Concern with Central Apnea

[Pugsy]

I am thinking of setting a pressure range of 8-11 as you suggested to see if the lower starting pressure of 8 would make it easier or more comfortable to fall asleep, and it could ramp up to 11 to hold back the obstructives. Let me know if anyone has any thoughts on this!

While I also don't like making too many changes at one time...in your situation I think it won't hurt a thing to reduce EPR and also reduce the starting pressures at the same time. Sometimes we gotta do what we gotta do so we can get to sleep. None of this stuff matters much if we don't sleep does it?

So make the changes tonight to 8 min and 11 max (leave EPR at 1 for now) and post results in the AM and hopefully I can see them before I leave tomorrow...if not I will check in later and follow up with you. I don't anticipate any major issues with any Obstructive stuff popping up with the reduction in starting pressures.
The machine should easily be able to get to where it needs to be in a timely manner with this small range. If it can't ...we deal with it in small bites. Right now we gotta get you to sleep first.

I am leaving for Vegas tomorrow morning....grandson and daughter live out there and going for a week long holiday.
I will still be around the forum some but not as often or as long and will probably stick to active helping threads like yours.
I love this forum but when I have a chance to do fun stuff with my family...sorry but you guys get the short end of the stick when it comes to my time. I won't abandon you...and if something should happen where I just can't get online...I have someone in reserve to help you if you run into trouble that can advise you like I would advise you. He and I don't always see eye to eye on how to do things but he knows me and will respect my wishes. ....or rather he knows that I know where he lives and will tell you that I scare the hell out of him.

[palerider]

I have someone in reserve to help you if you run into trouble that can advise you like I would advise you. He and I don't always see eye to eye on how to do things but he knows me and will respect my wishes. ....or rather he knows that I know where he lives and will tell you that I scare the hell out of him.

I'm not sure that she's talking about me, but I can promise you that she does scare me.

I do NOT want to be on her bad side.

[Bilbosax]

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So last night was a catastrophe. I set the APAP range from 8-11 as we discussed. I took no naps and was SOOOOO sleepy that I thought surely when I laid my head down at 9:00pm, I would be out! I stared at the clock all day just chomping at the bit to crawl into bed. But sadly, I laid in bed for over two hours without falling asleep. Eventually, I gave up and set the machine back to CPAP mode set at 11pm with an EPR of 1 out of desperation. You can see pretty easily that my breathing was pretty erratic everywhere except from about 12:15am - 1:30am.

If you ask me, I would have to lay the blame on a poor food choice last night. My mom had a Christmas party and served Taco soup. I had two bowls But unfortunately, and I have no idea why, I do not do well with tomato-based foods. I think I tried to trick myself into believing that it would turn out OK because I am now on CPAP, but I think the amount of insomnia I had last night could best be attributed to canned-tomato based products (canned tomato juices and stewed tomatoes seem to affect me the most)

If there are questions I would like answered, it would be these two:

1) One interesting observation is that when it seems that my brain thinks it is time to wake up is when the central apnea events become the worst. If I lay in bed and try to get that final 15 minutes - nothing but centrals like popcorn.

2) If I had no events from 9-11pm when my machine was in APAP mode, why was the pressure bouncing around everywhere when there was nothing to compensate for?

(So I go to get my Airfit P10 today at 4pm. Tonight I will add it to the mix, and make smarter choices about what foods I put in my mouth in the hours before bed. Until then, I have a day of exhaustion to deal with )

[realshelby]

The reason it was "bouncing around" is proof of the machine doing its job. Looks like you were showing better results when that method was in use? The machine can sense when an apnea is coming on and adjusts pressure to the amount needed to keep the apnea from shutting down the airway. Meaning you only have as much pressure as required at a given moment. That amount can vary quite a bit, as shown in your graph.

[Pugsy]

1) One interesting observation is that when it seems that my brain thinks it is time to wake up is when the central apnea events become the worst. If I lay in bed and try to get that final 15 minutes - nothing but centrals like popcorn.

