Central Apnea clusters happening despite changing pressure settings

[Needsleep54321]

Philips respironics dreamstation bi-pap
Pressure - 8.5-10.5
Pressure support - min1 max1
Humidity - 5
Hose temp - 3
Mask - Mirage quattro air full face mask
Flex - off
Sleep study ahi - 72 (mostly hypopneas)
O2 ring monitor - Wakes me with an alert at 90% or lower

Hi,

After starting cpap therapy i was initially having multple central apneas causing my o2 saturation to drop into the 60-70% range. My ahi would be around 50 the next morning, mostly centrals in clusters one after each other while the machine was either ramping up the pressure or maintaining a high or low pressure. After seeking advice i reduced the pressure, and pressure support and had a few nights with very low ahi scores, although i still couldn't stay asleep for long periods. The central apneas have returned though and I'm waking up several times an hour to breathe. My spo2 monitor is showing my oxygen dropping into the 80%'s. I've turned off flex and reduced pressure support from my initial settings. This has reduced the centrals to around 10 an hour but I'm still waking up lots gasping for air. I haven't slept more than a few hours each night for months now.

What can I do to improve my ahi, and to sleep through the night?

Oscar data last night

IMG-20210422-WA0006.jpg (178.07 KiB) Viewed 973 times

O2 ring data, last night

IMG-20210422-WA0007.jpg (84.64 KiB) Viewed 973 times

[Julie]

Why oh why aren't you posting in your other thread(s) so we can see what happened previously and how it went then? We don't want to look into other threads for info if we can help it - to help you.

[Needsleep54321]

I thought this qualified as a separate post as it has been so long since i last posted. Tomorrow I will remove this post and put it at the end of my previous thread.

[LSAT]

The constant wake ups may be causing the abundance of CAs. They may only be Clear Airway events when you are partially awake.

[Julie]

It's all part of your cpap story though (unless you post on a completely unrelated topic) so we can see the numbers, graphs, fixes, etc... nevermind, I'm cranky today.

[Pugsy]

Link to previous thread in case someone wants more history.
viewtopic/t181274/New-APAP-user--High-c ... -user.html

Stick with this newer thread now though.


Have you evaluated the flow rate to figure out if the flagged centrals/CAs are real asleep centrals or awake/arousal centrals?
http://freecpapadvice.com/sleepyhead-free-software

If the centrals are real asleep centrals they could be causing the wake ups.
If the centrals are a by product of an arousal from something else and you weren't asleep...then the wake up is causing the centrals.
You are also having enough obstructive stuff that they could also be causing wake ups.

To fix a problem you first have to try to identify the cause of the problem.

Your machine won't fix real asleep central apneas. You would need a different type of machine.

You probably need to see your doctor and maybe have an in lab sleep study so they can see for sure if you were asleep or not.

[palerider]

After seeking advice i reduced the pressure, and pressure support and had a few nights with very low ahi scores, although i still couldn't stay asleep for long periods. The central apneas have returned though and I'm waking up several times an hour to breathe. My spo2 monitor is showing my oxygen dropping into the 80%'s. I've turned off flex and reduced pressure support from my initial settings. This has reduced the centrals to around 10 an hour but I'm still waking up lots gasping for air.

You're waking up gasping for air because of the obstructive and hypopneas, NOT the centrals.

Your obstructives and hypopneas are because your base pressure is too low. increase the minimum by a cm a night, (and increase the max by 2 a night) until your obstructives and hypopneas decrease again.

