New APAP user. High central apneas.....Canada user

[Needsleep54321]

I will adjust the pressures today.

[Pugsy]

A couple of things to note about the Central recorded by CPAP machines is that often times they are not true central apneas. You will need to verify using an overnight oximeter or through a titration study in a lab to determine the nature of those events. The CPAP machine records any irregularities in breathing especially if you wake up frequently as central apneas; a flaw of the system. The other thing I noticed is that it is happening with you tracing is that it happens when your pressures increase. If you keep your CPAP pressure below 10, it may also reduce the central apneas. Hope that helps!

He has an overnight recording pulse ox and it is showing significant drops in O2 levels even now on the apap. He mentioned this in his prior posts.

And if you look at the pressure graph there are segments where there are truckloads of centrals at pressures below 10.
I know 10 is a common line in the sand but it isn't the gospel...I have seen complex sleep apnea develop with fixed pressures as low as 5 cm.

It would be nice if there was a line in the sand for the OP here stay below and not have the centrals but from the looks of the hyponeas at 7 cm....if there is a line where centrals didn't develop I am afraid that it would be below what is need to deal with the obstructive side of things.

[Pugsy]

If you want to take a crash course in identifying asleep centrals from awake breathing false positive centrals...watch the videos here
http://freecpapadvice.com/sleepyhead-free-software

Problem is...awake centrals or false positives don't cause O2 drops...so I have my doubts as to the chances of blaming enough of your centrals on false positives.

[chima2g]

Regardless of the machine's settings, if you were you told that you have positional sleep apnea, i.e. you have less events if you sleep on a particular side, I'd get myself a positional sleep device. I can't recommend any because I built my own,

In my case, I found that the number of events I had sky-rocketed if I used APAP and set my pressure manually with trial and error like Pugsy suggested. No idea how your doctor would feel about this but in theory if your adjustments clearly have a positive outcome then it would be difficult to object.

[Needsleep54321]

Me too. My o2 is dropping repeatedly. I'll adjust my pressures tonight to rule out another possible cause.

[Needsleep54321]

I just realized that on one of my charts, it shows me having many central apneas over an hour and a half with the pressure below 8. Should I still lower my pressure tonight? It looks like the lower pressure doesn't help.

[Pugsy]

I noticed that as well but lets see what happens with a higher minimum and lower maximum.

Remember 2 problems to deal with....hyponeas and centrals and each one requires a different avenue.

The hyponeas we know for sure need the minimum pressure.
At this point we don't know if your centrals are related to the pressure at all but you had a lot more when the machine went over 10 and sometimes you didn't have any centrals with the pressure at around 7 or 8 ish.

I know the machine wants to go higher and probably because of the flow limitations (I don't see a FL graph but the FL numbers reflect a rather active FL graph) but at this point the centrals are a bigger problem than the FLs are.

[Needsleep54321]

I just took a nap for an hour with no EPR at min/max pressure at 7/10 (I was too nervous to go down to 9). My AHI was 52 mostly centrals. So the lower pressure doesn't seem to make a difference. At least we are going through possible causes and eliminating them. I hope my dr will see this and be willing to get me an ASV without alot of waiting to do trial and error like this. I just want to be done with this do I can sleep finally. Here is my data from my nap.

Oscar data 5

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[Pugsy]

I have a sneaking suspicion that even if you went down to 6 or 7 cm fixed pressure that you would have a lot of central apneas.
Next time you take a nap...give it a try.

Like I said before...I know of people who get a truckload of centrals with even 5 cm fixed.
It used to be that people thought centrals were caused by only higher pressures but that's been proven to be untrue.
While they can be a cause they aren't necessarily the only cause out there.

[Needsleep54321]

I'm scared to fall asleep. I keep repeatedly waking up gasping for air. So many times. It's an endless cycle of torture. My oxygen drops, I wake up sob. Over and over every minute or two. For months not a single 10 minutes of restful sleep. If I lower the pressure to 7, my hypopneas will not be handled (72/hour). If I use the machine, my centrals are out of control (increasing every day). Either way has the same results. Constant torture.

[Pugsy]

How low does your O2 go without cpap?

Hyponeas are a reduction in air flow...not a total stoppage of air flow.
Central apneas are a total stoppage and likely to cause more desats than hyponeas.

[Needsleep54321]

I decided to return the min/max pressure to 5/18 (my machine has only ever gone up to 13) but keep the epr at 1 to try to reduce centrals. I'll know tomorrow if this helped at all. I didn't want to try the pressure of 7 because my hypopnea AHI is 72 so it wouldn't be treated. I'm more convinced that I simply have the wrong machine and require an ASV. Unfortunately, I have to wait a little while for my busy dr to be able to speak with him about this problem. I will try this new epr level and keep you posted of the results (if you don't mind. You are very generous with your knowkedge/time).

[Needsleep54321]

My O2 drops the same amount with or without APAP. Too low. Spo2 in the 60s, 70s and 80s.

[Needsleep54321]

Here is my oscar data from last night. Pressures returned to 6/18 min/max and epr 1, then 3 due to stomach pain from air in my stomach after about an hour. No improvement regarding central apneas. So far CAs at high and low pressures, with and without EPR. I suppose my only option at this point is to wait until I can speak with my sleep dr?

Oscar data 6

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[Pugsy]

Pretty much that's your only option. You get centrals even at 8 ish cm. Turning off EPR didn't provide the miracle quick fix we hoped for.

You didn't want to try a lower fixed pressure, which to be honest, I doubt would be all that helpful but there is a remote chance that maybe 7 cm fixed without EPR might not be totally useless in terms of dealing with the hyponeas. The without EPR is more to help with hyponea prevention than deal with centrals in this idea.

I would be more worried about the centrals than I would be about the hyponeas that might happen at a lower pressure but that's me.