Any advice for what seems to be treatment-emergent central apnea?

[almurray92]

I've been trying to use my CPAP, but I still wake up every day feeling awful. I was prescribed it a few years ago and used it diligently for the first three or four months but eventually became unable to tolerate it due to other medical issues. I used my CPAP sporadically until the past month when I was able to get my health issues under control enough that I've really been pushing myself to use the CPAP. I asked my doctor about treating the central apneas, but he won't make any recommendations or adjustments to my treatment since my AHI is under 5.

I was diagnosed with obstructive apnea based on an at-home sleep study with an AHI of 15, and as far as I'm aware, I was not suffering from central apneas before treatment. Over the past month, my obstructive index averaged 0.25 per hour, but my clear airway index was closer to 3. 


I am really struggling. I'm currently dealing with so much fatigue and tiredness that I'm completely disabled. I can't work, exercise, engage in hobbies or a social life, drive, be intimate with my partner, do any housework, or even keep up with basic self-care like brushing my teeth and showering. I'm debilitated to the point I'm essentially bed-bound from fatigue, and I'm just not getting the relief I should be getting from CPAP therapy. Any help would be really appreciated.

[Millstone50]

Not seeing a heck of a lot wrong there. Do you actually use the ramp of 45 minutes at the start of the night?

[staceyburke]

EPR can cause centrals. If you want to see if it helps lower EPR to 2 and then 1 and see if it is helpful. Later as your body adjusts to therapy you can increase the EPR up 1 and after awhile up another 1.

[Gideon]

Set your min to 8.
There is nothing in your charts that say to, but try it and see if it's better. Note that this may increase your centrals

As Stacey said you can decrease your EPR and see if that helps.

I don't want you to eliminate the centrals, I want your body to better adapt to your CPAP use and in your case that means having some centrals.

Do increase your min pressure though.

[PaulaO2]

Treatment induced central events go away with time. The more you use it, the more your body and brain adjust. Some people never get rid of them but most do. Use your CPAP. Follow the advice above. Keeping working at it. Even use the machine for a half hour or so each day while sitting on the couch watching TV. This helps to get you acclimated.

[almurray92]

I want to say I’ve been setting the ramp to “auto”?

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For my own edification, why do you recommend increasing the minimum pressure to 8?

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For my own edification, why do you recommend increasing the minimum pressure to 8?

[Millstone50]

Ramp is an issue because during the ramp time you're not getting the prescribed amount of pressure, not getting proper EPR and not getting an automatic adjustment in pressure until the ramp expires.

[Gideon]

"currently dealing with so much fatigue and tiredness"
This implies that you could be dealing with not enough air or volume, or not enough oxygen, even if your numbers are good.

A Min of 8 should have a positive effective on you and will do no harm. We can always adjust later if need be.

Also most users just need a min of 7 or 8. Fu) use of EPR also nefs a min of 7, even 8f you don't appear to need it for treatment of hypopneas.