Sudden increase in events

[BreathingLessons]

Hi all,

I've heard about ApneaBoard for a long time and am happy to finally have joined.  I was hoping you might have some insight for me.

I started CPAP therapy last year, and it has been going pretty well.  I've generally had an AHI of < 2.  However, in the past month or so, that has increased, and it has especially increased over the past few days (with 3 days of 5+ AHI in the past week).  The only thing I've changed in the past few days is sleeping on the other side of the bed, but that's never caused an increase in AHI before.  Most of these are reported as clear airway events, although my sleep study diagnosed me with OSA, with no reported central apneas.  I usually wake up in the morning with a belly full of air, which suggests to me that, if anything, my pressure is too high, but open to your thoughts. I sleep on my stomach, if that matters.

Would be interested in any insights or suggestions you might have.  The graph I posted was from last night, but of course happy to provide other info/other nights if needed or helpful.

Thanks in advance!

[Gideon]

Welcome to AB.
I would to see 10 minute view of your centrals to judge their character. The whole chart just zoom in until a 10 minute segment shows

In the meantime reduce your EPR to 2. That should help reduce your centrals, maybe not, and possibly I crease your obstructive events.

Repost with your results. Thanks

[BreathingLessons]

Thanks for your reply (and for your work on OSCAR!)

I'll try reducing the EPAP tonight, and attaching the 10-min charts from a few of last night's CAs.

Thanks again!

[Gideon]

It looks like your centrals are CO2 induced so we should be able to manage them.
What is most likely happening is your PAP machine has improved your breathing and as a result is flushing out more CO2 (the primary or main driver for our breathing) to below your apneic threshold and resulting in a central Apnea. This happens gradually, you see breaths getting progressively smaller. Now that you are not breathing CO2 increases and again crosses your apneic threshold gradually getting bigger breaths and once again flushing too much CO2 out repeating the cycle. Reducing EPR is the initial way we reduce this flushing of CO2

[BreathingLessons]

It looks like your centrals are CO2 induced so we should be able to manage them.
What is most likely happening is your PAP machine has improved your breathing and as a result is flushing out more CO2 (the primary or main driver for our breathing) to below your apneic threshold and resulting in a central Apnea.  This happens gradually, you see breaths getting progressively smaller.  Now that you are not breathing CO2 increases and again crosses your apneic threshold gradually getting bigger breaths and once again flushing too much CO2 out repeating the cycle.  Reducing EPR is the initial way we reduce this flushing of CO2

That's fascinating, thank you for not only providing the solution but explaining it. I will reduce the EPR tonight and report back.

[multicast]

You may also try to lower your lower pressure from 14 to 12.

[BreathingLessons]

You may also try to lower your lower pressure from 14 to 12.

Thanks!  I did try lowering from 14 to 13.6 based on the reasoning above.  Will move it down a bit more tonight at your suggestion.  Want to also add, I was thinking the CO2 idea really does make sense, because I have lost about 35lbs recently, which--I would think--would increase CO2 flushing.

Last night my AHI went down from the previous two nights, but still a bit above my average.  Maybe tonight I'll try reducing EPR another number, then maybe turn it off entirely? I feel fortunate I've never really had any problem adjusting to the CPAP, and don't think I need EPR for comfort.

Thank you again.

[BreathingLessons]

Lower EPR to 1 and pressure to 13-20 seems to have done the trick.  Two most recent nights are in the more typical range for me (AHI of 1.1 and 0.4, the lowest in about a month).  Thanks for the help.