Trying to Reduce CA Events

[chrotteg]

Hi everyone, I have been using CPAP for about three weeks and haven't felt much better throughout the day. I made another post regarding treatment but hopefully narrowing down my specific issue will allow me to get some more help. My sleep study showed I am split with OA and CA events (attached). Ever since I started recording my CPAP data, I have always had CA events, randomly throughout the night and also come in clusters. I have a feeling my tiredness is coming from my CA events as I rarely have OA events with the therapy. I am constantly waking up thoughout the night and I feel my sleep is obstructed with these events. The main reason for trying CPAP therapy was because my sleep efficiency, N3 sleep, and REM sleep are all low for my age, with N3 being 0%. Please let me know what suggestions you have to improve my therapy. Thank you for the help in advance!

[staceyburke]

I will give you two things to look at.  First is EPR sometimes causes more centrals and does until you get use to the therapy.  As you stop having them you then can add 1 and get use to that level - go to 2 until there are few if any centrals and then try 3.

The second one is that it might be positional apnea.  We don't look at centrals as positional usually but When they are clustered there is a possibility of it being positional.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[chrotteg]

Thank you for the advice! I have tried turning off EPR but still had central’s but there is a possibility I didn’t try for a long enough period of time. 

Regarding the positional apnea, I did have more events on my back in my sleep study. I always assumed with the chin tucking it would only pertain to OA events so I haven’t tried a collar yet. I generally sleep on my side but in my sleep study I think they said I was on my back like 15% of the time if I remember correctly. I also already prefer flatter pillows so I would consider my pillow decently flat, I always had neck issues even before CPAP with higher/harder pillows. 

Overall, I can definitely try EPR off again for a few nights with a cervical pillow. Would you say my pressures are ok (Min 7, Max 12)?

[stevew168]

Based on your mostly central apneas in your sleep study, if I read it right, you would likely benefit with an ASV. Here's my OSCAR screenshot from last night.

[SarcasticDave94]

In this case, with 13 CA and 13 obstructive hypopnea, then 1 mixed event, you may be needing the ASV you asked about in the other thread.

Merging these threads is maybe a good idea.

What you can try for now, EPR off and possibly minimize the pressure range. Your chart at the beginning here shows a max pressure of 8.x, so maybe you want to try straight 8 or 9. Note it may be less comfortable. Why try it? To see how those CA react. Predicted outcome: CA possibly don't care about your settings, reflecting a predominantly Central event status.

If half your report events are Central, yours were, that's what you tell doctor is your reason for ASV. If doc dismissed this offhand, dismiss doc and get another one that understands Central Apnea better.

The doc may say you need to try BPAP. Request a titration for BPAP and ASV. Then see what those results tell you. If it's like my CA, you're going to see maybe higher CA than now with BPAP without backup rates and lower with ASV, a BPAP with backup rate.

[stevew168]

In this case, with 13 CA and 13 obstructive hypopneas, then 1 mixed event, you may be needing the ASV you asked about in the other thread.

Hypopneas are often only scored as obstructive. ASV may fix them all, or you might need even more. (iVAPS?)

[SarcasticDave94]

It doesn't matter so much what the hypopnea are. Half the events are Central, so that's enough for the possibility of an ASV. No way that there's a need for iVAPS, nothing in the line of pulmonary disease involved for the OP.

13 CA to 13 hypopnea and the 1 mixed is a 0.5 CA, so there it is, exactly half. And I have seen hypopnea scored with Central and Obstructive based on some sleep reports others have shared. So differentiating them does happen.

[stevew168]

It doesn't matter so much what the hypopnea are. Half the events are Central, so that's enough for the possibility of an ASV. No way that there's a need for iVAPS, nothing in the line of pulmonary disease involved for the OP.

13 CA to 13 hypopnea and the 1 mixed is a 0.5 CA, so there it is, exactly half. And I have seen hypopnea scored with Central and Obstructive based on some sleep reports others have shared. So differentiating them does happen.

I did not suggest there was a current need for an iVAPS. LOL!

Counting Hypopneas equal to Centrals is not necessarily balanced without SpO2 data to establish Hypopneas. Now AASM requires 4% SpO2 desaturation in their current guidelines.

[SarcasticDave94]

...
(iVAPS?)

I did not suggest there was a current need for and iVAPS.

...

Which of your posts is accurate then? Your mention of "ASV may fix them all, or you might need even more. (iVAPS?)" or saying you didn't mention iVAPS? Why mention it if you didn't think there's a possibility it's needed?

[stevew168]

Please read exactly what I wrote again.