More CA now than OA on BiPAP

[CPAPforever]

I was on CPAP for 15 years and now BiPAP for 5 years. I needed BiPAP because needed pressure above 20 to control OA events. I am feeling more daytime sleepiness than usual so decided to look at my data instead of the average AHI for each night on machine. I run 0.5 to 2.5 average over 8-9 hours. But looking at my actual data, I am have periods of AHI above 7 for 2+ hours alternately with periods of AHI at almost zero. So my average over the night looks great, but hides the fact that 1/3 of my sleeping time my AHI is over 7. Most of my events are CA now but I do get an occasional OA event lasting up to 29 seconds, usually 1 or 2 per night. My IPAP settings for past year are IPAP=19 and EPAP=16. (Previous year we had it at IPAP=22 and EPAP=19 and my AHI was always under 1).

With the appearance of CAs which I previously did not have (almost all OAs and hypopneas before), I am wondering why CAs are now predominant. I am also concerned about the length of OA events even though they are few. My respiratory rate is sometimes as high as 45 per minute following a long OA event probably to compensate. I don't have mask leaks. Most sleep docs would look at the nightly AHI below 2.5 and say my treatment is fine. But I don't FEEL fine.

I will increase my IPAP and EPAP back to 22/19 to try to prevent long OA events and see what happens to my CA events. The new appearance of CAs is a bit troubling. Does this occur with aging or long term CPAP/BiPAP treatment? I don't think the CAs are enough to require ASV assistance at present but will be paying closer attention to those. I see my sleep doc for annual visit in Nov so have some time to tweak my machine settings.

Any advice or comments?

[Pugsy]

You might be having some arousals associated with the OAs and the centrals might just be post arousal centrals and not real centrals. Might just be arousals from some unknown reason. They might just be a symptom of poor sleep for some reason.

Might want to take some time and look at the events up close and see if they are real or not.
http://freecpapadvice.com/sleepyhead-free-software
Watch the videos here especially the last one to see if the centrals appear to be real or not.

Do you remember waking often during the night for some reason or other?
Any change in medications?

Welcome to the forum.

If you want to show us what you are seeing...
viewtopic/t158560/How-to-post-images-for-review.html

[CPAPforever]

All my CA and OA events occur following a brief stop in breathing. Looks exactly like the last video you referred me to. To answer your other questions:

I do no think I am having arousals as I don't remember ever waking during the night. I usually fall asleep almost immediately and wake up in the morning when my dog wants to go outside (7 AM). I am a very deep sleeper.

I have had nightmares occurring during REM sleep about 5 AM each morning. These tend to increase respiratory rate but don't cause events or stop in breathing.

Nothing has changed in meds, activity, etc. for a number of years.

[CPAPforever]

screenshot of series of CAs and an OA.

flow rate.PNG (55.32 KiB) Viewed 595 times

One CA appears to be related to turning/moving in bed. The others show stop in breathing before events. The OA event in the snip lasted 21 seconds.

[beepsilver]

Pugsy passed this along to me as to what members here like to see on a graph

viewtopic/t158560/How-to-post-images-for-review.html

[CPAPforever]

Here's another series of CAs that occured earlier that same night. None of these appear to be due to movement or change of position in bed.

flow rate2.PNG (53.16 KiB) Viewed 589 times

[CPAPforever]

Here's one night where AHI was 8.0 for over an hour due to events.

AHI.PNG (62.01 KiB) Viewed 584 times

[CPAPforever]

Here's a snip of the time that AHI was 8 with multiple events resulting in AHI of 16.77 for 25 minutes.

CA series.PNG (60.41 KiB) Viewed 583 times

[CPAPforever]

So does it appear that over years of CPAP/BiPAP, I sometimes just stop breathing followed by either a CA or OA?

[CPAPforever]

Good news. I adjust EPAP to 15 and kept IPAP at 19 and now my AHI has been below 1.0 for 3 days.