New CPAP user having many Centrals

[schn00gins]

Hello everyone,

Just got my PR system one auto with a-flex this weekend. Been trying to iron things out. First night I had a few OAs and hypos as well as centrals. Since then, I've increased my minimum from 5, to then 7, to then 9. Most of the time I never go above whatever pressure I'm being pulsed with. However, I'm still getting many many centrals. Which is bringing up my AHI. As a matter of fact, my AHI has continuously become worse since day one. I'm not sure if theyre arousals, because some of them last as long as 30seconds, and are often preceded by rapidly increasing and decreasing tidals, then I stop. However, these are not repeated--so I dont feel like its cheynne stokes.

Any help would be greatly appreciated. I understand that centrals more or less cannot be treated with CPAP. I guess I'm mainly posting on here for your overall expertise.

Below are screens from a few nights:

[Pugsy]

Are you using the Flex exhale relief? If so at what setting?

The zoomed in central that you show on Sun May 22 looks more like an arousal or post arousal CA to me anyway. The others where you zoomed in to some extent are not zoomed in enough to evaluate the breaths.

Do you wake very often during the night that you remember?
Do you have any issues with pain that make you toss and turn a lot?
Do you take any meds of any kind? If so, what?

Increasing the pressure isn't going to do anything to help the centrals. Can you post a report where you used 7 minimum instead of the 9 minimum?
Hide the calendar and turn off the pie chart so that the rest of the statistics will show up. The pie chart isn't really needed and between the 2...taking up space that would be better used showing the statistics.

I know these centrals seem like a large number to you but even if they were all the real deal (which I am reasonably certain they aren't) the docs won't get too concerned unless you start seeing them every hour, every night or in really dense clusters that average 5 or more per hour just in the central index.

[LSAT]

Often increasing pressure too high will increase CAs....You can't eliminate CAs by increasing pressure. You are very new to CPAP. I would set the machine to what your doctor prescribed and let it alone for a week or two.

[schn00gins]

Are you using the Flex exhale relief? If so at what setting?
A-flex setting 3. I feel like I'm fighting the machine to exhale in C flex

The zoomed in central that you show on Sun May 22 looks more like an arousal or post arousal CA to me anyway. The others where you zoomed in to some extent are not zoomed in enough to evaluate the breaths.

Do you wake very often during the night that you remember?
Yup!

Do you have any issues with pain that make you toss and turn a lot?
No

Do you take any meds of any kind? If so, what?
Melotonin

Increasing the pressure isn't going to do anything to help the centrals. Can you post a report where you used 7 minimum instead of the 9 minimum?
I'm not sure where the data went for 7minimum. But the last 2 or three nights have been at 8. Ill post those below

Hide the calendar and turn off the pie chart so that the rest of the statistics will show up. The pie chart isn't really needed and between the 2...taking up space that would be better used showing the statistics.
Well post better pics below

I know these centrals seem like a large number to you but even if they were all the real deal (which I am reasonably certain they aren't) the docs won't get too concerned unless you start seeing them every hour, every night or in really dense clusters that average 5 or more per hour just in the central index.

Starting from the 24th. The data with the 25th and 26th is with me new nasal pillow mask.

[schn00gins]

Often increasing pressure too high will increase CAs....You can't eliminate CAs by increasing pressure. You are very new to CPAP. I would set the machine to what your doctor prescribed and let it alone for a week or two.

I'm aware you can't eliminate CAs with PAP, but I didn't know you could make them worse with increasing pressure.

I may drop the pressures back down.

[Jay Aitchsee]

Lower the pressure, stop worrying about AHI, get comfortable with the treatment, learn what you're doing before trying to make adjustments. You're sleeping with an alien on your face. The first thing you have to do is get used to that.

[schn00gins]

Lower the pressure, stop worrying about AHI, get comfortable with the treatment, learn what you're doing before trying to make adjustments. You're sleeping with an alien on your face. The first thing you have to do is get used to that.

So what you're say is these look more like arousals?

[Pugsy]

The next time you post your reports do include the AHI and statistics on the left side. No need to redo the images you did above.

While increasing the pressure can cause and increase in centrals in some people...it's not something that happens often and usually when we see that happen there's a lot more centrals than you are showing and the breathing pattern usually looks more like CSR (which yours doesn't). So I don't think that your centrals are from the higher minimum pressure but it does look like maybe you could be by with less minimum so I would also go with a lower minimum.

The centrals above still look like arousal/post arousal centrals to me and since you report remembering a good number of awakenings during the night that goes along with the likelihood the centrals are related to arousals of some sort.

Do you know why you are waking often? Is this something new that just started with cpap therapy or has this been something that you have had going on for some time now. I would assume so...since you are taking the melatonin. What is your usual dose of Melatonin?

