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+--- Thread: Sudden appearance of CSR (/Thread-Sudden-appearance-of-CSR)
Sudden appearance of CSR - herenthere - 04-01-2023
During the 3 months I've been on PAP my average AHI has been around 4.5, mostly CA. But on 3 of the last 4 nights I've had AHIs of 12-15, with periods of CSR. During these periods I feel uncomfortable, like I'm getting too much air and hyperventilating. The CSRs and most of the CAs tend to start at the beginning of the 2nd sleep session, and they have never happened in the first session. (As on 3/29, when I did not get out of bed at all, so there was only one session and no CSRs.) Any advice on why the sudden appearance of CSRs and increase in CAs? And why never in the first sleep session regardless of length? With my wife's help I have ruled out positional effects.
RE: Sudden appearance of CSR - Psychotech - 04-01-2023
There are lot of leaks you need to get leaks under control, sometimes cpap detects leaks as central apnea, if you are a mouth breather try tapping the mouth even an cervical collar can help or buy a full face mask, if the mask is leaking tightened the strap
RE: Sudden appearance of CSR - herenthere - 04-01-2023
(04-01-2023, 12:36 PM)Psychotech Wrote: There are lot of leaks you need to get leaks under control, sometimes cpap detects leaks as central apnea...
There doesn't seem to be an association between leaks and CAs or CSRs. Here's another night with 2.4% large leaks, but none during the sessions with CSRs.
RE: Sudden appearance of CSR - Sleeprider - 04-01-2023
Your daily statistics show you're using EPR 3 but the pressure chart does not show both IPAP and EPAP pressure. There are lots of flow limitations, so I suspect that EPR is not actually working. I'd like to see a closeup of one of the CA clusters at a 3-4 minute resolution so the individual respiratory waves are more easily interpreted, and if you can use mask pressure in place of pressure we should be able to see the changes of inspiration/expiration pressure. I just want to be sure the CSR is not obstructive before going further.
RE: Sudden appearance of CSR - herenthere - 04-01-2023
A couple from the same night with a 3 minute window.
I used to have EPR showing, but since it was always where expected it seemed redundant. How can I tell if an OA is mislabeled CA? (Or the reverse.)
Thanks for your advice.
RE: Sudden appearance of CSR - herenthere - 04-03-2023
This is the phenomenon typically seen most nights. My mask was off for 70 minutes, and my SpO2 was steady at around 88-89. As soon as I put the mask back on my SpO2 went up and the CAs started with SpO2 oscillating between 96 and 87. The cycles were about every minute for a half hour. Since my mask had been off, it doesn't seem like this could have been precipitated by hypocapnia, so what brings this on?
RE: Sudden appearance of CSR - Sleeprider - 04-03-2023
The only solutions I know t this very high CSA rate is to cut the EPR or to move to ASV therapy. I really don't see a root cause that can be dealt with other ways. Central apnea normally is reduced by less pressure fluctuation and pressure support which ventilates CO2. My best advise is to try reducing EPR from 3 to 2, 1 or even off, and limiting the fluctuation of pressure to narrow range. You are currently at 5-15 pressure with EPR 3. I would limit that range to 6-10 with EPR 2, then cut EPR as needed to reduce CA.
RE: Sudden appearance of CSR - herenthere - 04-12-2023
Thanks Sleeprider. After a few nights with your recommended settings, it's looking like it may be the right track.
RE: Sudden appearance of CSR - Sleeprider - 04-12-2023
Thanks for the feedback! I hope you have continued success. Let me know.