Suddenly my Centrals got a lot more disruptive

[tcinoz]

        I was diagnosed with an assortment of apneas in mid January (43 p/h) and have been on a CPAP since then (about six weeks).

This week I've noticed that my CAs were gradually feeling more intense, until last night I had the worst night since I started treatment. One 'event' woke me up with such a force that I got up and even ten minutes later my blood pressure was sky high.

As can be seen from the first screenshot, I was up and about for much of the night, switching off the machine whenever I was too tense to sleep. For much of the rest of the night I was lying awake. Then some nasty CAs kicked in early morning, probably when I was just about to drop off.

I experimented with the pressure settings as nothing felt right. Normally I've been on 6.6 as anything higher seems to result in a more troubled sleep than the lower setting. My sleep doctor has ordered another sleep study for this weekend, but it will be several weeks before my consultation to discuss the results.

If someone can help alleviate this ordeal from a study of the screenshots (the second one is just a few minutes snapshot from the main one) I'd be very grateful.

Would an ASV machine really help with intense CAs like this? It's hard to understand what they mean by 'it takes a breath for you' and how that would start me breathing again.

[tcinoz]

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A freaky night last night with a lot going on, including a rare Cheyne Stokes sequence between 2:30 and 3:30, yet I slept better than the night before when my AHI was much lower. Maybe through sheer exhaustion.
My question remains: would an ASV machine be more appropriate in treating my symptoms? It's been really hard getting clear advice. Maybe my upcoming sleep study will provide some clearer answers, but if they do suggest an ASV, I wish I'd known after my four-week trial before I splashed out two grand on my own CPAP machine (no private health cover so no refund).

[Sleeprider]

Based on your charts, I think your best bet is the Aircurve 10 Vauto and a soft cervical collar. I don't see much in the way of central events there and if we were to get zoomed in, I could make a pretty good case for all obstructive and positional. That CSR is just repetitive obstructive events.

[tcinoz]

Based on your charts, I think your best bet is the Aircurve 10 Vauto and a soft cervical collar. I don't see much in the way of central events there and if we were to get zoomed in, I could make a pretty good case for all obstructive and positional.  That CSR is just repetitive obstructive events.

Thanks for your reply.

That cluster of OA and CSR events is pretty atypical. I can only think I must have got myself into a bad position during my nocturnal tossing and turning for that hour!

The reason I'm focused on the CA, H and RE events rather than the OA ones is that on some nights I am about to drift off and become aware that I have stopped breathing, which of course makes me wide awake again. It's disconcerting to say the least, and for three nights earlier this week the sense was that the stopping had a more determined feel to it. Also, I've never been a snorer or been conscious that my airways are obstructed other than when I get into a really bad position. I sometimes sleep on my stomach and it usually ends with some sort of obstructive breathing making me change position. Perhaps that's what happened last night and I was in too deep a sleep for the positional adjustment.

[Sleeprider]

The advantage of the Vauto plays right into your sleep onset centrals. You don't really have neurological CSA, rather you get some delay in moving from wake to autonomic sleep breathing. Night arousals and sleep stage centrals are similar. The Vauto has a configuration that lets us trigger IPAP with less spontaneous flow, and this usually works to prompt someone with CA events or pauses like this to breathe. Unlike your CPAP, we can trigger pressure support with very little air movement, and there is more pressure support to work with. I use this myself. With high or very-high trigger sensitivity, these events as we drift-off are met with a subtle "push" of higher pressure. That is usually enough to trigger a spontaneous breath. Hard to describe, but you will find many threads on this forum where we discuss it and obtain very good results. Do an internet search using these terms: high trigger sensitivity site:apneaboard.com. I think you will find what you're looking for.

[tcinoz]

Thank you Sleeprider, that's helpful and sounds worthy of further investigation on my part. I did just read your replies to a lady also using a Vauto and it sounds like the adjustments offer more flexibility and ability to tweak. Those pressure settings (anything above 10) would blow my head (and mouth) apart, though! Can the Vauto typically be used with a maximum pressure level of 7 or 8?

I discovered today that what I thought was to be a second 'regular' sleep study this coming Sunday night (but this time in a hospital setting) is in fact a CPAP review. I'm hoping they'll be able to fine tune my settings based on the results without the need for a second machine, having bought my Airsense 11 only 3 weeks ago and not qualifying for any refund. That said, I shall quiz my sleep doctor in the follow-up consultation about the Vauto option as that does seem to cater for many of my specific AHIs. When you're cursed with a sleep disorder, you willingly pay for the best quality sleep that money can buy, I'm realising!

Thanks again for your help. Informative and much appreciated.

[Sleeprider]

I have a current thread where I'm coaching EPAP min at 5 with PS 4. There are things you can do to control the air in your mouth and that is something we can work on. How do you feel about switching to and Airfit P10 or P30i? A 10 cm pressure is actually very low and equal to less than 4-inches water-column. In other words it s the amount of pressure it takes for you to blow through a straw and make bubbles in only 4-inches of water (juice glass). With bilevel pressure support, you are only at the peak IPAP pressure for a fraction of a second and your perceived pressure is much lower. The perception of pressure is largely mental and relatively minor aids and training can overcome the problem.

[stevew168]

The best option for a bipap would probably be an ASV. I have one and it almost completely eliminates centrals, as will as most OAs, without waking me. I love it!

[tcinoz]

The best option for a bipap would probably be an ASV. I have one and it almost completely eliminates centrals, as will as most OAs, without waking me. I love it!

Thanks - yep, the ASV does seem to have the widest range of options. One thing I've noticed is that almost no two nights have been the same, and with half a mind open to the possibility of having to use a machine if and when I catch Covid or some other cursed virus, the more flexible the options that the machine offers, the better, IMHO.

[tcinoz]

Thanks Sleeprider. Interesting.

I have tried other masks with limited success (Airfit F20 and F30i). Even though my nose does get partially blocked, the nasal mask works best of the three. It allows me to tape my mouth using a bandage which I tie at the back of my head before I put the mask on. That way not only does it cover my lips (just tightly enough) but it also stops my cheeks from puffing out! (for the record, I found a chin strap cumbersome and of little or no help). I will look into the other masks you recommend, though. Thanks for that.

My figures for last night were about the best they've ever been, but I'm still waking up a lot towards the end of my sleep, each time with higher blood pressure and increasing brain fog after a certain point. Before I had the machine i found it impossible to lie back down during these hours and I would get up and try and go back to sleep in a recliner chair. The more upright position felt less of a head-spin. I think it may be to do with O2 levels, and I'm hoping my CPAP review will be able to home in on what exactly is going on and what the cure is. Presumably higher pressure settings, if I get used to them, would help deliver more O2 (if that's what the problem is).


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