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

[Pugsy]

Give me a bit to find the medical documentation for this radical idea. I don't have it handy.
And if it were me I would block the vent hole under the nose.
This is something that is done by doctors in special situations...so I got this idea from medical documents not to mention I have seen it work in real life on another forum. Don't remember if I have seen it work here on this forum or not but for sure on another forum.

[Needsleep54321]

I don't think I can muster the courage to do that. It sounds scary/dangerous. I got a new full face mask with the bipap machine (airfit f20). Each night I woke up once with the hose disconnected from the mask (airfit f20). I wake up not getting much air through the little hole, with low o2 and gasping for air. It's very scary. (Even though I wake up countless times s night gasping and low o2...also scary). Everything about sleep is scary and stressful now.

[Miss Emerita]

Not pushing this idea at all -- maybe the same one Pugsy mentioned -- but I wanted you to know about it.

It's called enhanced expiratory rebreathing space (EERS). More information here:

http://www.apneaboard.com/wiki/index.ph ... ace_(EERS)

And scientific information here:

https://jcsm.aasm.org/doi/full/10.5664/jcsm.27984

I would say discuss this with your doctor, except that your doctor seems so unhelpful. Any chance you can change doctors?

[Pugsy]

Very well.

I am out of ideas. I don't see this machine ever working for you but there is a very slim outside chance but IF it does...it's not going to be a quick solution. Months most likely and it's a maybe at that.

Keep nagging your doctor. You probably have just swapped hyponeas for central apneas. Both are bad news.

[Pugsy]

Not pushing this idea at all -- maybe the same one Pugsy mentioned -- but I wanted you to know about it.

It's called enhanced expiratory rebreathing space (EERS). More information here:

http://www.apneaboard.com/wiki/index.ph ... ace_(EERS)

And scientific information here:

https://jcsm.aasm.org/doi/full/10.5664/jcsm.27984

I would say discuss this with your doctor, except that your doctor seems so unhelpful. Any chance you can change doctors?

Yes, and there is more documentation available about it. Just takes a bit of research and I don't have the time right now to go digging and since OP doesn't want to do it...no real need. I know of 3 people on Jason's forum who did it with success. I don't frequent the AB forum. There is documentation as to where some docs have the patients block or severely reduce air flow from just one vent (when that is all the mask has). I never had enough guts to advise blocking an only vent but it has been done...but with the DreamWear and the 2 vents...it's more doable and not so nerve racking or scary.

But it has been done by doctors who aren't afraid to think outside the box.

[Needsleep54321]

I'll look into the vent blocking more. Thanks for your help! I can't switch drs. No selection here. I tried changing respiratory therapist. Others said it would only cause more delay. And that I need to be patient.

[Miss Emerita]

With EERS, you block the original vents but add tubing plus a vent:

EERS is accomplished by blocking the mask exhaust vents using Mack's Silicone Putty (earplugs), and adding a length of tubing to the mask that terminates in a mask exhaust vent. For safety purposes, an antiasphyxiation/safety valve is included in EERS for full-face mask setups to ensure continued airflow in the patient circuit in the event of CPAP failure. This safety valve can be omitted in nasal therapy. EERS creates a larger dead-space by moving the mask vent to a position further down the tubing toward the xPAP machine.

[Pugsy]

With EERS, you block the original vents but add tubing plus a vent:

EERS is accomplished by blocking the mask exhaust vents using Mack's Silicone Putty (earplugs), and adding a length of tubing to the mask that terminates in a mask exhaust vent. For safety purposes, an antiasphyxiation/safety valve is included in EERS for full-face mask setups to ensure continued airflow in the patient circuit in the event of CPAP failure. This safety valve can be omitted in nasal therapy. EERS creates a larger dead-space by moving the mask vent to a position further down the tubing toward the xPAP machine.