Because you were awake and those flagged centrals aren't real centrals. They are the machine reporting awake breathing irregularities by mistake. It has no idea if you were asleep or not...it only senses and reports air flow.
Our awake breathing is highly irregular when compared to asleep breathing...and the machine can and will give you false positive flags.
Go here and read and watch the videos and learn how to spot awake vs asleep breathing.

http://freecpapadvice.com/sleepyhead-free-software

If you are awake when any flags occur...they don't count. You have to be asleep for any flags to matter.

2) If I had no events from 9-11pm when my machine was in APAP mode, why was the pressure bouncing around everywhere when there was nothing to compensate for?

The machine will respond to flow limitations, snores along with OAs and hyponeas (doesn't respond to centrals at all)....so it was responding to reductions in air flow that you don't necessarily see because the machine was doing its job...preventing the collapse in the first place instead of trying to fix things after they happened.

[Bilbosax]

Because you were awake and those flagged centrals aren't real centrals. They are the machine reporting awake breathing irregularities by mistake. It has no idea if you were asleep or not...it only senses and reports air flow.

Thanks Pugsy. I have watched all of the videos you suggested, and I have to both agree with you and disagree at the same time. Several of the centrals that are flagged for me during the night appear to happen after arousal and are clearly false. But I always have them for real when I am first slipping into sleep. At the moment that my brain starts to slip into sleep and to produce dreamlike images, I stop breathing and wake up moments later gasping. Very annoying. And I am awake a lot of the night, and I can see which ones look real and which ones don't as the videos point out. But in the morning starting around 4:30am usually, I start gasping A LOT! Over and over again as I try to slip back into sleep, as if my body is saying "nope, you are done for the night, better luck tomorrow"

....so it was responding to reductions in air flow that you don't necessarily see because the machine was doing its job...preventing the collapse in the first place instead of trying to fix things after they happened.

Interesting. I didn't know that they acted proactively, I always thought that it was acting after the fact. For a sensitive sleeper like me, though, I wonder if my system would find all of these adjustments, although small, distracting???

(By the way, I hope you have a fantastic time on your trip!!!)

[djams]

But sadly, I laid in bed for over two hours without falling asleep.

Question for you about this 2 hours. I can see that the machine was increasing / decreasing pressure due to small flow limitations while you were awake. This can happen due to congestion, and I my awake breathing registers FL occasionally. BUT, in the leak rate chart I see a large leak spike (looks like you adjusted your mask) right at 22:45, and then the flow limitations disappear until the time that you gave up and turned the machine off. Do you remember what you did here? It makes me suspect that over the entire time prior to 22:45, your mask may not have been allowing you to breath freely.

If you ask me, I would have to lay the blame on a poor food choice last night. My mom had a Christmas party and served Taco soup. I had two bowls But unfortunately, and I have no idea why, I do not do well with tomato-based foods. I think I tried to trick myself into believing that it would turn out OK because I am now on CPAP, but I think the amount of insomnia I had last night could best be attributed to canned-tomato based products (canned tomato juices and stewed tomatoes seem to affect me the most)

You may be sensitive to nightshade vegetables.

[palerider]

1) One interesting observation is that when it seems that my brain thinks it is time to wake up is when the central apnea events become the worst. If I lay in bed and try to get that final 15 minutes - nothing but centrals like popcorn.

Well, first, please hit F9 and F10 to turn of the calendar and that useless right panel..

As to the centrals when waking up.. as it was explained to me... it's a phenomenon that's seen fairly often with people, and hasn't quite been explained It may just be "transition apnea", which is caused as your body switches from asleep breathing to awake breathing, and back again. Those two states are controlled by different systems, which is part of why you can generally tell whether someone is awake or asleep by looking at their breath shape traces on the flow rate chart. This would also account for the centrals when you're going to sleep.

2) If I had no events from 9-11pm when my machine was in APAP mode, why was the pressure bouncing around everywhere when there was nothing to compensate for?

Look at the flow limit chart, you'll see a spike in FL's and an increase in pressure just after that.

(So I go to get my Airfit P10 today at 4pm. Tonight I will add it to the mix, and make smarter choices about what foods I put in my mouth in the hours before bed. Until then, I have a day of exhaustion to deal with )
[/quote]

I'd suggest you try these settings tonight.

mode: autoset, min 10, max 12 (ok, I really want to say 20), EPR 1.

