High AHI- need some help!

I don't understand all this panic over centrals but people do freak out over the least little central.

1....it's normal to have an occasional central apnea anyway....normal...we all have them....real asleep centrals. Sleep onset centrals or sleep stage transition centrals....entirely normal...no big deal and expected.

2...yes, sometimes a few people have more than an occasional central apnea happen once they get put on cpap and we can't blame it on sleep/wake/junk false positive flags....again they aren't a problem unless present in really large numbers or causing desats or if they keep bouncing a person out of sleep.

Sometimes the centrals (if real asleep centrals) will fade as the body adjusts to cpap pressures. Sometimes it doesn't and sometimes a different machine is needed.
Before talking a different machine though.....doctors will develop a wait and see policy because sometimes the centrals will simply go away on their own. It all depends on how many centrals a person is seeing...

3 to 4 centrals per hour like the OP showed on the report above....probably wouldn't even cause the doctor to raise an eyebrow even if every single one of those centrals was the real deal.
Docs won't get excited until someone is having over 5 centrals (real asleep) per hour ....every hour.....every night.

When someone is new to cpap therapy often they don't sleep so great. They wake up a lot for various reasons and with those wake ups comes the increased chance of SWJ flagged events happening. These machines can't tell sleep status. They measure air flow only and often our awake breathing is very irregular compared to asleep breathing and the machine can and will flag that irregular breathing as some sort of apnea event not limited to centrals either.

So we don't totally ignore the centrals but we put them on the back burner for now and have newbies work on adjusting to sleeping with the mask and machine and optimize their therapy in terms of reducing OAs and hyponeas (the only thing we can fix with cpap/apap machine pressure anyway). Worry about them later should they still be present in numbers that warrant concern once someone has been on cpap for a while and they are reporting that they are sleeping soundly for the most part.

If someone needs more pressure to reduce the OAs and hyponeas...then they need more pressure.
Fix what you can with the cpap/apap machine and then see what's left in terms of centrals. More pressure might increase the centrals in a small minority of people....greater chance of it not being a problem though.

Pugsy wrote: ↑

Sat Apr 20, 2019 9:20 pm

I don't understand all this panic over centrals but people do freak out over the least little central.

My *guess* is not knowing any better, and the idea that centrals mean that something's broken in you... since we all breath perfectly fine during the day (we don't). Obstructives are easy to understand, sort of.. I guess... but "I'm not even trying to breathe? OMG I'M GOING TO DIE!" (well, yes you are, eventually, but not from a few centrals here and there).

People that understand the respiration loop cycle and how CO2 drives respiration understand WHY we feel the need to breathe, and why, if that CO2 is a little low, we don't feel the need to breathe, until that builds up again... that's also why you breathe really hard when exerting yourself, you gotta get rid of that CO2 that the exertion creates in your cells.

Pugsy wrote: ↑

Sat Apr 20, 2019 9:20 pm

1....it's normal to have an occasional central apnea anyway....normal...we all have them....real asleep centrals. Sleep onset centrals or sleep stage transition centrals....entirely normal...no big deal and expected.

It's also *extremely* common to have central apneas while awake and doing things... of course those aren't central sleep apneas. but nobody even thinks about those (central apnea essentially means you're just not trying to breathe).

Pugsy wrote: ↑

Sat Apr 20, 2019 9:20 pm

2...yes, sometimes a few people have more than an occasional central apnea happen once they get put on cpap and we can't blame it on sleep/wake/junk false positive flags....again they aren't a problem unless present in really large numbers or causing desats or if they keep bouncing a person out of sleep.

I don't know of any real evidence that a few centrals here and there are actually disruptive to sleep... doesn't mean they can't, I'm just not aware of it. Now, there's lots of other breathing issues that DO disturb sleep, as we both know, but your body simply *not needing to breathe* for a few extra seconds... that's really a non-issue, until, as you mention, they're so frequent that you actually start to desaturate your O2 levels.

I've held my breath for a minute, and barely noticed a drop in my measured SpO2 levels.

(note, I know you know all this, Pugsy (pigsty?(I'm sure that's going to come up next time on the phone)), I'm just trying to expand a bit.

Gerryk wrote: ↑

Sat Apr 20, 2019 4:29 pm

Just out of curiosity what was your machine originally set at? From my experience having a wide pressure range doesn’t work well. As long as your machine isn’t going over a certain pressure, drop that upper max pressure down. If you find your lower setting comfortable to start but that the machine begins to react to events and increases pressure, raise the lower pressure up and use the ramp feature.