Yep. Since the OP is using a nasal mask and one that happens to have 2 vent holes then my guts just go to blocking one vent.
It might be just enough to do what we want.
If not ...that's when I defer to the doctors for sure.
Now if he was using a Full Face mask...I wouldn't suggest it.
When using a nasal mask then if someone were to run into trouble the mouth would open and change the dynamics.
Most of the time these masks vent a lot more than is what is technically necessary just to move the CO2 laden air out.
Stuart told me that when he was designing the Bleep. He tried the design that the engineers said would be enough venting and he hated it. He said it was way too restrictive and people would hate it so the Bleep actually vents more air purely from a comfort aspect than it technically needs to vent just from a CO2 aspect.

It's an interesting prospect this EERS stuff and can be accomplished in several ways. When I first read about it my eyes popped wide open but then as I read more and actually saw some positive results I felt better about it.

But like I said...only mask I personally will suggest trying this approach is the DreamWear with 2 vent holes available.
I am not comfortable blocking a mask with only one vent hole. I leave that up to the doctors.

[Needsleep54321]

I spoke with my sleep dr today. I'm just stunned right now. He said that he doesn't believe that the high number of central apneas are from the APAP or bipap. He said he thinks I need to just use a chinstrap (even though there were not many leaks). He said he's putting me back on an APAP for a couple of weeks. If that doesn't improve, then onto a CPAP for a couple of weeks. If that doesn't improve, then back onto a bipap for a couple of weeks. All while using a chinstrap. If after all that, if no improvement, then he would consider a machine with a back up rate. He says I just need to learn to relax and my centrals will go away. He then offered me sleeping aids (pills). I said no because I've tried many before and they have all made me very restless and I couldn't stay in bed. This upset him and he said I'm not even trying to make this work. I can't believe this is happening. I need real help and he thinks I just need to relax. How am I supposed to go several more weeks like this? I can't switch drs, there's no one else. Does this make any sense??

[Needsleep54321]

I'd like to be more comfortable with my machine for the next couple of days. It's a dreamstation autobipap. The settings are ipap 25, epap 4, ps 3-4, biflex off, rise 3. I'm having 2 problems.

1) the ipap is often at 7. This is hard to breathe in. (The pressure doesn't go high enough to counter the hypopneas...which still isn't very high. It caps at usually 10 to13 depending on the night (sometimes even 8 or9)). I gave asked my respiratory therapist to adjust this multiple times but no improvement. Once, his change brought it down to 5.

2) often when I inhale, it gets cut short (as I'm falling asleep I inhale deeply. I wake often so this is bothering me and keeping me awake longer).

Edit: I was able to adjust the APAP (when I had one), but the Bipap is more difficult to understand. I can't just raise the lower pressure (i don't think there is one?).

[chima2g]

I don't have my sleep study results.

Ask you doctor to email you the results of your sleep study. It would be some help for us to see them (but not necessarily). You'll need them to hand at some point in the future anyway and it should list how more severe your apneas are on your back as a percentage.

Worse on my back

Please could you tell us if you have a positional sleep device?

He said he thinks I need to just use a chinstrap

A good chinstrap can give excellent improvements if you're able to prevent any air from entering your mouth and cheeks completely as it reduces the area your machine has to inflate. Once I achieved this, it allowed me to reduce my pressure setting which then reduced hypopneas and CAs without causing OAs. I can't recommend any because I built my own but if it were me, I'd try this one. https://www.ebay.co.uk/itm/Knightsbridg ... 07397?var=

It looks like the main problem is your machine and its settings, but unfortunately you can't always expect all AHI improvements to come from just the machine. A chinstrap and a positional sleep device are a good start.

[Needsleep54321]

Thanks for the advice! I sleep on the couch so I don't roll to my back (but still end up on my back a few times a night). I'll look into a positional device. As for the chinstrap and lower pressure, I still had severe centrals at a max pressure of 7 (then my hypopneas weren't helped). I don't know how well that will work, but I'll definitely give it a shot. I have to try everything I can. I get my chinstrap this afternoon. Thanks again.

[NewToSleepApnea]

Need sleep - any improvement. We have similar symptoms but yours is much more severe. Pulling for you. Hope to hear you are improving.