High Central Apnea, Setting Changes

[lbl82]

   
   
I'm going over my data and for 2 nights.  On May 27th, my min. pressure is 18 and 20 is my max.  My EPR is 3. My start pressure is 15 with a ramp of 45 minutes.  I slept almost 8 hours and my AHI is under 5.  On May 31st, my min. pressure is 18 and 20 is my max. My EPR is 3. My start pressure is 14 with a ramp of 45 minutes.  I slept 9 hours and my AHI is almost 10. 

Could my start pressure make that big of a difference? 

I've also noticed that my days over the last 2 years that my AHI was under 5 my average sleep is 7 to 8 hours.  When my AHI is over 5 my average sleep time is 9 to 10 hours.  Any ideas on why?

[Gideon]

This is a case where you need to manage your Central Apnea.  Central Apnea frequently behaves in a consistent way, and that is inconsistently, we call that consistently inconsistent.

Let's reduce your EPR to 1 as this is very likely to have a large impact on your Centrals.

Set EPR=1, full time.

With CPAP of most varieties your efficiency of breathing improves. This means that your Oxygen Saturation levels go up, and that is good!  It also means that you are flushing more CO2 out of your system which also "sounds" good, BUT . . .   flushing CO2 out of the system can lower the CO2 level in the blood to below your apneic threshold which then causes Central Apneas.  CO2 level is the main driver of our signal to breathe, so by lowering the EPR we are trying to increase the CO2 level in our blood above the apneic threshold.

[lbl82]

   
I thought lowering EPR would make it harder to breath out? I lowered my EPR to 2 on May, 28th and my AHI increased! My Doctor has prescribed me(I haven't gotten it) a BiPAP.  He said my centrals are caused because I'm having a hard time breathing out because of the high pressure.  I'm confused.  Does he not know what he is talking about?  I'm getting a second opinion anyway.

[Gideon]

Which BiPap are you getting?  This is VERY important. The ONLY BiLevel/BiPap that is designed to treat Central Apnea, is an ASV.  
Look at Page 5 (7 on a computer) of the following document for what mode treats what condition,  What treat Complex/Mixed/Central Apnea.

For practical purposes your AHI didn't go up (yes it did a bit) it Demonstrated the Centrals inconsistency.
Try, EPR = 1, or since EPR = 2 showed no appreciable difference, Try EPR = 0.  Failure to significantly reduce your Central Apnea, adds evidence that you need to get an ASV, IMHO the ResMed ASV based on the many successful users of that machine here at AB

And yes, lowering EPR will marginally impact your exhale, but the immediate issue to get managed is your Central Apnea,  Comfort issues would be addressed after the primary issue is better managed, Central Apnea.  That is a serious issue and it needs to be addressed!

[lbl82]

I found that it is cheaper to purchase one on [Commercial Link Removed] Supplier #1
than to go through my insurance. I wanna get the Resmed AirCurve 10 VAuto Bilevel Machine. Is that the one your talking about?

Where on the data sheet is my number of episodes of Central Sleep Apnea?

Looking at my data what else should I do besides EPR to 1? Should I change the ramp time and start pressure? Change the minimum pressure?

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[Gideon]

Clear Airway / CA is Central Apnea.

[lbl82]

My Doctor wants my AHI under 5. From 5 to 15 is mild sleep apnea, etc...  What about Central Sleep Apnea?  Is there an "acceptable" number for Centrals?

[Jeff8356]

Your AHI (Apnea Hypopnea Index) includes your centrals (aka: Clear Airway or CA).

Have a look at this wiki page: http://www.apneaboard.com/wiki/index.php...ndex_(AHI)

When your AHI is 5 or under your Dr will consider your apnea treated. How you feel is a different story.....

[Crimson Nape]

AHI stands for Apnea Hypopnea Index. It is a combination of both Obstructive and Clear Airway, Apneas (the "A" of the AHI) plus Hypopneas(the "H" in the AHI). The CA's are included in the AHI of 5. The 5 would be any combination of these types.

I hope that I read your question correctly.

[SarcasticDave94]

To be declared medically treated, the AHI will be 5 or less while using a CPAP class machine. AHI as far as I recall includes CA, OA, and H.