If your machine does not reach max pressure why reduce it. Your giving bad advice there is no need to reduce the max pressure

Gerryk wrote: ↑

Sat Apr 20, 2019 5:46 pm

You guys really are no helpful at all. Just because someone has a different idea or thought than you doesn’t mean they are wrong or have nothing to add. Keyboard warriors in this world have gone nuts. I am not able to
Look at the data is my phone but a pressure that is to high can cause a central apnea. Closing the pressure gap could help determine the problem.

High pressure does not cause Central Apnoea. I have central apnoea my machine can go to 25cm/h20 to clear my central apnoea (but my ASV is a specialist machine designed to treat CA’s) the original poster’s machine does not treat CA’s and we need more data to decide if the OP has complex apnoea that would benefit from a different machine.


We are keyboard warriors who post here to help users not to spout rubbish but based on data provided, in this instance the pressure increase is not causing the CA’s

High pressure sure can cause a central. You are the one giving bad advice and not being a nice person.

Gerryk wrote: ↑

Thu Apr 25, 2019 5:53 pm

High pressure sure can cause a central. You are the one giving bad advice and not being a nice person.

And you sure can die from drinking too much water, or putting too much salt on your food.

Listen to people that know more about the subject than you do.

Though I doubt that you will.

Dog Slobber wrote: ↑

Sat Apr 20, 2019 4:45 pm

Gerryk wrote: ↑

Sat Apr 20, 2019 4:29 pm

From my experience having a wide pressure range doesn’t work well. As long as your machine isn’t going over a certain pressure, drop that upper max pressure down.

There are reasons to drop the max pressure, but that's not one of them.

Drop the max, if you're reaching it and:

• You are suffering from aerophagia
• You can't tolerate such high pressures
• You start experiencing excessive mask leaks at higher pressures

Right now his max pressure is 20cm. He never goes beyond 14cm. What do you suggest he lower it to? 18cm? 16cm? If he did absolutely nothing would change on his charts.

I agree. It won't affect the therapy to lower the max pressure if it doesn't cause problems currently. And it may be needed sometime in the future. For example, my machine may spike to 15 a few times, and some rare nights, spike to 17. But if I have a cold, use a muscle relaxer, etc, it is good to have that available as my pressure needs do go up.

I also have another reason why the max pressure I don't use helps me to sleep better. When my pressure does spike, it is because I have rolled onto my back. When the pressure goes high enough to flap my cheeks a little, I don't like it and roll back onto my side. This keeps the spikes very short and not very high. But without them, say a max pressure of 14, I would roll onto my back and STAY there. And my machine would be detecting lots of events rather than preventing them. So, having my machine able and willing to go higher, keeps me from needing it to go higher.

The only reasons to limit the max pressure is if that max pressure is causing a problem. The user will feel those problems and/or see them in the data.

ANY pressure can cause centrals. Doesn't have to be "high" pressures.
OP is having centrals at the current minimum of 10 cm...and having time where the pressure is much higher and zero centrals happening.
There's a lot of information lacking from this current situation that is really needed to forum any opinion at all about the centrals the OP is seeing flagged.

If ....big if....it is from the pressure then the current minimum of 10 is also a problem and reducing the maximum isn't going to change that fact at all. I have my doubts as to just how much of a factor any pressure is with the OP in this thread because of centrals being flagged at 10 cm ....and times with much higher pressures being used with zero centrals being flagged. Doesn't follow common sense logic for it to work out like that.

The number of people using higher pressures and NOT having centrals pop up....much, much higher than the very small percentage that will have centrals pop up at ANY pressure. Remember it can happen at 4 cm just as easy as it can at 10 or 12 or even 20. If it's going to happen to someone the chances are the amount of pressure isn't the trigger. It's the fact that there is any pressure.

palerider wrote: ↑

Thu Apr 25, 2019 6:10 pm

Gerryk wrote: ↑

Thu Apr 25, 2019 5:53 pm

High pressure sure can cause a central. You are the one giving bad advice and not being a nice person.

And you sure can die from drinking too much water, or putting too much salt on your food.

Listen to people that know more about the subject than you do.

Though I doubt that you will.

As others have said and I agree their are people like you here who have such a miserable life you need to try to make others feel bad. I have had three different Dr’s explain to me how a pressure to high can cause a central. But as a miserable keyboard warrior you know better.

