Still having very high events after starting CPAP

[Ashton]

Hi guys, 

Only just finished my sleep study a few months ago and was told I have central and obstructive and I’m having 94 events per hour… I’m 31 fit healthy don’t smoke or drink so after that I was prescribed a cpap with a pressure of 6.0 then went to 7.0 and my events dropped to around 60! 

I was then told this is the best it will get and see you later. Not sure if anyone can help me reduce my events or does this seem ok ? Im very new to all this so sorry if I’m asking simple questions

[SarcasticDave94]

Without data it's only a guess, you could be victim to high pre-existing Central Apnea and doctors that ignore or otherwise don't know how to treat it. Again only a guess.

We need you to get and use OSCAR to give data on current usage. If you can get it, the diagnosic report's detailed data will be very helpful.

[Gideon]

My GUESS is you are failing CPAP and most likely need a different machine.

BUT....

Let's get data and look at it and see what the data says.

Get a copy of your Sleep Test including the charts and tables, not just the summary.

And post the nightly charts from OSCAR, see my signature for how to organize the data then attach the screenshot.

[Ashton]

Thanks for the quick reply! here is a few screenshots of my OSCAR

i never got anything from my study but i will email the clinic and ask for the full report  
 

   

   

   

[Gideon]

Please post several random 10 minute views of your CA events to verify consistency throughout.

What you have is ideopathic central apnea. It is NOT CO2 based or Treatment Emergent Central Apnea.

This is as bad as it gets. You have failed CPAP. The machine you want is the ResMed AirCurve 10 ASV it is designed to treat these Central Apnea.

First a series of questions looking for possible causes.

What is your general health?
Any cardio pulmonary condition
COPD
Asthma
stroke
Seizure
Other CNS issues (Central Nervous System)
Meds
Pain killers
CNS med
Brain injury

[Ashton]

           

here is a few random 10 odd minute sections for you and thank you for looking at them for me much appreciated.

so Dr told me a ASV would be of no use to me i asked him why so many centrals and he said that's just the way i am?!

iam 31 fit healthy if anything under weight

only condition i have is exercise induced asthma which is controlled with a preventor

 also currently on an opiate based pain patch from a pretty bad motorbike accident its fairly low dose though considering i was on about 10 times this amount a year ago
i would of thought with the centrals im having now i should of been dead back then

---

       

[SarcasticDave94]

My take? WOW, holy guacamole. All aboard the Central Apnea Trainwreck Express! Uh well this is ResMed ASV territory, no other machine can combat the mess. Getting it may be the hard part, treating with ASV is easy.

The only complication is Asthma other than CA. And your doc is wrong, these CA are treatable, with ASV. This tells me your doc is incapable of treating or seeing your CA as needing treatment. Might need to fire him and get some other doc willing to listen, file this as just a maybe for now.

Be assured we see the CA, I've been there myself even with high CA and Respiratory disease.

[Gideon]

Well your doc is at least partially right, if you keep using a CPAP you will have to live with it.
You want an ASV. Many of your countrymen import them from the US

[Ashton]

Will going higher on the pressure help at all? I’m just sick of waking up so tired and with a big headache every day…

Or changing it to bipap instead of fixed pressure? I feel pretty ripped off by my Dr just getting me the machine and saying see you later

[ICEMAN]

No do not increase pressure, from reading others previous post, increased pressure and EPR most often increase higher CA's " related to that issues re washing out C02 ? but those in here, much more detail precise better explain?

See below was previously posted By "Gideon Online Wiki Editor " in a thread I had posted but my CA were only getting at some times into the low Teen's Numbers?

RE: How does ASV prevent CA's re low Co
Ok here are the basics.
Neither CPAP, APAP, nor BiLevel wo backup (VAuto or "S" models) are capable of treating CA, they are not designed to do so. Yet these are the machines that are prescribed to nearly all Apnea patients. Instead what we do is manage settings to AVOID CA events. These machines are designed to treat obstructive events.

The most common, not the only, central Apnea we see is CO2 induced Central Apnea, Frequently this is Treatment Emergent Central Apnea.

This occurs because our machines flush out more CO2 than before CPAP. When CO2 goes below the apneic threshold a central Apnea event occurs.

To "treat" with these devices we reduce the amount of flushing that occurs. Usually the first thing we try is to reduce this flushing by reducing the pressure difference caused by EPR, Flex, PS depending on the machine.

This treatment is frequently a balancing act between Central and Obstructive events. The cations that reduce obstructive events tend to increase Central events and vice versa.