Increased Central Airway Events

[droo_d]

Since starting cpap therapy in January, I've been seeing high number of events for Central Airways and under ~0.30 for Obstructive. In terms of sleep quality, I definitely notice a huge difference compared to sleeping without the CPAP but I've had restless sleep and notice I wake up randomly although it's not due to leaks or dry mouth due to use of XyliMelts (Thx Zonker). I have changed my minimum in the past month due to weight changes in recent months but now I am back to the original weight I started CPAP with and will keep Minimum at 9 moving forward. My AHI has been averaging at ~3 and I'm looking for advice to get these central airway events down if possible.

Would a VPAP or ASV help with this situation or should I ignore this?

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[khauser]

I'm no expert on bilevel systems, but I don't think you're there yet.

You need to zoom in to some of those CA events so we can see the flow rate that led up to them.

[Pugsy]

You aren't having enough centrals to qualify for ASV and have insurance pay for it or even a regular bilevel machine (which may or may not resolve the centrals anyway).
And some of them might not even be real asleep centrals anyway. Go here and watch the videos and learn to figure out if you were asleep or not when you see a flagged event. While it talks mainly about false positive arousal related centrals you can also have false positive OAs and hyponeas as well. I have them all the time.

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

[droo_d]

I'm no expert on bilevel systems, but I don't think you're there yet.

You need to zoom in to some of those CA events so we can see the flow rate that led up to them.

Thanks! Don't know why I never thought about actually learning how to read the flow rate myself to see whether they're false CAs from waking up. Appreciate this. I'll check them out thoroughly tonight

[droo_d]

You aren't having enough centrals to qualify for ASV and have insurance pay for it or even a regular bilevel machine (which may or may not resolve the centrals anyway).
And some of them might not even be real asleep centrals anyway. Go here and watch the videos and learn to figure out if you were asleep or not when you see a flagged event. While it talks mainly about false positive arousal related centrals you can also have false positive OAs and hyponeas as well. I have them all the time.

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

Thank you Pugsy. Never crossed my mind to learn how to actually read the flow rate which could've saved me a lot of second guessing over the months. Just watched the quick video and it's a lot easier to interpret than I thought. I'll go back and check out a couple days worth of data to see what conclusion I can find.

As for insurance, I would 100% be willing to pay out of pocket for a bilevel machine if it was confirmed beneficial for my case. Will find out later thanks to you!

Edit: I also did notice that when I decreased EPR from 3 to 2 back in Feb, my overall AHI went down. Since I already have it as Ramp Only @ 2, would I see any benefits/disadvatanges of decreasing this down to 1 or even increasing this back up to 3 as it's setup as Ramp Only and not Full Time?

[Pugsy]

First figure out if they are even real or not.
If not asleep...the best ASV in the world can't fix awake events but it might try and annoy the hell out of you with it trying to breathe for you. Remember one of these machine can tell if we are asleep or not. ASV is no different...it responds to irregularities in air flow and it might try to fix your breathing while you are awake and you probably wouldn't like that.

Medically doctors or insurance companies won't even raise an eyebrow until we start seeing above 5 centrals per hour average and we are for sure asleep when they happen.

If the bulk of any flagged events happen to be awake/arousal related we have to try to fix the bad sleep first by figuring out what is causing it. Sometimes easier said than done.

[khauser]

Also I think you need a different prescription for the more advanced machines, or you'll have to buy used.

[droo_d]

First figure out if they are even real or not.
If not asleep...the best ASV in the world can't fix awake events but it might try and annoy the hell out of you with it trying to breathe for you. Remember one of these machine can tell if we are asleep or not. ASV is no different...it responds to irregularities in air flow and it might try to fix your breathing while you are awake and you probably wouldn't like that.

Medically doctors or insurance companies won't even raise an eyebrow until we start seeing above 5 centrals per hour average and we are for sure asleep when they happen.

If the bulk of any flagged events happen to be awake/arousal related we have to try to fix the bad sleep first by figuring out what is causing it. Sometimes easier said than done.

Will do Pugsy! I had some data from May in my work computer. Checked it out and it seems like I was awake from RLS.

I just put 2 and 2 together and know for a fact, my constant wake ups are due to having Restless Leg Syndrome (RLS) which I've experienced for over 5-8 years in the day-time. However, I didn't know it actually affected sleep until 10 minutes ago. I will certainly dive deep into this topic and look into other threads. I am taking magnesium but I will attempt to increase the dosage in the meanwhile.

Everything is making much more sense now to me.

[Deborah K.]

Hi Droo_d,

My husband has been on apap for three years. He had terrible RLS for many years before he started pap use. After being on pap for some time he noticed lots of good changes. One was that his RLS just went away. We're both really happy about this. Maybe yours will go away too.

[droo_d]

First figure out if they are even real or not.
If not asleep...the best ASV in the world can't fix awake events but it might try and annoy the hell out of you with it trying to breathe for you. Remember one of these machine can tell if we are asleep or not. ASV is no different...it responds to irregularities in air flow and it might try to fix your breathing while you are awake and you probably wouldn't like that.

Medically doctors or insurance companies won't even raise an eyebrow until we start seeing above 5 centrals per hour average and we are for sure asleep when they happen.

If the bulk of any flagged events happen to be awake/arousal related we have to try to fix the bad sleep first by figuring out what is causing it. Sometimes easier said than done.

I've been analyzing and have noticed more than 90% were indeed false positives from arousals likely do to with RLS. I decided to choose nights where I had Min @ 9 so that I wouldn't have induced centrals due to higher pressure. I did find a few that appear to be actual central events but I'm only seeing 1 or 2 actual events in total per a night so I don't see this as too alarming right? A lot of false OAs like you said. Super interesting to see this.

The first photo seems like an actual central. The second photo seems like it may be from arousal. Just want to confirm whether that seems correct. Ty!

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[droo_d]

Hi Droo_d,

My husband has been on apap for three years. He had terrible RLS for many years before he started pap use. After being on pap for some time he noticed lots of good changes. One was that his RLS just went away. We're both really happy about this. Maybe yours will go away too.

Wish that was the case for me! I've noticed I'm still getting a lot of arousal wake ups due to RLS. Glad to have noticed this 7 months into CPAP and will be factoring in supplements to help with that

[Pugsy]

The first CA/central...yeah a for sure asleep central.
It's normal to see them occasionally and not a big deal.

The second one....what I call iffy... there wasn't a real blatant in your face arousal breathing but sure doesn't look like for sure asleep breathing either. Some arousal breathing is so blatantly arousal related there's no doubt but sometimes the breathing rate doesn't look horribly arousal but it doesn't look like asleep either. I just chalk those up to being iffy and move on. Can't do much about them after the fact anyway. If I saw a large number of those "iffys" then I might look a little closer and worry more. Most of the time you will have a good enough idea though especially if you look at the breathing more to the left of the "iffy" flag than you can see here on this image.
I might have an obvious arousal and then sort of odd breathing pattern for 2 to 4 minutes and then the flag. The arousal might be 2 to 4 minutes prior to the actual flagging....in my mind it is still arousal related.