Central CSA increased after starting APAP

[abf]

Hi all,

I have looked around in the forum and I've found some good info but the info doesn't seem to fit the problems I've been experiencing. I had a home sleep study and the results were CSA of 5.6/hr, OSA 2.67/hr, and obstructive hypoapnea of 11.27/hr. I was prescribed an APAP with pressure settings of 5-20, with settings and equipment for comfort, as needed. A bought a resmed airsense 10 autoset. Since being on the therapy, my sleep apnea symptoms have increased (heavy breathing, shortness of breath, choking feeling) and my CSA values have increased (most often above 8/hr but as high as 26/hr), while obstructive apnea and hypoapnea values have decreased. NOTE: those low and high per hour scores don't seem to depend on the length of usage. I've used settings with EPR (ramp only, full-time; EPR from 1 to 3) and without EPR and pressure levels and differences in levels (i.e., min 6, max 12, min difference 2, max difference 14). I haven't had a full night with lower pressure settings, 5 to 8, because when I start on those settings, I quickly feel like it is giving me adequate airflow.

In one of the attached images, I provide information for the night of Dec. 2nd, 2019, highlighting a period of around 1 hour of sleep. During a 12-minute period (5:25 to 5:37) within that hour, I was flagged with 24 true apneas (long pauses between significant increases in flow rate). In this image, a few things are highlighted that seem to be typical of my results. I have noticed that the machine increases pressure around the time that I experience CSAs. Also, CSA events tend to stop as the leak rate increases. Leak rates are often below 30.

The number of hours a night that I have slept with the mask has varied. My scores, total CSA and the average CSA/hr, are highest for nights when I take off the mask. For nights when I keep the mask on, the rate of CSA events tends to be similar to the nights where I take the mask off. The obvious question is, at what point of my sleep cycle do I have the mask for different usages? I'm not sure. I'll study this question and get back to the forum, once I look over the results again.

My questions are; should I go with a lower pressure, should use EPR (ramp only, full-time), and should I use CPAP settings instead of APAP?
Thank you in advance. Please let me know if I should include different screenshots or views?

[Pugsy]

Welcome to the forum.

Please read this thread for graph formatting hints.
viewtopic/t158560/How-to-post-images-for-review.html

Don't zoom in without at least showing the original detailed report that you are zooming in on.
On the left side under the calendar click on the Details tab instead of the Events tab so that we can the AHI breakdown.
Also hide the calendar and
Turn off the pie chart (Preferences/appearance tab...remove check mark) then all the statistics will move up under the AHI information.

On the report above for 12/2....how long did it take you to fall asleep?

Any chance you were awake at any time between 5:30 and 6:30?

Please do another screen shot of 12/2 in the normal format per the instructions in the link above.

[alancalan]

I am not sure if this will help, but check out this link. There are contra indications for Centra Sleep Apneas in some people and it can affect breathing and the heart, be careful. You have a lot of CSAa. I looked into this because I was having a few CSAs averaging 0 to 3 per night. One night I had fr 5 hours of sleep. I need to start going to sleep earlier.

https://www.aastweb.org/blog/pros-and-c ... leep-apnea

[palerider]

I am not sure if this will help, but check out this link. There are contra indications for Centra Sleep Apneas in some people and it can affect breathing and the heart, be careful.

from a discredited study.

I looked into this because I was having a few CSAs averaging 0 to 3 per night. One night I had fr 5 hours of sleep. I

That's *COMPLETELY* insignificant.

[ChicagoGranny]

I am not sure if this will help, but check out this link. There are contra indications for Centra Sleep Apneas in some people and it can affect breathing and the heart, be careful. You have a lot of CSAa. I looked into this because I was having a few CSAs averaging 0 to 3 per night. One night I had fr 5 hours of sleep. I need to start going to sleep earlier.

https://www.aastweb.org/blog/pros-and-c ... leep-apnea

You need to read and quote the later study.

No relationship became apparent between sleep apnea or ASV and death.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277244/

[palerider]

I am not sure if this will help, but check out this link. There are contra indications for Centra Sleep Apneas in some people and it can affect breathing and the heart, be careful. You have a lot of CSAa. I looked into this because I was having a few CSAs averaging 0 to 3 per night. One night I had fr 5 hours of sleep. I need to start going to sleep earlier.

https://www.aastweb.org/blog/pros-and-c ... leep-apnea

You need to read and quote the later study.

No relationship became apparent between sleep apnea or ASV and death.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277244/

SERVE-HF was a great example of a terrible study modality, and a ridiculous kneejerk reaction.
some of the worst problems with that abomination of a study:
https://journal.chestnet.org/article/S0 ... 5/fulltext

[ChicagoGranny]

some of the worst problems with that abomination of a study:
https://journal.chestnet.org/article/S0 ... 5/fulltext

Reading that makes me think the authors of Serve-HF should have consulted cpaptalk members.

[KandyX]

SERVE-HF was a great example of a terrible study modality, and a ridiculous kneejerk reaction.
some of the worst problems with that abomination of a study:
https://journal.chestnet.org/article/S0 ... 5/fulltext

Yet "experts" like these still reference the incorrect conclusions of that study... http://www.youtube.com/watch?v=OM3XMI6vA-Y&t=17m30s

[palerider]

some of the worst problems with that abomination of a study:
https://journal.chestnet.org/article/S0 ... 5/fulltext

Reading that makes me think the authors of Serve-HF should have consulted cpaptalk members.

Its a shining example of how poor the standards of treatment actually are in the medical community.

We wouldn't have considered the asv group "treated", old machines, unacceptable usage, unacceptable results, it's no wonder there was no advantage seen from the asv.

[palerider]

SERVE-HF was a great example of a terrible study modality, and a ridiculous kneejerk reaction.
some of the worst problems with that abomination of a study:
https://journal.chestnet.org/article/S0 ... 5/fulltext

Yet "experts" like these still reference the incorrect conclusions of that study... http://www.youtube.com/watch?v=OM3XMI6vA-Y&t=17m30s

That's why we have to be vocal in our own care.