Gerryk wrote: ↑

Thu Apr 25, 2019 6:34 pm

As others have said and I agree their are people like you here who have such a miserable life you need to try to make others feel bad. I have had three different Dr’s explain to me how a pressure to high can cause a central. But as a miserable keyboard warrior you know better.

How many doctors have prescribed 4-20 or 5-20 and think that is a good idea? Most of us here know that wide open is a prescription for failure. This forum exists because most doctors do not know HOW to use a cpap, how to dial into correct settings, and how to make it comfortable. This is one thing where people have been there, done that are often better able to help.

Please explain how lowing a max pressure of 20 to 14 (or anything in between) will reduce centrals in a person who never goes above 14?

What I was talking about above is that to high of a pressure can cause centrals and someone said no it can’t. And went on and on. As pugsy said a central can occur at any pressure but for many the higher the pressure the worst it can get because pressure is what causes them. What I tried to say about the original post when I was jusped on is why have the machine set to wide open. You yourself said it is a recipe for disaster.

Gerryk wrote: ↑

Thu Apr 25, 2019 6:34 pm

As others have said and I agree their are people like you here who have such a miserable life you need to try to make others feel bad. I have had three different Dr’s explain to me how a pressure to high can cause a central. But as a miserable keyboard warrior you know better.

You're completely wrong, I have no desire for you, or anyone else "feel bad".
I simply want prevent people that don't know any better from being led astray by your *bad "advice"*.

It amazes me that people such as yourself choose to give me such power as to be able to make you "feel bad".

Gerryk wrote: ↑

Thu Apr 25, 2019 6:53 pm

What I was talking about above is that to high of a pressure can cause centrals and someone said no it can’t. And went on and on. As pugsy said a central can occur at any pressure but for many the higher the pressure the worst it can get because pressure is what causes them. What I tried to say about the original post when I was jusped on is why have the machine set to wide open. You yourself said it is a recipe for disaster.

Having the *minimum pressure setting* too low is a recipe for disaster.

The max pressure setting is *immaterial* for the vast majority of people.

Gerryk wrote: ↑

Thu Apr 25, 2019 6:53 pm

What I was talking about above is that to high of a pressure can cause centrals and someone said no it can’t. And went on and on. As pugsy said a central can occur at any pressure but for many the higher the pressure the worst it can get because pressure is what causes them. What I tried to say about the original post when I was jusped on is why have the machine set to wide open. You yourself said it is a recipe for disaster.

I think you are misunderstanding advice given. I didn't see anybody saying that centrals can't happen at higher pressures. They responded to your advice to lower the max when there was no need to do so. This person has no evidence of the rare case of centrals caused by high pressure. And as I mentioned earlier, there are reasons to leave the max higher than what you normally use. When I take a muscle relaxer, I don't have to change my settings. My machine will go higher as needed and take good care of me.

As for the wide open, THAT problem is due to the LOW minimum pressure, not the max pressure. The minimum is much more important the max. A lot of people quit cpap because they don't feel any better. Well, if the minimum is set at 4 or 5, and you need 11 to prevent most events, starting at 5 will leave you untreated as it goes up slowly and then goes back down again. People think they are using their machines and not having any success. And some doctors only look at compliance and don't realize they aren't getting much treatment.

The other problem with a low minimum is that many people feel starved for air. They rip off the mask and quit. They don't realize that just raising the minimum a little will get them past that feeling. I actually have this problem when I have a bad cough. I get a coughing spasm and it feels like I am out of air and have to rip off the mask. Obviously, I can't sleep if I am ripping off the mask every few minutes. The solution? When I have a bad cough, I raise my minimum from 11 to 13, and I can then cough multiple times without feeling deprived of air.

While there are certain reasons to lower a max, it is not useful advice for most situations, and could reduce success for some people. As i mentioned in a previous post, my machine rarely goes to 15, and only for short spikes, but the fact that it does when I roll onto my back, helps me to NOT roll onto my back. Without a max higher than 14, I would be untreated, and probably still severe since I would sleep on my back a good percentage of the night.

While I was trying to find my sweet spot I was having SWJ hypopneas.
The machine not knowing I was awake (more or less) would raise my pressure to the point I would get mask leaks and keep me awake. So I capped my max at 15 while I worked on dialing in. Now that I have leveled out I have gone back to max 20. Took me awhile to get there for various reasons. I thought it was a good reason to cap pressure temporally.
JPB