High AHI- need some help!

[Dog Slobber]

Have you ever heard that higher pressures can cause central
Apnea’s?

Which is NOT relevant unless you are suggesting that he lower his pressure below 14.

Is that what you're suggesting?

If you believe he should lower his max pressure than instead of complaining about others not being helpful. Give him a number.

What should he be setting his max pressure to?

[katestyles]

Have you ever heard that higher pressures can cause central
Apnea’s?

The Original poster does have quite a lot of CA marked on his sleepyhead graph. Indeed, there is more CA in a night than OA. However, since we have no information to give us a sure knowledge of whether this was actual open-airway apnea, caused by too much pressure, (or merely breath holding after an arousal and deep breath) and we do have evidence that the APAP is trying to increase the pressure above the minimum therapy pressure, (as a reaction to snore/flow limitation/events,) then the most sensible reaction is to increase the minimum pressure, while leaving the maximum pressure alone.

Once a minimum pressure that reduces as many obstructive events as possible has been established, it may be appropriate to reduce the maximum pressure. If a slow increase of minimum pressure over time increases the CA events, then it will need to be reduced, but the maximum pressure is likely to remain irrelevant in the near term, and should stay as high as it can.

[palerider]

Have you ever heard that higher pressures can cause central Apnea’s?

Multiple things here.

First, the emergence of complex sleep apnea (which is centrals apnea appearing under pressure), only affects approximately 1 in 7 people.

Second, that pressure doesn't really matter, it happens with some people at 7cm pressure, others in various places in the teens, there is no pressure to be afraid of.

Thirdly, central apneas are unjustly vilified by people that know any better. People think "OMG I MIGHT NOT TRY TO BREATHE" (for a few seconds).

So what? Your body breathes when it needs to, because of the amount of co2 in your blood, sometimes, the extra ventilation of cpap can lower the co2 in the blood and you simply have no drive to breathe until that co2 builds up in your blood. It is *NOT* harmful.

The only time that centrals become an issue is if you are having them repeatedly, with enough of them, your o2 levels will start to drop, but a few here and there are harmless.

Hold your breath for 10 seconds, that's absolutely nothing, but.... it's a central apnea.

Now, hold your nose and TRY to breathe as hard as you can, ... that's an obstructive.

We should do what we can do prevent obstructives.

[katestyles]

Have you ever heard that higher pressures can cause central Apnea’s?

Multiple things here.

First, the emergence of complex sleep apnea (which is centrals apnea appearing under pressure), only affects approximately 1 in 7 people.

Second, that pressure doesn't really matter, it happens with some people at 7cm pressure, others in various places in the teens, there is no pressure to be afraid of.

Thirdly, central apneas are unjustly vilified by people that know any better. People think "OMG I MIGHT NOT TRY TO BREATHE" (for a few seconds).

So what? Your body breathes when it needs to, because of the amount of co2 in your blood, sometimes, the extra ventilation of cpap can lower the co2 in the blood and you simply have no drive to breathe until that co2 builds up in your blood. It is *NOT* harmful.

The only time that centrals become an issue is if you are having them repeatedly, with enough of them, your o2 levels will start to drop, but a few here and there are harmless.

Hold your breath for 10 seconds, that's absolutely nothing, but.... it's a central apnea.

Now, hold your nose and TRY to breathe as hard as you can, ... that's an obstructive.

We should do what we can do prevent obstructives.

Come to think of it, I would love for some central apneas to have appeared now that my machine is running flat out at a fixed 20cms. It would give me an argument to use with my doctor to allow me a BiPAP so that I could have more than 3cms of exhale relief. And if I was getting Centrals, perhaps the Obstructives would have stopped. They haven't yet.

[palerider]

Have you ever heard that higher pressures can cause central
Apnea’s?

The Original poster does have quite a lot of CA marked on his sleepyhead graph. Indeed, there is more CA in a night than OA.

Very good point, however, the thing (I believe) to note is that those centrals are scattered around, not grouped, and are quite probably more of a post arousal thing... also, the cai isn't high enough that I'd even give it a second glance.

The obstructives, like you said, are what should be focused on.

[palerider]

Come to think of it, I would love for some central apneas to have appeared now that my machine is running flat out at a fixed 20cms. It would give me an argument to use with my doctor to allow me a BiPAP so that I could have more than 3cms of exhale relief. And if I was getting Centrals, perhaps the Obstructives would have stopped. They haven't yet.

Heh, be careful what you wish for, more PS might induce centrals for you.

[Pugsy]

Have you ever heard that higher pressures can cause central
Apnea’s?

Did you know that people can get central apneas from as little as 5 cm pressure?
It's not always a "high" pressure that causes centrals to pop up. It can be any pressure.
Did you know that most people won't have a problem with high pressures anyway? Lots of people using pressures in the upper teens and even 20s and don't have central apneas. I have seen 18 cm and not have a single central apnea happen from the pressure.
Did you know that the number of people who have central apneas triggered by cpap pressure (any pressure) is around 10% of the people put on cpap?
Did you know that if the machine never ever goes above a certain pressure then it really makes zero difference where you set the maximum? It's a moot point...if the machines could be set to 100 cm and the highest anyone ever went to was 10 cm....simply doesn't matter what the maximum is set to as long as it is above 10 cm if someone wants to cover all bases. Could also be set to 100 cm if it could be set that high.

It's not worth fighting over....but if the machine never goes above something...it hurts nothing to limit the max OR leave the max wide open. Leaving it open won't cause centrals even if there is a line where centrals pop up with so and so pressure (actually a very small subset of that 10% of people who have cpap induces centrals) because the machine isn't going anywhere anyway....is it? Remember if it never goes above so and so pressure....just because it can go higher doesn't cause anything if it doesn't make use of the "can go higher".