Did you know that it is normal to have some centrals anyway? Even if they are the real deal it's normal to have a few here and there. The centrals shown so far don't appear to be the "real deal" though...they appear to be more related to awakening or arousal and a typical irregular breathing pattern or big gulp of air that we do and don't realize we are doing it.

I also liked AFlex better than CFlex. I thought AFlex felt more "natural" but from what I have read there really isn't a huge difference between the two.....but I still liked AFlex better so that was what I used when I was using a Respironics machine. Use whatever feels the best for you. There are a very small number of people who do experience centrals just from the drop in pressure with exhale relief...but again I don't think that is what is going on in your situation. At some time in the future you might consider reducing or turning AFlex off but I wouldn't do it right now while you are still adjusting to this whole therapy. The most your machine can reduce at that setting of 3 is 2 cm anyway. The amount of reduction is flow based...so it depends on the force of your own breathing and if you tend to breathe more on the shallow side then you most likely aren't getting the full 2 cm available.

So I would suggest reducing that minimum...you don't need the 9 cm anyway...the machine won't go where it doesn't think it needs to go and those little spikey increases that look like saw teeth are test pressure probes and not the machine responding to something it doesn't like.

If your frequent awakenings are something new since starting therapy you might consider a really limited apap range or even setting minimum to equal maximum on the off chance that those pressure changes (like the probes) are a disturbing factor in terms of sleep quality. Some people can sleep through some massive pressure changes but some other find that even the slightest variation can cause so low level arousals which could potentially affect overall sleep quality.

I would instead of playing with the pressures so much...reduce the minimum and see what happens and at the same time try to figure out what might be causing those awakenings. Easier said than done sometimes.

It is normal to have centrals happen during sleep stage transition..especially sleep onset...these are normal and they aren't a problem unless they are happening in such numbers that a person simply never progresses to the other sleep stages....your numbers aren't nearly enough to really qualify for worrying about.
The fact that you remember waking means that you also have a greater chance of having a "normal" sleep onset central after the awakening when you go back to sleep. So some of your centrals may be "real" in that sense but that doesn't necessarily mean something bad is going on and the centrals are a problem requiring anything to be done about them.

[schn00gins]

Definitely learned a great deal from your post. Thank you.


I am new to CPAP (as of saturday).

I take 6mg of melatonin everynight.

I'll try dropping my pressures down to 6 and then either narrowing my auto or turning off pulse pressures.

[LSAT]

Definitely learned a great deal from your post. Thank you.


I am new to CPAP (as of saturday).

I take 6mg of melatonin everynight.

I'll try dropping my pressures down to 6 and then either narrowing my auto or turning off pulse pressures.

Check out this recent post.....
viewtopic.php?f=1&t=111856&p=1074369#p1074369

[avi123]

It is always recommended that a patient consult with their doctor before making any changes to their therapy or medical treatment.

[Lucyhere]

You also might be interested in this article re Melatonin.

http://www.huffingtonpost.com/entry/mel ... 40567a1e1e

[palerider]

It is always recommended that a patient consult with their doctor before making any changes to their therapy or medical treatment.

It is always recommended that Avi be put on the foe list.

[Pugsy]

Who told you to take 6 mg of melatonin? That's way more than is usually advised.

Do you have problems falling asleep? We already know you have problems staying asleep? How long has this been going on?

[schn00gins]

You also might be interested in this article re Melatonin.

http://www.huffingtonpost.com/entry/mel ... 40567a1e1e

Definitely learned a great deal from your post. Thank you.


I am new to CPAP (as of saturday).

I take 6mg of melatonin everynight.

I'll try dropping my pressures down to 6 and then either narrowing my auto or turning off pulse pressures.

Check out this recent post.....
viewtopic.php?f=1&t=111856&p=1074369#p1074369

Wow. Very interesting information. I've always heard that the higher doses actually have an opposite affect, but admittedly I never looked them up and assumed they were talking about the larger pills (10mg), because if the smallest pill sold in most stores is 3mg, then surely that's the small dose

I will absolutely be removing melatonin from my regimen.

Who told you to take 6 mg of melatonin? That's way more than is usually advised.

Do you have problems falling asleep? We already know you have problems staying asleep? How long has this been going on?

Sometimes I have problems staying asleep. I would be no means even come close to insomnia though.


Update:

Last night when much better. Auto min/max 6, A flex 3. My device really started hurting the base of my septum about 2/3 or 3/4 through my sleep (right around the area of the filtrum). I also have the humidifier set to 5 because I get stuffed up really easily then have to take the mask off early on in the night if lower. Condensation in the tube was causing the gurgles, and i was getting drips on my upper lip in the supine position. At about 7:30, I really started tossing and turning for the aforementioned reasons and ended up taking off the mask for the last bit of sleep.

However, my arousals dropped substantially from the first 4.5hrs and my AH was below 1.5 during that time.