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[Tommysnoozer]

Hi, I hope this is helpful? Please advise if there's anything more to to upload.

I'll try a lower EPR tonight.
Thanks,
TS

[Geer1]

Your AHI on average is much higher than your first example indicated and your Statistics page indicates the majority of them are usually central apneas although there are some obstructive events as well. CPAP treatment can induce central apneas and higher EPR often makes it worse as it looks like it did last night as well as back on Nov 25th when you did the same test.

Back in August 19-22 you tried turning off EPR at a lower pressure and AHI was still high. Can you post some of the charts from those days, I want to see if you were still having centrals with EPR off or if you were having OA/H because of the lower pressure.

Also do you have a sleep study report? It would be good to know if it makes any notes of central apneas prior to starting treatment?

[Tommysnoozer]

Hi Geer1, here's the reports from those nights. I'll get my last sleep study (mid-July this year) uploaded tomorrow. I'm off to work for the night but will check back here when I can.
Happy New Year,
TS

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Screen from Aug 22nd

[Geer1]

As I was thinking even without EPR you still were having central apneas. You were also having more hypopneas which may have been because of the lower pressure or possibly were central in nature.

The sleep study will be good to see since it should tell us if you were having central apneas without CPAP, in which case you need a different machine in order to deal with the central apneas (might need one anyways even if they are just treatment induced).

Make sure to black out or hide any important information from sleep study (names, addresses, phone numbers for both you and doctor etc).

Have a good new years as well, don't work too hard.

[Tommysnoozer]

Hi, here's my screenshot from last night - seems better. I'll attach it and my sleep report over 2 posts.
Thanks,
TS

[Tommysnoozer]

Further Sleep Study screens. There are two more screens of charts that look like Seismographs but have no indication as to what they are (presumably HR, Snore or PLM). I've not included them.

[Geer1]

That was with EPR = 1? I would stick with that for a while and see how things go.

You do have treatment emergent central apneas. Another name for this is complex sleep apnea. EPR is what triggers these centrals the most, if you continue to have centrals you can try turning EPR off which should help more. Continued regular use may cause these centrals to trail off as the body gets used to the CPAPs effects but that isn't always the case.

If you continue to have lots of centrals even with EPR off then you only have a couple options. I don't know much about EERS but have seen it mentioned on here and it is the only option you could try with your current machine. It relocates the exhaust vents further up the hose so some carbon dioxide stays in your system (low carbon dioxide is what causes the central apneas). The other option is to get a different machine, ASV is what is required to treat central apneas.

[Tommysnoozer]

Thanks for the info Geer1. Yes the EPR was at 1. I might try it off for tonight and see what results I get. I used the machine for a long time without EPR and didn’t noticeably struggle to exhale. 

It’s promising that I managed a night (mon 30th) with barely any Central events. I suspect I rolled onto my back again last night (might have to rig up a T-shirt with tennis ball). 

I was prescribed an APAP by my consultant at the review of the sleep study posted above. The technician I was sent to after the review muttered something along the lines of the NHS/Sleep Clinic not providing one, and instead sent me off with a nasal mask.

If I have to buy one then so be it, but I’ve booked my machine in for a service this month, so will ask about an APAP/ASV when I go in. 
TS

[Geer1]

Centrals are not likely being caused by sleeping on your back. The tennis ball trick is meant to help with obstructive apnea and all it will do is add discomfort. It does not affect your CO2 levels nor how your body reacts to CO2 levels which is the real problem behind these central apneas.

APAP and ASV are two very different machines. APAP is very similar to what you currently have with one difference, the pressure can fluctuate. Instead of having a constant 10 cm of pressure you might be able to use a range of say 6-12 or 8-12. Maybe would provide some minor improvement in comfort but overall I don't think it would make a significant difference as you obstructive apnea and hypopneas seem to be treated decently with CPAP and your pressure is not that high.

ASV is the only machine that treats central apneas.

Right now you are best off to continue trying EPR of 1 or turning it off and seeing how your results are. If your centrals aren't bad then your treatment appears to be sufficient. If you have bad nights with lots of centrals than I would recommend talking to your doctor/sleep therapist and asking them if ASV might be required to treat your central apneas.

[Tommysnoozer]

Good to know Geer1, thankyou. I'm much better informed for my next visit to the Sleep Clinic (where I'll be bringing up these observations).

I've included last night's screen. I don't feel particularly rested and the Centrals are prevalent again. I've had better nights rest after only a few hours (sometimes <2) of using CPAP but with no/lower Centrals - which highlights the fact that the Centrals are a decisive factor in my quality of sleep. I'll persevere with a low EPR/EPR off for a week or so and report back. 

TS