New to cpap, dialing in settings myself. Cant get periodic breathing and centrals under control

[Braydar]

Hello. Hope everybody's therapy is going well. I've only just started A-CPAP last week. I don't have insurance and I wound up having to get a machine privately and working on getting it set up by myself. I know that's not generally at the top of the recommendation pile, but it's either do it myself or don't get treatment.

Anyway, I'm going to post a few screen captures of my Oscar page. Does anybody have advice regarding dealing with my central apnea and my periodic breathing? My in home sleep study came up with an AHI of 13 and the majority was obstructive apnea and hypopnea with only a few centrals. Is it possibly a different breathing disorder?


https://imgur.com/gallery/BOYtRZG


My leak score is "high" as I have a respironics machine and it counts the total leak, as leak. One of my nights there has an actually high leakage and that was me testing out the "large" marked nose pillows

If needed I can post more nights, more zoomed in sections, and I can also post a redacted screen capture of my in home sleep study using an apnea link air.

[Pugsy]

How much time are you spending awake with mask and machine on? It's not uncommon to have a lot of awake time during the night what with wearing a mask and all the newness of using cpap.

Were you awake then that PB segment was flagged? It's right at the end of the night and it's very possible you were awake and the awake/arousal breathing irregularities got flagged and if you weren't asleep they don't count.

Go here and watch the videos especially the bottom one

http://freecpapadvice.com/sleepyhead-free-software

You can have false positive centrals/CAs or even false positive OAs and hyponeas. The machine doesn't have a way to know if you are asleep or not. It measure air flow only. Anything that is awake/arousal related doesn't count except it points to not sleeping.

Now asleep OAs can cause awakenings though and thus false positives are secondary result of real asleep OAs.

[Braydar]

Hello Pugsy

I don't spend very much time awake on the mask, but there is some of course, so the AHI should be slightly lower. I don't suffer from insomnia, but I do generally wake up once or twice to use the restroom and when I do I'll turn off the machine. Some sleep/wake junk in the mornings as well that are padding the AHI by a bit but lots of my sleep events are real positives. I don't lie awake at night kept up by the machine.

My machine doesn't seem to be really bad at false positives but the AHI should be a couple points lower.

That section I highlighted actually might be awake, I'm not completely sure.

This is a better example of the event I'm talking about:



I get at least a couple of these types of events a night, where a central apnea will come before a section of periodic breathing that lasts up to 45 minutes

[Pugsy]

Periodic Breathing is just a waxing and waning of the air flow that lasts at least 2 minutes.
The 3 events you zoomed in on above....note the increase in breaths right before the whatever was flagged...that's arousal breathing.
You might not remember it but something caused an arousal and your breathing changed.
If that were my report I would classify them as SWJ or sleep/wake/junk and not real asleep events. Now if you had been obviously asleep and then after the flag we saw that irregular breathing we would assume the event caused the arousal but when we see evidence of arousal just prior to the flagged event we assume false positive flagging.

Not unexpected with someone new to cpap therapy. Lets face it...this isn't exactly a normal experience and the brain is going to have to take some time to get okay with its new best friends...the mask and machine.

Centrals/Clear Airway apneas....we can't do much about them with your type of machine and with at least some of them being arousal related about all we can do is try to improve on sleep quality as best we can.
It's normal to have a few centrals here and there that are real and we are asleep...so don't panic over the centrals just yet.
Lets worry about them later once you have some more time and experience on cpap under your belt and your brain has learned to trust its new best friend.

Are you one any medications of kind? If so, what. This is important so please answer this question. Be specific with names...don't do what a lot of people do and say BP meds...there are a lot of different kinds of blood pressure medications out there.

If you start getting PB and flagged centrals/CAs that look like this below...then we worry. Right now it's too soon to be worrying because we can explain away some of them. Besides...your flagged events wouldn't look like the kind of events we worry about with PB flagged breathing. The pattern is not the same.

I do suggest increasing that minimum from 9 to 10 and lets see what happens with both the obstructive stuff (OAs and hyponeas, FLs, snores) and the centrals. Report back tomorrow with detailed report after the change (if you get it changed tonight) along with a report on sleep quality. If you wake during the night reach over and turn the machine off and then right back on again so that we have a known awake time to evaluate any flagged events that might happen near the known awake time. Makes for easier evaluation.

This is worrisome and for good reason. Large number of real centrals and a definite Cheyne Stokes Pattern.
PB is flagged just so the docs can evaluate the waxing and waning of the air flow. Most of the time it's not CSR pattern we are looking at. CSR is one type of PB but it isn't the only type.

[cyeh01]

Hello Pugsy

I don't spend very much time awake on the mask, but there is some of course, so the AHI should be slightly lower. I don't suffer from insomnia, but I do generally wake up once or twice to use the restroom and when I do I'll turn off the machine. Some sleep/wake junk in the mornings as well that are padding the AHI by a bit but lots of my sleep events are real positives. I don't lie awake at night kept up by the machine.

My machine doesn't seem to be really bad at false positives but the AHI should be a couple points lower.

That section I highlighted actually might be awake, I'm not completely sure.

This is a better example of the event I'm talking about:



I get at least a couple of these types of events a night, where a central apnea will come before a section of periodic breathing that lasts up to 45 minutes

Hi Braydar, there's a big chunk of what looks like CA events between 6:43 and 6:58 that is interesting. Were you awake at that time and what is the average length of each event there? It's probably SWJ but IMHO SWJ can be significant if it adds up.

[sonno]

I had similar issues with centrals and periodic breathing. In my case they resolved quickly by turning off auto and using a fixed pressure instead, by turning off flex/epr and by Shifting to ffm ( which you already have).

[palerider]

I had similar issues with centrals and periodic breathing. In my case they resolved quickly by

turning off auto and using a fixed pressure instead,

Unlikely

by turning off flex/epr

Probable... but which? they're not the same.

and by Shifting to ffm ( which you already have).

Again, unlikely.