Fixing (CPAP-induced?) central apneas

Hi all,

I've been on a CPAP for about 2-3 months on and off. I'm still fine tuning the settings but have finally gotten used to it/got the settings right to the point where I can generally sleep through the night with the mask on.

AirSense 10 CPAP
P10 Nasal Pillows
Pressure range 6-10.4
Ramp on
EPR = 2

A couple questions I have:

1) Any ideas on correcting the central apneas that are occurring? Should I try lowering my pressure maximum to see if the lower pressure helps reduce the CA episodes?
2) How bad are my leaks? I've been trying mouth taping and chin straps - the attached data is with a chin strap.

TIA!

How's your sleep quality? Sleeping soundly for the most part or are you waking often for some reason or other?

Do those leaks wake you at all?
It's not a real pretty leak line but it is within the machine's ability to compensate for so it isn't negatively impacting the actual therapy.
If you are taping your mouth shut and the tape is still staying secure by morning then we can't blame mouth leaking but that does leave mask movement as a potential cause of the leaks.
If you are sleeping soundly and the leaks aren't waking you up there isn't any urgent need to do anything about them at least in terms of therapy itself.
If the leaks are waking you up then they need to be fixed or worked on because anything that disturbs our sleep is unwanted and that includes leaks that might be under the large leak threshold but because of the impact on sleep and not so much the impact on the therapy itself. If it is mask movement....you might try a different size P10 nasal pillow or snug up the headgear a little bit.

The centrals....we don't know what is causing them but I have my doubts that they are related to the pressure. I doubt that reducing the pressure is going to make that much of a difference.
If by some chance the trigger for the centrals (assuming you are sound asleep when those centrals got flagged) is the use of EPR you could try reducing or turning off EPR use.

If you are awake when those centrals were flagged then you need to not have the awakenings that might be causing awake/arousal related flagged centrals. The fix for that problem is to fix the sleep problem.

My sleep quality was improving as I became more accustomed to my CPAP. It's been worse lately as I've been experimenting with various mouth tapes and chin straps to try to get the leaks under control (I've been waking up in the night and subconsciously ripping off the tape, etc).

The leaks themselves aren't waking me up, but another member did suggest getting the leaks down so we could see my "true" CPAP data, without the interference from the leaks. Personally, I think I'd choose the good night's rest with the CPAP and existing leaks, at least for the moment, as being able to sleep through the night with the mask on has been a hard-fought battle these last couple of months.

As far as the cause of the leaks - it's probably a combination of my mouth opening and my tossing and turning which is dislodging the nasal pillows a bit. I'll try tightening up the headgear as you suggested.

Is EPR known to trigger centrals? I have my EPR at 2 and I seem to sleep better with it on (I had feelings of breathlessness that caused nighttime awakenings, when I tried reducing EPR).

Franko39 wrote: ↑

Sun Mar 03, 2024 6:44 pm

Is EPR known to trigger centrals?

It can be for SOME people but it's a rather small minority of people. Most people won't have EPR be a problem.
I use what would be like EPR of 4 (I use a different machine that exhale relief isn't limited to 3 like your machine is limited) and I don't have a problem with centrals.

Since you know you probably aren't sleeping soundly I would bet a good chunk of those centrals are awake/arousal related and you aren't sound asleep when they get flagged and if you aren't asleep they aren't real centrals and they are a symptom of the poor sleep quality.
A few "real asleep" centrals are normal to see and not a big deal. So.....I don't know that your centrals really are worth worrying about.
Even if every single central flag was the real deal you aren't really having enough of them for any doctor to want to worry about or do anything about anyway.
BUT I bet a sizable chunk of what you see are more related to arousal/awake breathing. Remember the machine only measures air flow and while awake, or tossing and turning, we often breathe irregularly compared to asleep breathing but the machine can only measure the air flow and it can and will flag that irregular breathing as some sort of apnea event but if we aren't asleep then they simply aren't real and they don't count other than to point to poor sleep quality.

If you want to use SleepHQ to upload your report to we can zoom in on the flow rate and look to see if those centrals look "real" or "arousal/awake" related. You can learn to zoom in yourself but it takes a bit of education to learn what to look for.

