central apneas at end of decrese flow wave ?

[firyspell]

Being new to cpap..

i see frequent central apneas ( duration ranges from 20 to 30 second) only at the termination of decrese flow wave.

on my sleep study i have RDI= 25 with no apnea and few hypopnea ... and being tired all day ... a trial of auto is started ... not sure if cpap is more helpful for rera..

using apap.. i see few obstructive apneas on resscan .. which were not in sleep study although i slept both on side and on back...

my one day rescan summary is as under...

autoset : pressure 5 to 8
EPR : full time

well overall AHI= 3.8
obstructive = .9
central = 2.7
hypopnea = .1
leak... median = 0 95th percentile= 7.2 max= 20
pressure... median = 7.2 95th pecentile-= 8.9 max= 9

pls. advice what setting in pressure, epr, auto or cpap mode are helpful in decresing centrals .. i will try different settings accordingly.

[timbalionguy]

I'm not a doctor, so take my advice with that in mind.

I think you really meant your pressure range was 5-9, but maybe EPR is giving you that extra CM of pressure.

First make sure your leaks are as well controlled as possible, and also make sure you are not mouth breathing 9Use chinstrap, tape mouth shut, or switch to full face mask.)

For most folks, 5 is too low a start pressure. And, you are maxing out your high pressure.

In your case, I would raise both your low and high pressure to give you a range of 6-10. I would also work at not using EPR, if that is possible. Try this for a night or two and see if 1.) your rate of centrals changes, and/or 2.) your AI component decreases. If you see that you are having more centrals, stop and talk to your doctor.

Next is raise your lower pressure from 6 to 7 CM. If your 95 percent pressure is still close to your max pressure ( <1 CM), increase that as well. Again, watch carefully for an increase in centrals, and stop if your centrals change by more than a tiny bit. If successful though, I suspect you will find this setting more comfortable.

What concerns me here is the length of your centrals. You may be one of those folks with fairly mild apnea that will require advanced therapy to deal with the centrals.

[firyspell]

I'm not a doctor, so take my advice with that in mind.

I think you really meant your pressure range was 5-9, but maybe EPR is giving you that extra CM of pressure.

First make sure your leaks are as well controlled as possible, and also make sure you are not mouth breathing 9Use chinstrap, tape mouth shut, or switch to full face mask.)

For most folks, 5 is too low a start pressure. And, you are maxing out your high pressure.

In your case, I would raise both your low and high pressure to give you a range of 6-10. I would also work at not using EPR, if that is possible. Try this for a night or two and see if 1.) your rate of centrals changes, and/or 2.) your AI component decreases. If you see that you are having more centrals, stop and talk to your doctor.

Next is raise your lower pressure from 6 to 7 CM. If your 95 percent pressure is still close to your max pressure ( <1 CM), increase that as well. Again, watch carefully for an increase in centrals, and stop if your centrals change by more than a tiny bit. If successful though, I suspect you will find this setting more comfortable.

What concerns me here is the length of your centrals. You may be one of those folks with fairly mild apnea that will require advanced therapy to deal with the centrals.

thanks dear.. i will try settings for few days as u mentioned... but wht is this Advanced Therapy

btw what is this

[sleepsurfer]

"i see frequent central apneas ( duration ranges from 20 to 30 second) only at the termination of decrese flow wave."

i'm not sure what you mean by this statement. however, our sleep study results are virtually identical. you will find it difficult to find people with UARS on this site as they are mostly afflicted with OSA. and while people will genuinely try to help you, it will be difficult for them to relate to your syndrome because while they are both sleep breathing disorders, they are vastly different.

i think what you are experiencing with your central apneas is something i have also encountered. central apneas often occur after an EEG arousal for someone with UARS. that is because when we are unconscious, our breathing is controlled by an involuntary response to carbon dioxide levels in our blood. when you have a smooth even breathing pattern with a sudden arousal which increases your respiration but does not actually awaken you then your brain will sense that carbon dioxide levels are low and will cause a cessation in breathing until the carbon dioxide levels rise again. sometimes this can take many seconds depending on how oxygenated your blood became during the arousal.

so, your apap, which is designed to treat someone with OSA will lower the pressure when it sees a central apnea, when in our case, raising the pressure would be a correct adjustment.

hope this helps,
sleepsurfer

[timbalionguy]

Sleepsurfer described very nicely why you might need the 'advanced therapy' machine I mentioned in a previous post.