You are free to do as you choose but so are the others and it all works out just fine. I have the max wide open myself.
It rarely comes close to the maximum now but there was a time when I did....and I still didn't have any central apneas pop up.

High pressures don't always cause central apneas. Any pressure (high or low) can cause central apneas in a very small minority of people.

[Gerryk]

Yes pugsy I know a central can occur anywhere. I also never had any when I was set at 22 cm. My reason was if someone is having central’s why not cut the potential high pressure down to just above where they hit a high. Their could be a possibility the machine isn’t recording properly and yes I have had that happen on two machines.

I edited this. Sorry Pugsy I am on my
Phone and type with my thumbs.

[katestyles]

Yes pigsty I know a central can occur anywhere. I also never had any when I was set at 22 cm. My reason was if someone is having central’s why not cut the potential high pressure down to just above where they hit a high. Their could be a possibility the machine isn’t recording properly and yes I have had that happen on two machines.

Good, so we are all agreed.

I wonder what is causing the centrals for the original poster?

There are some things that I can see, like the fact that 10 cms of pressure is not stopping the obstructions.
I can also see that the centrals are recorded right from the end of the ramp.(SH is saying that the ramp is off - but I think it is not.)

What I cannot see is what is causing the machine to raise the pressure.

[palerider]

Yes pigsty

*Raises eyebrow*

[Pugsy]

I wonder what is causing the centrals for the original poster?

There are some things that I can see, like the fact that 10 cms of pressure is not stopping the obstructions.
I can also see that the centrals are recorded right from the end of the ramp.(SH is saying that the ramp is off - but I think it is not.)

What I cannot see is what is causing the machine to raise the pressure.

Flow limitations or snores are likely driving the pressure increases....and the graphs for those 2 data points are absent.

Centrals are happening at 10 cm and/or higher....with the fragmented therapy (obvious breaks in therapy line) I wonder how many of those centrals are real asleep centrals and how many are SWJ sleep/wake/junk arousal/awake centrals getting flagged by mistake.
I don't think that the centrals are caused by the pressure though....my money is on they aren't real asleep centrals which is why I suggested what I suggest back as my first reply here.

Now it is possible that the obstructive stuff is causing an arousal and then during the arousal the central gets flagged....so an idea might be to try to reduce the number of obstructive in nature events (OAs and hyponeas) and improve the sleep quality and maybe if those centrals are arousal related they will decrease as the OAs/hyponeas decrease.

We don't know if he is asleep when the ramp time is completed and those centrals pop right up....
There's a lot we don't know and we really need more complete information that what we have right here to know if those centrals are even worth all this discussion or not.
If he's not asleep....they simply don't count.

And I just realize Gerry call me a pigsty....sigh. I assume typo but with the way things are going....maybe not.

[katestyles]

And I just realize Gerry call me a pigsty....sigh. I assume typo but with the way things are going....maybe not.

dang you, autocorrupt!!

[katestyles]

I wonder what is causing the centrals for the original poster?

There are some things that I can see, like the fact that 10 cms of pressure is not stopping the obstructions.
I can also see that the centrals are recorded right from the end of the ramp.(SH is saying that the ramp is off - but I think it is not.)

What I cannot see is what is causing the machine to raise the pressure.

Flow limitations or snores are likely driving the pressure increases....and the graphs for those 2 data points are absent.

Centrals are happening at 10 cm and/or higher....with the fragmented therapy (obvious breaks in therapy line) I wonder how many of those centrals are real asleep centrals and how many are SWJ sleep/wake/junk arousal/awake centrals getting flagged by mistake.
I don't think that the centrals are caused by the pressure though....my money is on they aren't real asleep centrals which is why I suggested what I suggest back as my first reply here.

Now it is possible that the obstructive stuff is causing an arousal and then during the arousal the central gets flagged....so an idea might be to try to reduce the number of obstructive in nature events (OAs and hyponeas) and improve the sleep quality and maybe if those centrals are arousal related they will decrease as the OAs/hyponeas decrease.

We don't know if he is asleep when the ramp time is completed and those centrals pop right up....

If he's not asleep....they simply don't count.

Thanks Pugsy - I am trying to learn as much as I can here - and be open-minded.

So when the OP returns to the thread, it would be helpful to see the flow limitations graph, and a report on how asleep/awake they think they were.

This reminds me of the charts Greentree was posting - they had a bazillion centrals, but thinking ended up that it might well have been awake-breathing.

[Pugsy]

Gerry.....don't worry about the typo. I thoroughly understand thumbs and those tiny screens on phones.
Autocorrect on the phone comes up with some really weird stuff.

I could edit all the posts and fix it but it's not a big deal. Trust me....I have been called worse either on purpose or by a typo.

I actually had a little chuckle...wondered if you had snuck over and looked in my living room...I am in the process of switching out winter clothes for summer clothes and it does resemble a pig sty right now. Big mess.

[Dog Slobber]

I'd also like to add another contributing factor for all the Centrals. Simply being new to CPAP.

My charts for my first few weeks looked very much like the OPs. A lot of clustering of CAs at session start/end but also a fair amount through out the night. As I got use to the machine, started to sleep better, learned to breath with the pressure and against the pressure all the CAs started disappearing.

Now 0, 1 maybe 2 a night.

As suggested, wait for the snore and Flow Limit graphs, look after the Obstructive and the Hypopnias and the CAs will probably take care of themselves.