Still central apnea after using CPAP for 3 weeks

[kevinpz]

Hi guys!

I've been using a CPAP for more than 3 weeks now, and I've bought my machine through insurance last week. So now I try to tune it perfectly.

Here's my apnea diagnosis (Philips Alice NightOne):

• AHI: 8.4 events / hour -> 0 central
  
  
• Average SpO2: 95%
  
  
• Lowest SpO2: 91%
  

Now I'm around 2 or 3 AHI, with almost all of them categorize as Clear Airway.

I've tried to change the following settings:

• Change the mode to Auto for Her (wake me less often the night)
  
• Totally disable ramp up mode, not really useful when the pressure is at 6 when I go to bed
  
• Turn off EPR as I've read that it could cause Central Apnea
  

But I seem to still have these central apneas appearing ...

Do you have any idea of what changed could I make to lower them? (even if I know than the number is low)

   
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Thanks!

[mesenteria]

What is the typical duration of your CAs?  If they are near 10 seconds, and not creeping into the 13 and higher second range, they are likely to be holding your breath and turning over, maybe plucking at the covers...who knows.  This is common.  If they're longer, then maybe it's something else.

You said you turned EPR off.  Why off?  Why not experiment with it dialed back to 2, or to 1?  It may make a difference to you.  I'm sure you know, from reading here, that it would take a run of about 3 nights to see if there's an acceptable change that is somewhat constant before trying other changes.  This is due to night-to-night variability.

I know, you see other posted charts and they show AHIs of 2.1, 1.7, 0.9, and some can't help but crow over their latest 0.0 (and who could deny them?!?).  And I wouldn't stand in your way for a fraction of a single second when you are bent on getting your 3.0 down from that number.  It's a reasonable goal.  But, you are treated, according to the science, the industry standard, and to statistical tables that predict longevity in populations.

[Gideon]

Kevin, I can't find a copy of your sleep studies. In this case, it is important to know if you had centrals prior to CPAP, I suspect so. Also, because you left the calendar enabled for your screenshots I cannot confirm if EPR is off or you disabled the EPAP line on your pressure chart. From your text, I assume EPR is off.

IF the above is true you may need ASV to resolve your Centrals.

[alexp]

Hi guys!

I've been using a CPAP for more than 3 weeks now, and I've bought my machine through insurance last week. So now I try to tune it perfectly.

Here's my apnea diagnosis (Philips Alice NightOne):

• AHI: 8.4 events / hour -> 0 central
  
  
• Average SpO2: 95%
  
  
• Lowest SpO2: 91%
  

Now I'm around 2 or 3 AHI, with almost all of them categorize as Clear Airway.

I've tried to change the following settings:

• Change the mode to Auto for Her (wake me less often the night)
  
• Totally disable ramp up mode, not really useful when the pressure is at 6 when I go to bed
  
• Turn off EPR as I've read that it could cause Central Apnea
  

But I seem to still have these central apneas appearing ...

Do you have any idea of what changed could I make to lower them? (even if I know than the number is low)







Thanks!

Look how the spikes on the leak graph match prrtty closely your clear airways events. My first guess is that you are probably just opening your mouth from time to time.

[Sleeprider]

I'm seeing settings at 6 min to 16 max with EPR 3. Your maximum attained pressure is only about 9.0 cm. My recommendation is to cut the EPR from 3 to 2. That should reduce CA, and we will cut it back to 1 if you need further assistance. There are some CA events, but nothing to be too worried about, and I think simply reducing EPR should bring them under control.

[kevinpz]

Hi!

First, sorry I totally forgot to answer here ... And thank you a lot for all your answers!
So I'm going to achieve my 3rd months with my CPAP, AHI is around 2 or 3, so considered as treated.

As when I posted the message a few months ago, I don't have a lot of OA, but I still have some CA.
They usually last around 15 to 30 seconds ...

@bonjour: my sleep report says:
Philips Alice NightOne, at home:

• AHI: 8.4 events / hour -> 0 central
  
• Average SpO2: 95%
  
• Lowest SpO2: 91%
  

So I don't think I had central before, or the home sleep test was not really accurate.

@alexp this is something I've noticed also. A lot of the CA events seem to match with a spike in the leak zone a few seconds before, but not during the event. So that would not be central apnea, but just my mouth opened?

I tried to reduce the EPR to 2 instead of 3, increase the min to 7, but nothing seem to have changed the results. (I give it a few days each time, changing one parameter at a time, and waiting before changing a new one)

Here're some other charts in case of any of you would have an idea!

   
   
   

Thanks a lot!

[Geer1]

@alexp this is something I've noticed also. A lot of the CA events seem to match with a spike in the leak zone a few seconds before, but not during the event. So that would not be central apnea, but just my mouth opened?

I tried to reduce the EPR to 2 instead of 3, increase the min to 7, but nothing seem to have changed the results. (I give it a few days each time, changing one parameter at a time, and waiting before changing a new one)

There are a few different types of central apnea some of which are normal. One of those is what they call sleep transition central apnea. From medscape.

Up to 40% of healthy individuals may exhibit central apneas during sleep-wake transition. The central apneas occur during the period that chemoreceptors are resetting and instability of ventilation control occurs. They are usually brief and not associated with significant oxygen desaturation. The clinical significance of this entity is unknown. Once stable sleep is reached, normal individuals should not have more than 5 central apneas per hour of sleep.

If you are having leaks that are causing arousals then a sleep transition central apnea following said arousal is not the issue. If you look at the zoomed in data on OSCAR you should be able to see if the leak occurred before the central apnea and if so look at the flow data. If you see that at the end of the leak your flow rate spiked for a few breaths (sign of an arousal) and then was followed by a central apnea then then sleep breathing these were just normal sleep transition apneas. The leak and the arousal would then be the issue you need to try and sort out(if I had to guess I would say mouth breathing but could be other leaks too). 

Regarding EPR if lowering or raising it doesn't make a difference then don't worry about adjusting it. Set it at what you find comfortable. EPR is only an issue if it is causing more apneas to occur.

[DeepBreathing]

Kevin, the apnea you selected in the 3rd shot above does highlight one potential mechanism - leak leading to unstable breathing leading to central apnea. I think this is a real apnea, not holding your breath. I think there are too many individual events to be anything other than genuine treatment-emergent central apnea. You could probably fiddle with pressures and EPR etc till the cows come home and not get any consistent and persistent improvement. You AHI doesn't warrant the expense of an ASV machine so we need to try something different.

I'd suggest you try Enhanced_Expiratory_Rebreathing_Space (EERS). There is a good write-up in our wiki.

[Geer1]

That central apnea example looks to me like a perfect example of post arousal sleep transition apnea. There was a very clear arousal at 6:21:45, rough jagged uneven breathing followed by a central apnea then back into normal sleep breathing. We can't be 100% sure without EEG but I would be willing to bet on it.

The leak seems to have occurred at practically the same time as the first arousal breath so it is hard to know if that was an arousal caused by the leak or a leak caused by the arousal (spontaneous, caused by periodic leg movement etc).

I agree the number of centrals seems to be high though to be normal centrals unless there is something causing these arousals now (maybe body just isn't used to having the CPAP machine yet).

[Sleeprider]

Kevin, I think a trial of EPR at 1 and off should be tried before you jump into other solutions. Leave pressure at 6 or 7 for now.