See all the flagged events on the flow rate below??? Those are all arousal/awake related.



Asleep breathing is very rhythmic and regular...like what you see before the cluster of events.
This person has a sleep problem....not a therapy related problem.

Here's one of mine. I circled the asleep time in red and the other stuff I wasn't asleep.



Same report and time frame but zoomed in a little closer so you can see the details better.

Your leak line is a bit ugly but it isn't so bad that it is "clouding" your data results.
If you were sleeping soundly and feeling great I would tell you to just ignore the ugly because the prettiest of leak lines don't guarantee that we are getting "perfect" therapy or feel like superman/woman.

While sometimes I have got lucky and got a perfect 0.0 leak line....most nights I don't have a pretty leak line and some nights it is quite ugly but I sleep through the leaks so I just shrug my shoulders and move on.

Primary goal....get good sound sleep and feel decent. Nice pretty reports come in second IMHO.
Without sleep none of the data means much.

Pugsy wrote: ↑

Sun Mar 03, 2024 7:11 pm

Your leak line is a bit ugly but it isn't so bad that it is "clouding" your data results.
If you were sleeping soundly and feeling great I would tell you to just ignore the ugly because the prettiest of leak lines don't guarantee that we are getting "perfect" therapy or feel like superman/woman.

While sometimes I have got lucky and got a perfect 0.0 leak line....most nights I don't have a pretty leak line and some nights it is quite ugly but I sleep through the leaks so I just shrug my shoulders and move on.

Primary goal....get good sound sleep and feel decent. Nice pretty reports come in second IMHO.
Without sleep none of the data means much.

I really appreciate your insights - the support and assistance I've received on these boards has been phenomenal and I couldn't have gotten this far without yours and others' help. I absolutely agree with your mindset/approach to the reports. I'll stop focusing so much on the leaks and CA events and refocus my efforts on ensuring I'm getting sound/uninterrupted sleeps.

Regarding those CAs - I've attached a couple zoomed-in photos of the CAs as they occur. Are you able to glean any insights from these photos?

I also uploaded my data to SleepHQ as you had suggested. Can you please tell me how I can share the data with you? I don't see any charts referencing flow rate.

Thanks again,

Franko

IMHO all the flagged CAs are arousal/awake related. You may not remember the arousal but your breathing pattern sure looks arousal related to me.

I am sorry but I don't know how to use the SleepHQ software other then once you post the report link then I can go interactive with it and zoom in to check patterns.

Don't worry about it too much....the zoomed in pics you shared pretty much just confirmed my suspicions and I would bet my last dollar I would see the same if I could use SleepHQ.

It's not critical at this point. So don't worry about it. Someone who is familiar with what you need to do with SleepHQ will likely be around later.

I don't have central apneas flagged except rare arousal related....so I don't have a good example of a real asleep central apnea to show you but I do have a good example of 2 apneas while I was asleep. Just pretend that the flag says CA instead of OA.



look at the breathing pattern right before and after each flagged event. I was sound asleep I am sure and I most likely have no memory of it. Now look at your breathing pattern before and after the flagged event. See how you breaths are bigger and smaller with some little spikes? That's arousal or full awake breathing. We don't take big breaths when we are asleep so when you see anything other than nice even rhythmic breaths...we know we had some sort of arousal that we may or may not remember.

I normally remember maybe a half a dozen awakenings but if I take the time to zoom in and look for arousal breathing I might see 20 more and if I am having a bad night...30 or more. We may or may not remember and arousal but I always tell people that if you remember 2 then I bet you had at least 4 more that you don't remember.
This high arousal thing is normal for me....I have other health issues that mess with my sleep quality and the machine just can fix anything other than airway issues.

Work on the sleep quality and maybe some work on the mask leak because it wouldn't be impossible for those leaks to be causing arousals.
Reduce the arousals...you centrals will reduce as well as a by product of fixing the potentially arousal causing leaks.

You DON'T have central apnea and you don't have enough real asleep centrals to worry about.
Put that worry right out of your head.

Thank you again for all of the advice and guidance! It's reassuring to have one less thing to "solve". I think I'll refocus on getting good rests/sleeping through the night with the CPAP, and then look into the leaks more once I've got things stabilized a bit more.