My clear airway / central apneas aren't going away

[Gyddyup]

Well i'm 86 days into therapy and was hoping these events may have subsided by now. (I had no centrals during my sleep study and have read these can be induced as a result of CPAP.)

I'm getting anywhere between an AHI of 1 and 11 each night for these event, and averaging 4.7 over the 86 days. Total average is 6.3, so the obstructive and hypo's are mostly under control.

Has anyone else had a similar experience of it taking this long to get under control? or am i being overly worried? I have been waking up more refreshed, but get still very fatigued as the day progresses.

Am booked in to see my sleep doc late next month, so am just curious about the experience of others.

thanks

   

[DeepBreathing]

Your upper limit of 18 cm h2o is pretty high and could well be the cause of your central apneas, if the machine is actually getting up near that pressure. I'd definitely talk to your doc about it, and see if you can't get a trial on an AirCurve 10 ASV. My guess is that will fix the issue.

The downside is that ASV machines are hellish expensive. I don't know about current pricing but when I bought mine a couple of years ago the price here in Oz was the same as in the States (and the AUD was a lot stronger than it is now). I was able to get a 5 year warranty and five years unlimited follow up and consultations (which I've never used).

[DeepBreathing]

Another thought has occurred to me - what is your EPR setting? Some members have reported a reduction in pressure induced centrals by reducing the EPR. Though you probably need it pretty high when breathing out against 18 cm.

[Sleeprider]

CA events at this rate are not a very big concern, and it's likely we can help you minimize them. For starters, what is the distribution of these through the night. Are they clustered early and late, or do they tend to occur evenly through the night? The earlier question about your EPR setting is also relevant.

[Gyddyup]

thanks for the replies.

I occasionally hit 18cm; 90% pressure is around 14.5. might drop it back 16.

Full time EPR started off at zero; 2nd month on 1cm; 3rd month on 2cm. Hasn't seemed to make any difference over the three months to the clear airway events. I was getting some chest tightness/soreness and read on another thread about increasing the EPR, which has definitely helped.

These events appear in clusters (at any random hour) throughout the night; with about 30% always happening a couple of hours before i wake up.

thanks again
Paul.

[OpalRose]

Gyddyup,
Just reading your post of AHI of 6.3 average over 86 days.

If you would post a recent screen shot showing the following graphs: events, pressure, Flow rate, and leak rate graph, then it would be easier to see what is going on.
Also include the detailed information to the left of graphs.

If you 90% pressure is 14.5, then I agree you can drop the max number from 18 to 16.

The CA events may lessen in time, but if they are a good portion of you AHI, then you may need to be on a different machine, like an ASV.

[PoolQ]

Many of my centrals show up during my rem sleep which is normal and not really a central apnea:
1. Brain stem does not tell you to breathe when you really need to
2. The CPAP is washing out your Co2 and so the brain stem does not think you need to breathe.
3. You are dreaming or starting to wake and are moving around some. You ever hold your breathe when doing physical activity? Like picking up something or sitting up? This can register as a central.

My centrals have never changed and my Doctor always said to not worry about them, which of course I did because I was not getting rested. For me it turned out that I had mild COPD on top of sleep apnea, once that was taken care of I sleep like I did in high school

Never give up, never surrender.

[WakeUpTime]

It took almost a year for me to settle and get a handle on sub-5 AHI. Before that, I had almost a year of AHI #'s of 7-10. I blame some of that on me for keeping the pressures higher than they should have been. I'm always trying to push the pressure up to eliminate OSA but the higher levels seem create CSA.

Now, most of my AHI is still a result of CSA -- perhaps 3 of the 5 AHI). That still bugs me and I feel it the next day sometimes. But it's far better than it used to be.

My advice is to really make sure you're not overdoing it with higher-than-needed pressure. It's definitely a case that too-much is a bad thing. I went to a BiPAP machine to help me reduce air. However, if you do make lower pressure changes, give yourself time at each setting (perhaps one week) to know your overall results.

[Gyddyup]

However, if you do make lower pressure changes, give yourself time at each setting (perhaps one week) to know your overall results.

I guess that's one of the 'features' with CPAP treatment - understanding there is no quick fix when fine tuning settings, you can't go off the results of just a night or two and make more changes.

I will lower the pressure and go from there. Thinking about it more, i've probably delayed my adjustment time by upping the EPR before bringing to centrals down. (but the chest tightness has been freaking me out - even though i know it's all good cardio wise)

OpalRose have most recent chart i have access to.

am dreaming of sleeping like my high school days
thanks all.
Paul.

   

[OpalRose]

Gyddyup,
Yes, you do have a lot of CA's., but they don't seem to be triggered by higher pressure.

Open up the flow rate where it is shaded in green to get a better look.
It seems that the machine flagged PB and CA's at the same time.

I would still bring the max pressure down as you stated prior just to play safe,
and either turn EPR off or try to use 1 as an EPR setting.

Also, in preparation for your upcoming doctor visit, see if you can print out some of this data for Doctor to look at. If you are unable to get the CA's down, you may need an ASV machine as stated in prior posts.