Mostly central apneas! What happened to me?

[mrapnea]

Hey guys and gals! How are you?

I've been wearing my APAP for almost 4 months now, and for the first month and a half, I felt awesome! That even motivated me to start losing weight. I wasn't morbidly obese, however I had about 40 extra lbs (give or take). Since I started dieting and excercising, I managed to lose about 19lbs, however I have noticed that since I lost that weight, my AHI started going up!

When I started treatment I had, at most, 1 central apnea per night, and the rest were obstructive in nature (AHI at diagnosis aprox 25). However now, I can have as many as 5-6 central apneas per night, and at most 1 OA, or 1 hypopnea. I started feeling super crapy again. I feel incredibly tired, and started having memory issues again!

What is going on?? I imagined at first that losing some weight could have lead to less airway resistance, therefore I lowered the pressure a little bit, however even when I kept lowering the pressure, still I would get 4-5 central apneas per night, with almost no obstructive episodes. I'm at 6.4 cmH2O, and can't seem to manage to make the central apneas go away.

I have no major leaks, as a matter of fact I barely leak at all. Lately sleepyhead shows that I have stopped snoring all together as well, with very little flow limit.

I have no idea what's going on, I do know however that I have started feeling like doodoo again. Any help or insight you could provide me, will help me a lot!

I attached 3 screenshots from my sleepyhead, you might see something I'm not seeing.

Thank youuuuuuuuuuuu!!!!!

[bombayone]

I am sorry that you are not feeling well. Your centrals are insignificant. I would be more concerned with the short duration of your sleep causing you to feel poorly. Please try sleeping longer.

[mrapnea]

I am sorry that you are not feeling well. Your centrals are insignificant. I would be more concerned with the short duration of your sleep causing you to feel poorly. Please try sleeping longer.

Yeah I agree with the short duration. I have never managed to sleep longer than 5hs in my adult life, and this past year has been worst than ever... What was worrying me a little bit, is that I sleep 4hs and have 5-6 centrals during that very short period of time. I imagine I'm barely getting any rest at all... Plus it was super weird that the OAs almost dissapeared and were replaced by centrals... That is some funky stuff, you have to admit that much...

[Dog Slobber]

The number of CAs isn't the issue, but CAs / hour and that's only about 1(ish). And I also don't think that that's anything to worry about. Centrals are just not the problem Obstructives are.

For me, eventually the CAs just started dwindling until they all but went away. Now I get 0, 0.1, 0.2 per hour. For many (unless you are diagnosed with Central or Complex Apnea), I think the cause is erratic breathing and sleep / wake / junk. Which lessens as we become accustomed to CPAP therapy.

EPR can also be a cause for CAs. I noticed your at 3. At such a low pressure (6.4) EPR may not be that necessary.

I'd set my EPR to 2, and watch how things go for the week.
Then set to 1, and give it another week.
Rinse and repeat.

Now, you've got a perfectly good APAP machine. Why are you running it at a constant pressure.

I'd, set it to a minimum 6cm and leave the max at 20cm. With your numbers, I doubt the pressure will ever go much higher anyway. CA's don't influence pressure increases.

[LSAT]

What do you think raising your fixed pressure each night will do for you?...NOTHING! You can't fix CA's with more pressure. Do you even know what your CA's are?

[djams]

Not trying to be argumentative, but looking back at your first thread, it appears that your CA situation is unchanged. You were also using APAP mode at that time. Why the change?

viewtopic.php?t=174408

My experience matches dogslobber's. SWJ centrals dwindle away as you adjust to therapy and learn to sleep more soundly.

My advice is to work hard on getting more sleep. Google "sleep hygiene"

FYI - It's really best to keep all questions related to your therapy in a single thread.

[mrapnea]

What do you think raising your fixed pressure each night will do for you?...NOTHING! You can't fix CA's with more pressure. Do you even know what your CA's are?

Actually, I wasn't raising my pressure... I was lowering it as far as possible without having OAs re-appear...

[mrapnea]

Now, you've got a perfectly good APAP machine. Why are you running it at a constant pressure.

I'd, set it to a minimum 6cm and leave the max at 20cm. With your numbers, I doubt the pressure will ever go much higher anyway. CA's don't influence pressure increases.

I did try APAP for a couple of weeks, however it seemed that everytime the pressure went up, as soon as it started going down (during the downward slope) CAs would show up. It was almost perfect: pressure would go up, later would start lowering slowly, and during the lowering part a CA would appear. So I titrated the pressure to the lowest point where I would have no OAs, no hypopneas, and left it there.... For a while it worked wonders. I probably had 3 weeks where my highest AHI was 0.7, with purely CAs, and as a matter of fact, with the pressure I currently have I barely get any OAs or hypopneas (the most I get are 1-2 per night).

[tyrone747]

Now, you've got a perfectly good APAP machine. Why are you running it at a constant pressure.

I'd, set it to a minimum 6cm and leave the max at 20cm. With your numbers, I doubt the pressure will ever go much higher anyway. CA's don't influence pressure increases.

I did try APAP for a couple of weeks, however it seemed that everytime the pressure went up, as soon as it started going down (during the downward slope) CAs would show up. It was almost perfect: pressure would go up, later would start lowering slowly, and during the lowering part a CA would appear. So I titrated the pressure to the lowest point where I would have no OAs, no hypopneas, and left it there.... For a while it worked wonders. I probably had 3 weeks where my highest AHI was 0.7, with purely CAs, and as a matter of fact, with the pressure I currently have I barely get any OAs or hypopneas (the most I get are 1-2 per night).

I'm the same way with APAP. As soon as the pressure starts to drop it's a CA.

[Jay Aitchsee]

I have no idea what's going on, I do know however that I have started feeling like doodoo again. Any help or insight you could provide me, will help me a lot!

5 hours sleep is not enough!

Sleep Hygiene

[Miss Emerita]

I notice that your charts in the earlier thread showed you were sleeping almost six hours per night. Do you feel you’re sleeping less now? Has something changed to prevent you from sleeping longer?

Can you clarify your settings? According to these recent SH reports, Ramp is off, but on the pressure charts it looks like it’s on. And your EPR is 3, but only during Ramp. Is it entirely off the rest of the time? I don’t myself know what to do with the information if you can clarify your settings, but it might help the experts as they advise you.

For what it’s worth, I resisted “sleep hygiene” for a long time. It all sounded kind of faddish to me. But as my days got foggier and foggier, I finally tried doing the whole routine. To my amazement, I found that it helped. I miss reading in bed, but not enough to start trashing my sleep all over again.