New to APAP: should I adjust settings for what looks like treatment CA's?

[Pikala02]

Hi all,

Recently diagnosed with mild sleep apnea -- AHI 6.4.   Been studying and reading through the guides and posts concerning treatment-emergent central apneas and adjustments to limit them.  I had 2 central apnea events vs. 38 obstructive during my sleep study, and now with treatment I have no OA (yay!) but several centrals, but certainly not as high as others I've seen on here.  

Based on last nights data:
-- Do I need to increase my min. pressure to around 5.6 or 6, or is 5 just fine since I did not have any obstructive events?
-- I turned the ramp off -- feel air starved at 4.
-- I turned EPR down to 2 (or maybe I need to turn this down to 1 and see how it goes?)

Thank you!!

[staceyburke]

I would raise the min to 8.  Also in the next post change the height of the graphs so we can see the Flow Limits. You can change the size of a single graph by clicking the bottom of the graph and hold down the button as you move the graph up and resize.

[Pikala02]

Thank you so much for the tips regarding the individual graphs.  I made sure the Flow Limits. were visible and attached a new graph.  While increasing the pressure, should I also lower the EPR to potentially lower the CA's (current EPR set at 3)?  Was thinking of lowering to 2 and see how that goes.  I realize that the few CA's I'm seeing might go away in a few months once my body acclimates to treatment.

Thanks again!

[SeePak]

Hi Pikala.

welcome

I will be surprised if your CA events go away.
Mine have not, after 35 years.

CA events are times when you stop breathing, regardless of why you do.
This is reflected in your Time in Apnea on the left side of your chart.

When you stop breathing, CO2 builds up ( this is all natural by the way) you take another breath ( usually a large one cause the feeling of CO2 build up is called air hunger and if intolerant you take large breaths and exhales which rid you of the CO2 which starts the process over again, causing multiple CA events )

And CO2 is what gets Oxygen out of the air you breathe and into your blood, and into every cell in your body.

The real strategy, IMHO and other experts , is to get tolerance of CO2 so that you enable/allow all the proper chemical reactions to take place.

There are breathing exercises to help with this ( ironically they involve breath holds ! )

And adding pressure AND EPR will drastically affect this process by washing out too much CO2.
The health implications for this are just being understood now.

There are people far more knowledgeable here that have the experience and possibly the data? to show that we adapt to the extra air and CA events go away.
That has not been my experience.

Check out Patrick McKeown on line.

Following his breathing exercises since July, i am now beginning to sleep without CPAP, and hope this continues !!?? will see.....

[PeaceLoveAndPizza]

I agree with Stacey that raising the min should help quite a bit. 

To put his suggestion into settings...

Mode APAP
Min pressure 8
Max pressure 12
EPR 3 full-time
No ramp

That should tell us quite a bit about how the flow limitations will respond to a wee bit higher pressure. Ramp is not helping with therapy, but if you must use it keep the time to as minimal as required to fall asleep.

[Pikala02]

Thank you for your insight!  I think some of this is a little like trial and error and finding what works.  I have read a little more about CO2 wash out and how higher pressures can complicate the situation but EPR also plays a role.  Interesting about breath holding...I'm terrible at that.  I will look into this further and see if there are any studies linking the two (even if there isn't, it's still something I'm interested improving).

---

PeaceLoveandPizza -- thank you for looking over my chart.  I did notice I am having quite a few flow limits. and it seems tackling those with a higher pressure may take care of those and the CA's possibly (although it seems higher pressures might make CO2 washout more of a possibility).  Either way, I have some things to try and will certainly report back once I have some nights to "practice".

[SeePak]

Pikala.

Here is the link for the Phenotype study, and talk about High Loop gain, CO2 intolerance.

Much more in there as well !

https://pmc.ncbi.nlm.nih.gov/articles/PMC7865730/

[PeaceLoveAndPizza]

Pikala02, don’t overthink things. There are many rabbit holes you may find or be lead to that will not get you closer to a good nights rest. 

It takes two to three months to adapt to using a CPAP. Any changes during that time need to be monitored and you need to avoid dial-spinning nightly. Small incremental changes are best, unless something truly loses the plot and requires a major change.

[SeePak]

Hey Pizza, rabbit holes, not sure what you reference there?

Pikala, how long have you been diagnosed and using PAP therapy?

Pizza makes a good point, could take awhile to get used to therapy etc. 

I am thinking you should make no changes yet to your prescribed therapy if you have just started?

Also, something that I look for is how have you been sleeping?
How is your mood, tired during the day or fatigued?

If all those are ok, not sure why you want to adjust anything?

[SarcasticDave94]

With the OSCAR chart saying CA at AHI under 2, I'd not decide to have this dictate CPAP therapy. With 2 CA on the study and pretty low on CPAP, they're deemed to be your minority issue in my opinion.

Education passing on as I've got the other Central Apnea that isn't treatment emergent. Regardless of Central Apnea type, treatment or predominant, all CA therapy actions reside on side A of the therapy teeter-totter. On side B of the same CPAP teeter-totter resides all other events and therapy actions. Side B is flow limits, Obstructive Hypopnea, and Obstructive Apnea. Action to influence/push down side A events will result in side B events going up, and vice versa. Almost always true.

Monitor CA as you wish, but I'd advise not to act on these unless they go super haywire and hinder otherwise good looking treatment.