If your central apneas are really in response to CO2, you will need to be checked for how bad your desats get before your body starts breathing on its own again. If you are not experiencing signaficant desats, perhaps your real issues lie elsewhere. But if yiu are seeing significant desats, then the 'advanced therapy' is what you might need. BTW, what sleepsurfer described is a good definition of 'periodic breathing'.

The 'advanced therapy' is a machine called a 'adaptive servo ventilator'. This machine measures your breath volume on a breath-by breath basis. If you fall below your four minute moving breath volume average, the machine will raise your inhale pressure, perhaps quite aggressively, and do it in a manner that is designed to induce you to breathe on your own.

If controlling CO2 saturation is important, the ASV machines can be 'tuned' to control your inhale-exhale cycle to keep your CO2 saturation closer to where your doctor wants it.

The two machines on the market that feature this technology are the Respironics BiPAP Auto SV Advanced, and the ResMed VPAP Auto SV.

There are really nice macines, but extremely expensive.

[firyspell]

THX.for explaining.. my desats. in recent sleep study was above 92 % .. and no obstructive or central apneas but with autoset S9, i am seeing a few obstructive as well as centrals... flow limitations as well.. however with settings u mentioned above.. centrals have decreased both in duration and quantity...

LAST night, i set pressure in the range of 7 to 12 with EPR to 1
AHI -= 2.3
OBSTRUCTIVE = 0.7
Centrals = 1.3 ( 10-20 sec. duration)
pressure: Median= 7.4, 95th percentile= 9.9, Max.= 10.8

i will try with EPR off and see how it goes .

[sleepsurfer]

The 'advanced therapy' is a machine called a 'adaptive servo ventilator'. This machine measures your breath volume on a breath-by breath basis. If you fall below your four minute moving breath volume average, the machine will raise your inhale pressure, perhaps quite aggressively, and do it in a manner that is designed to induce you to breathe on your own.

If controlling CO2 saturation is important, the ASV machines can be 'tuned' to control your inhale-exhale cycle to keep your CO2 saturation closer to where your doctor wants it.

The two machines on the market that feature this technology are the Respironics BiPAP Auto SV Advanced, and the ResMed VPAP Auto SV.

There are really nice macines, but extremely expensive.

thanks for this info timbalionguy. i went through alot of BS to go from a basic cpap to my pr system one remstar apap with data capability. god, i can't imagine what getting one of these asv machines would be like. but unfortunately as i have been experimenting with many settings and closely analyzing the results of my waveform reports, i can see that the pr system one technology may not be able to treat my UARS. hopefully firyspell will have better luck with his/her treatment.

[sleepmba]

I'm not sure how much I would rely on the Rescan software. It may call a certain period a central apnea when you are mouth breathing, mouth leaking, talking, or even drifting off to sleep. Have a look at my blog about central apneas, hopefully you'll find it informative. http://www.sleepandcpap.blogspot.com

[JohnBFisher]

Once again, I jump in to point out that what Resmed's Rescan and Respironics Encore Viewer may call a "Central Apnea" would be much better called a "Clear Airway" event.

Central apneas occur when the body fails to trigger normal breathing. But ALL that these systems can measure is if the airway is open and no breathing occurs. One of the models actually listens for a change in the heart rate, but it still could not sort out if this was an event that occurred during the transition from wakefulness to sleep.

So, what these machines may be measuring is an open mouth (mouth breathing), or the transition from wakefulness to sleep, or when someone shifts in their sleep, awakens just a little, but not enough to be aware of it, and then transitions back to sleep ... or it might be a central apnea.

That being said, I highly recommend discussing this with a sleep specialist. You need one who is board certified and understands how to deal with central apneas. There are too many doctors who handle sleep patients without an honest awareness of the problems that central sleep apnea can cause.

Additionally, I recommend that the original poster ("firyspell") read more about Central Apneas using the following set of links. And of course, I would be happy to help answer questions that might arise.

Links to Central Apnea
viewtopic.php?p=457566

[Tielman]

So, what these machines may be measuring is an open mouth (mouth breathing)...

I have noticed that by mouth taping my Clear Airway Apneas have dropped by about 50% from 2.x to 1.x. I'm going to agree with John that this could be a measurement of mouth breathing. You may want to try a full-face mask, or a chin strap, or even mouth taping to ensure that this isn't the case.