I think the 8 was too low for you after what you were used to (11).

[Bilbosax]

I'd suggest you try these settings tonight.

mode: autoset, min 10, max 12 (ok, I really want to say 20), EPR 1.

I think the 8 was too low for you after what you were used to (11).

Sounds reasonable to me. I'll give it a whirl. I hope adjusting from the full face mask to the Airfit P10 isn't too big of a hurdle. I don't breathe much through my mouth much in the full face mask, so I hope it is fairly seemless.

@djams, you may be right about nightshades, but I seem to eat way too many potatoes with a smile on my face to think that it is just nightshades. But, I suppose limiting them all from my diet for a time would be worth it. I am desperate for sleep!!

Thanks guys

[djams]

I'd suggest you try these settings tonight.

mode: autoset, min 10, max 12 (ok, I really want to say 20), EPR 1.

I think the 8 was too low for you after what you were used to (11).

Sounds reasonable to me. I'll give it a whirl. I hope adjusting from the full face mask to the Airfit P10 isn't too big of a hurdle. I don't breathe much through my mouth much in the full face mask, so I hope it is fairly seemless.

@djams, you may be right about nightshades, but I seem to eat way too many potatoes with a smile on my face to think that it is just nightshades. But, I suppose limiting them all from my diet for a time would be worth it. I am desperate for sleep!!

Thanks guys

Don't forget to switch the mask type in the clinical menu.

[Bilbosax]

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Happy Holidays Everyone! This right here is my gift. I never would have thought that I could achieve a report with so few events in it when this first all started. But thanks to the kind and good-hearted people on this site, I actually feel like I am going to survive. My depression is better than it has been in years, I am on zero medications, I have quit vomiting every morning, I can pay attention to what is happening around me, and it has only been about a week since I signed up here. I feel grateful and blessed. So thank you CPAPTALK, you have changed my world! I am learning so much!

Since my last post, I have moved my machine from a set pressure of 11cm to a range of 10-12cm. I recently obtained a pair of Airfit P10 nasal pillows, but I decided that I would continue using the Simplus full-face mask for a bit until my chinstrap arrives, plus, I just wanted to get a couple of good weeks of sleep under my belt to build up a bit of a "reserve" just to get my feet on dry ground before I make the change. I thought I could also practice some stuff during the day to try and train my "lazy tongue" to minimize mouth leaks when I finally do switch to the P10. Unfortunately, I am still not sleeping through the night. I wake up at least twice during the night and have trouble going back to sleep, but everything feels like it is moving in the right direction and is manageable.

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Take a look at this breathing pattern. I don't know if I had a glitch in my machine, but on two separate occasions, I had a run of these weird breathing patterns. It looks like my breathing was "stuttering". Do I need to be concerned with this?? Was this me or my machine?

[Pugsy]

Good job.

Nothing to be concerned with in that weird breathing pattern I don’t think.
Looks like cardiac echo to me but PR will be along later to confirm and/or explain.
Short version is sometimes just the machine picking up something that doesn’t really mean anything and we have see it before. As to why? No one seems to know.

[palerider]

Good job.

Nothing to be concerned with in that weird breathing pattern I don’t think.
Looks like cardiac echo to me but PR will be along later to confirm and/or explain.
Short version is sometimes just the machine picking up something that doesn’t really mean anything and we have see it before. As to why? No one seems to know.

That's kinda what I thought, but I'd have to zoom in and count pulses for a minute and see if it was a reasonable count for a pulse rate.

[Bilbosax]

I zoomed in and counted peaks for a minute and it was 73. Is it possible that somehow it is simply showing my heart rate in my flow rate graph??

[palerider]

I zoomed in and counted peaks for a minute and it was 73. Is it possible that somehow it is simply showing my heart rate in my flow rate graph??

I'm sure there's a scientific explanation, but I don't know what it is.

All I do know is that we've seen it before, with some people it's a now and then thing, and with a few others, it shows up more often... One guy mentioned it to his doctor, who said "yeah, happens sometimes, nothing to worry about".