New User - AHI 53 on APAP

[nairb49]

Hello!
Posting about my husband who just started CPAP. Had a home sleep apnea test which demonstrated an AHI of 15.
We purchases the resmed APAP Airsense - online - due to COVID it wasn't possible to get fitted in person.
This is the second night of use and both nights the AHI has been 50+.
When I look on sleepyhead its showing that its mostly clear airway apneas. My husband says he has a naturally slow resp rate and he can feel it 'pulsing' and pushing him to breathe which is bothering him. I turned on ERP at 3am last night as he was adjusting it for an hour and couldn't fall back asleep (see graph) and that seemed to help with the comfort but didn't change all the CAs.

He is using the dreamwear full face mask as he is a mouth breather, with allergies, and has a very flat nasal bridge.

Any help with the settings?

[Pugsy]

Does he have an appointment with his sleep doctor anytime soon? If not....make one and sooner than later.

I don't think we can fix his problem with some minor tweaking of the settings but we can try.

Try minimum of 6 and maximum of 7....and no EPR...and see what happens. Report back tomorrow please.

[nairb49]

Thank you pugsy!
I changed it to min 6 and max 7 but I heard loud snoring so I upped the max to 8 after about 20 minutes.

Here is the new graph with min 6 and max 8.

It looks much better. Thinking to just keep like this and see if the CAs naturally improve.

Will definitely try to get an appt as well.

[Pugsy]

It's better but still ugly. Some people get what is called treatment emergent central apnea once they start cpap therapy where they didn't have any real problem with centrals before starting cpap and they only had a problem with obstructive sleep apnea. Looks like your husband is one of those people. Depending on what you read maybe about 10 to 15% of the people who start cpap will end up with complex sleep apnea which is where people have both obstructive sleep apnea and central sleep apnea.
Those CAs or clear airway flagged events are central apneas. More pressure can't fix those from this machine and sometimes actually makes them worse which looks like what happened on those prior reports.

The machine was going higher with the pressure because of the flow limitations which are early warning signs the airway was trying to collapse. Unfortunately the going higher caused more of a problem than the problem it was trying to fix was causing.
It happens sometimes when apap mode is used and why apap or auto adjusting pressures aren't always the best way to go about doing things for a few people.

Sometimes with time the body adjusts and those central apneas will fade with time and the body's adjustment. Sometimes not and sometimes a different machine is needed when the centrals persist to the point they are so numerous they are causing a problem.
If the doctor saw this now....he would probably adopt a wait and see policy because sometimes the centrals will fade away on their own but I always advise people to at least alert the doctor to what is happening just as a precaution when we see this many centrals happening. A few central apneas aren't a problem and in fact it's normal to have a handful through the entire night. This is more than a handful so we keep one eye on them for sure. No need to panic but we don't ignore them either.

Right now to let the machine increase the pressure to try to kill off the flow limitations is potentially causing a bigger problem than the flow limitations are causing. That's why you see the pressure line maxed out so much and not many OAs or hyponeas being flagged.
Those FLs could grow up to be OAs or hyponeas. Snores are also warning signs that the airway is trying to collapse and will also cause the pressure to increase when in the auto adjusting mode.
Snores and FLs are a big driving factor in the auto adjusting algorithm pressure increases and in most people we let the machine do its job but in your husband's situation we have to limit the pressure in an effort to also not trigger central apneas.

So do for sure follow up and at least make that appointment with the doctor because it likely will be a little while before he can be seen and we don't want to have this number of centrals continue to happen forever and be totally ignored. They can be just as harmful to the body as obstructive apneas when present in large numbers. It's okay to give it some time but not time without supervision if you know what I mean.

With a bit of time the body will often adjust and the centrals can fade to a less troublesome number but sometimes they won't and other options are available when it doesn't happen.
Especially true when someone is new to cpap therapy and not sleeping soundly and a lot of false positive central apneas get flagged during awake breathing.

Hold your breath for 10 seconds. That's essentially a 10 second central apnea. No air is moving because there is no effort to breathe but the airway is entirely open. By itself a random holding of the breath for 10 to 30 seconds isn't going to do much to affect oxygen levels but if piled on back to back for a prolonged period of time with a lot of them happening in a short period of time it can cause a problem...so that's why we don't ignore them totally.

[Miss Emerita]

Just to check: on your husband's sleep report, was there a breakdown of his apnea events into obstructive and central? If so, what was the breakdown?

[Pugsy]

Home sleep studies don't always separate central apneas from obstructive apneas. It depends on the level of detail or type of home sleep test that was done.

Do you remember if he wore some sort of chest wall belt or abdominal belt when he did the home study?

Do you remember the name of the sleep test? If you don't have a written copy of the report....request a copy.

It wouldn't be totally impossible for the primary problem to have been centrals in the first place despite snoring...or he might have had complex sleep apnea all along which opens up a whole new can of worms....and why that appointment with the doctor is so important.

[nairb49]

Thanks for the detailed reply!

The home sleep study was ResMed apnealink. According to that study the CA was 0.2. Not sure if its accurate at all.

Last nights result is much better - AHI was <5.

Should I turn up the max pressure to 8.5 or just leave as is?

Thanks

[Pugsy]

Leave these current settings in place for a week. Let the body adjust more to cpap in general. It's the not adjusting part that causes the over production of central apneas which we do not want to have in the numbers he was having.

Then if you want to start slowly increasing the maximum you might try it but watch the centrals closely. Sometimes there is a fine line between where the pressure triggers centrals and doesn't. We don't always know where that line is.
Trying to kill off the FLs by allowing the machine to go higher might not be the best thing for your husband if the more pressure causes central apneas.

To be honest...if this were my husband's report...I would give it a month before I even considered allowing the machine to try to kill off the FLs....and it's the FLs that are causing the machine to max out the pressure.
That last cluster...I would ignore for now.

[Miss Emerita]

Wow, that's an amazing improvement.

Just to underline Pugsy's comment: when my inhale pressure is 10, I get enough CAs to disrupt sleep (though WAY fewer than your husband is getting). I've been at IPAP 9.8 for 2 months and am seeing decreases in CAs -- actually had none a couple of nights recently. But I'm going to sit at this IPAP pressure for at least another month before venturing up to 10 again. (The reason I'd like to do that is to get even more help with flow limitations, though they are a lot better now.)

[nairb49]

Thank you both!

I will leave things be He is feeling great.

[RogerSC]

Love to see this, so great for the CPAP user being helped. And encouraging for others having difficulties.