said get rid of that machine and then the VA gave him a Resmed Auto S10 Autoset.
SideSleeper, you are correct, that is my situation. Once the ResMed is over five years old, I'm eligible for a replacement. I really do like the S9; I'm hoping I can get it repaired.
This is an older post/question but I may have some valuable information re: mask leaks related to central apneas. My experience, as below, indicates there’s an association and it’s likely related to what was said above re: CPAP machine adjusting pressure when a large leak happens. Here’s what I found:
I have Periodic Limb Movement disorder, or PLMD, in addition to sleep apnea. Prior to October-November 2020 my CPAP therapy was well-controlled with an AHI average of about 0.80 with no central apneas. At that time my CPAP data showed a relatively sudden jump in central apneas which corresponded to an increase in my daytime sleepiness. Through videotaping my sleep it showed that my PLMD had gotten much worse over the past few months, but I didn’t associate the PLMD with the central apneas so it was pretty confusing for me and my doctor as to why I was suddenly having central apneas.
Several months later, while I was doing more videotaping, I noticed that whenever a periodic limb movement resulted in an arousal, I had a habit of putting my finger under my mask to scratch my nose (an F20 full face mask), resulting in a large leak. So then I wondered if these arousals and leaks had something to do with the increase in central apneas. I set the video camera and the CPAP machine to the current time to within one second of each other and compared the times on video when I had an arousal and finger-to-mask leak to the OSCAR data. Sure enough, when I had the arousal and leak it was very likely that a central apnea was recorded closely afterwards.
This theory was further confirmed over the next couple of years in that when I was well treated for my PLMD, the central sleep apnea score went down dramatically. I use clonazepam as the primary treatment for the PLMD and whenever I had an increase in clonazepam, the central sleep apneas decreased and as I became tolerant to the Clonazepam, slowly the central apneas returned. Over the last year, I lowered the clonazepam significantly, then increased it again 4X. Oscar data for that period regarding Central apneas looks like a roller coaster ride or a wave pattern that corresponds exactly with the dates of the increases and decreases.
I’ve showed this OSCAR data through screenshot of the past 2 years marking dates of clonazepam changes (which correspond exactly with all at the highest and lowest CA score periods) to a couple of doctors. Unfortunately because they’re so committed to the idea that clonazepam or other sedatives can only increase CA’s or AHI under all circumstances, and without having an alternative explanation, they still refuse to believe the data that’s right in front of them.
My situation may be an exceptional case but, if you are seeing an unexplained increase in CA’s, then looking at mask leaks as a possible cause could be worthwhile.
P. S. I will edit this reply to include a JPEG of the Oscar data once I include the last clonazepam increase. If you don’t see that here, but would like to, please reply or PM me as I’ve just forgotten.
"My situation may be an exceptional case but, if you are seeing an unexplained increase in CA’s, then looking at mask leaks as a possible cause could be worthwhile." - I can second that! Being prone to centrals I investigate them pretty thoroughly and many are certainly associated with leaks of many stripes for me, not just large leaks.
I can second that! Being prone to centrals I investigate them pretty thoroughly and many are certainly associated with leaks of many stripes for me, not just large leaks.
Even smaller leaks too. Good to know. Had a good chuckle seeing your avatar pic.
