Now have central apnea since starting CPAP therapy

[ajack]

as pugs said turn off the epr, You may need to do this over a few nights, reducing as you go.
They are probably pressure induced clear airways CA. The body is adjusting the co2/o2 balance, these normally go away within 12 weeks. Rather than a true central CA with an o2 drop.

[caynana]

[caynana]

Thanks to all who replied yesterday with helpful suggestions and comments. I turned off the EPR last nite as suggested by Pugsy and ajack but I didn't last too long. I woke up gasping and couldn't exhale without blowing thru my mouth against the pressure. I turned the EPR back on and did fine the rest of the nite...or so I thought, until I checked my Sleepyhead report this morning. My AHI was 12.44 and I had lots of mask leakage. I had Clear Airway 45 events, Hypopnea 9 events, Obstructive 20 events, and Large leak 12 events. I slept about 6 hours and woke up a few times to adjust my mask and once to go to the bathroom. As I mentioned in an earlier post, my sleep score without CPAP was 9 and no centrals, so I'm doing worse with the CPAP therapy than without. This is so discouraging and I really need to make this work because I have a history of atrial fibrillation and congestive heart failure. I had ablation surgery in October which was successful, so I'm no longer in afib or CHF but have been told by my cardiologist that there is no cure for afib or CHF and they could come back in the future. She also told me that sleep apnea can cause afib and afib causes CHF, so as I said, I really need to get this apnea under control. I'm determined to make this work, but am needing help and encouragement right now. I think I will try lowering the EPR by just 1 tonite and see if that helps and if I can tolerate it. (It's set for 3 right now). I can try to progress from there. If lowering the EPR doesn't work, I'm wondering if I need to find a better mask solution as I think I may be having mouth leaks with the Dreamwear nasal cushion that i'm presently using. I can't wear the chin strap with it because I'm unable to get a good seal when both are on. I still have the full face mask that I could try again but had lots of leakage with that too and an AHI of over 12. My best scores were with the nasal pillow mask with chin strap but I couldn't tolerate the nasal dryness & the pillows also stretched my nostrils and made my nose sore. This may be too much information but I'm hoping the forum can provide some tips or suggestions on things to try. Maybe I should just wait it out and see if these centrals go away over time as happened with Biguugly? Since I have good nites and bad, my AHI averages are under 5 but I'm not sure that's an accurate picture of what's going on with me. I'll attach some more screen shots for Pugsy in case they would be helpful. I admit I still don't understand what all the graphs mean even after watching all of Pugsy's video links. This is a great forum and I appreciate all the help I've gotten so far.

[caynana]

[caynana]

[caynana]

[ShinRyoku]

Is your doc aware of the CAs? If they are real CAs (not false positives while awake), your managing healthcare provider may decide to wait a while to see if they get better vs changing you from APAP to CPAP or a different type of PAP altogether.

Lowering EPR to 2 sounds like a good next move.

It will be important to work on finding a mask that can work for you without too much leaking as well as to prevent mouth opening. Maybe try a different chin strap. Also, I've had really good results using Chin-Up Strips to prevent mouth leaking: http://chinupstrip.com/ - I buy them on Amazon.

If you have nasal congestion, then working on that can also help with mouth leak.

[chunkyfrog]

Since you have only been at this for a couple of weeks, you may not yet be adapted to therapy.
I would suggest you use the machine while awake (in addition to when sleeping)
Practice should help you get used to the difference in exhale effort,
and help strengthen the muscles involved.
Good luck, and welcome to the forum.

[Pugsy]

Let's zoom in on one of the clusters.
Go back to the Events table and the CA/Central group.
See the event #24 timed at around 4:15? Highlight that event and click on it.
Your graphs on the right will zoom in and we will be able to see that event and a couple of others on either side of it.
Get a screen shot at that level of zooming in....don't back out trying to get more or zoom in trying to get closer.
Just highlight that #24 event and then click on it. Then get that level of zooming in.

You can reduce the size of the Flow Limitation graph...it's easy to see that the FLs are driving the pressures up.
If you are having much nasal congestion it can cause the machine to increase the pressures when it may not be necessary because nasal congestion isn't the same as airway collapse restriction in air flow but the machine doesn't know that.

[caynana]

[caynana]

Pugsy, I don't see anything in the flow limit graph except that small box in the lower left corner and I don't know what that means. I think I understand from what you said, that if my nose isn't clear that the machine could interpret that as an airway obstruction instead of just a congested nose and then raise the pressure when it's not necessary. Does the pressure increase then cause the frequent apnea's or are you saying they really aren't apneas, just nasal congestion or ?? I'm sorry I'm such a slow learner, but I don't know how to read the graphs even after watching the videos and I don't understand cause and effect. What does the unnecessary pressure increase do? Is it the reason for the mask leaks, or the frequent apnea's or is it just a comfort issue or ?? My nose doesn't actually feel congested and when I'm awake, I breathe thru my nose. I appreciate you taking the time to teach this newbie the ropes. Thanks for your patience.

[Pugsy]

Thanks for zooming in on the centrals. They looked pretty much real to me but I am not the greatest and this level of evaluation.
Since is closely follows a known awake time where you turned the machine off and back on then maybe these are sleep onset centrals...or maybe just related to the unstable breathing that sometimes happens to people who get put on cpap.
In other words those that you zoomed in on...don't look like SWJ breathing to me.

See if reducing EPR changes anything...there's a very small percentage of people who get centrals from cpap therapy who actually have the bilevel situation that using EPR produces be the cause of the centrals. I have seen it happen...reduce or eliminate exhale relief and the centrals go away. I can't guarantee it though. It's a maybe and affects only a very small % of people but it's an easy experiment to do that doesn't cost any money so worth trying.

You still aren't probably having enough centrals to get the doctor to do much this early in cpap therapy. It's very possible that they will go away on their own with a bit of time or reduce to much less annoying numbers.

Compare your flow limitation graph to mine here.
And this one is rather "busy" for me. Usually it is even less active. Flow limitations and snores and OAs and hyponeas all will drive the pressure. We don't see much going on with you except for the FL graph. If you aren't noticing much nasal congestion then it's unlikely your active FL graph is related to nasal mucosa swelling.

[Pugsy]

The machine in the for Her mode does seem to sort of be more sensitive to the FL stuff. I know my own FL graph in the for her mode is a lot "busier" than in the regular mode.

So if you switch to the regular mode I suspect the FL graph will look less ugly. How much less ugly I don't know.

I do think that maybe an experiment using the regular auto mode might be also worth trying. While I doubt it will change the centrals..wouldn't hurt to try it and at the same time see if the machine tones down the FL response and pressure changes.

And if turning EPR off is too uncomfortable just try reducing it and see what happens. You can work your way down and it will be easier than going from 3 to off in one big jump.

[caynana]

Thanks for all your help Pugsy. I'll try to lower the EPR to 2 tonite to see if I can tolerate it. And I think I'll try those chipupstrips recommended by Shinryoku. Has anyone ever tried Somniflex sleep strips? They cover the lips to keep the mouth closed and have a small vent hole to allow some air exchange.

[ShinRyoku]

Has anyone ever tried Somniflex sleep strips? They cover the lips to keep the mouth closed and have a small vent hole to allow some air exchange.

I Googled and can't find anything for "Somniflex sleep strips". Do you have a link you can share?

The other thing I've been trying lately is the Ultimate Chinstrap: http://sleepapneasolutionsinc.com/?page_id=2

So far I haven't decided whether to stay with the Chin Up Strips or the Ultimate Chinstrap. Both seem to work well.