[Needsleep54321]

After looking at my oscar and O2 data from last night and reading your suggestions, it looks like the majority of the O2 drops are due to hypopneas and centrals (some of which are actually hypopneas) especially the last half of the night. It also might be that the repeated waking is contributing to the amount of hypopneas and centrals (idk how to really know this). I raised my pressures from 8-10.5 to 8.5-11.5. This seemed to help a bit. My O2 is still dropping (thankfully I have an O2 ring that wakes me when the O2 reaches 87% so it won't continue to drop. I can't tell from this data why I am waking so often. Here are the data from last night.

screenshot-20210423-083833.png (69.24 KiB) Viewed 902 times

1619180984488_0_Report.png (113.08 KiB) Viewed 902 times

0_Report.png (118.51 KiB) Viewed 902 times

[palerider]

After looking at my oscar and O2 data from last night and reading your suggestions, it looks like the majority of the O2 drops are due to hypopneas and centrals (some of which are actually hypopneas) especially the last half of the night. It also might be that the repeated waking is contributing to the amount of hypopneas and centrals (idk how to really know this). I raised my pressures from 8-10.5 to 8.5-11.5. This seemed to help a bit.

Your charts are hard to interpret because of your nap midday causing a lot of blank space, and scrunching up the night. Turn off the midday nap display by clicking off the first segment in the bar chart at the bottom of the left panel, that will expand the parts of the chart we care about.

What I see though is that you have a FL, or an OA, and because philips machines aren't very responsive, you then have more events, where it finally starts raising pressure, but it's too late to stop you from being partially awake, and having (probably) transitional centrals (referred to as "sleep wake junk" afterwards.

Raise your minimum to 9 (I'm guessing 10 or 11 will end up being needed), and put the max at 20 (or 25) so that you're not preventing the machine from increasing pressure to keep you from having obstructive events, As it is, your settings are preventing the machine from doing it's job.

[MidearedCat]

After looking at my oscar and O2 data from last night and reading your suggestions, it looks like the majority of the O2 drops are due to hypopneas and centrals (some of which are actually hypopneas) especially the last half of the night. It also might be that the repeated waking is contributing to the amount of hypopneas and centrals (idk how to really know this). I raised my pressures from 8-10.5 to 8.5-11.5. This seemed to help a bit. My O2 is still dropping (thankfully I have an O2 ring that wakes me when the O2 reaches 87% so it won't continue to drop. I can't tell from this data why I am waking so often. Here are the data from last night.
screenshot-20210423-083833.png1619180984488_0_Report.png0_Report.png

The graph you posted indicated that excessive motions correlated with high pulse rate but at the same time you had sufficient O2 saturation. On the other hand, all low O2 cases combine with moderate pulse rate of < 70BPM and no excessive motions. This can lead to a conclusion that your sleep problem is escalating during normal O2 levels due to some other reason. The drops of O2 may be just responses to the initial problem. Did you check out your blood level of CO2? Total blood C02 should be 23-31 mmol/l. In terms of pressure PCO2 it is about 35 – 45 mmHg. If your CO2 lower you can suffer hypoxia even at 100% O2 blood saturation.

[Needsleep54321]

Here's the better chart view and another closer look at the last half of the night (wrong order, sorry) . The reason my pressure is so low is because I swallow a painful amount of air, and the higher pressures seem to increase the number of centrals i have even more. But im willing to try again of its necessary.

screenshot-20210423-140542.png (69.52 KiB) Viewed 876 times

screenshot-20210423-140510.png (70.59 KiB) Viewed 876 times

[Needsleep54321]

I just spoke with my respiratory therapist and he strongly urged me to keep my current pressures for at least a week to see if there's an improvement. When we've tried higher pressures, it created more problems than it solved. If these current pressures (8.5-11.5) don't improve my apneas, I will come back here and try your great suggestions. Thanks for your help, see you in a week with an update.

[Needsleep54321]

Currently trying to train myself to sleep for a longer stretch at night. I noticed that my apneas increase as the night goes on (waking often and going back to sleep). It's a work in progress, but looks promising. I raised my epap which helped decrease the amount of hypopneas. I am going to bed at the same time each night, and sleeping as long as I can. If I wake up and can't fall asleep again within about 10min, I get out of bed and must wait until the next night to sleep again. I am having issues with mask leaks waking me often. This makes it difficult to stay asleep. Still trying to find a full face mask that doesn't leak much. I will keep updating.

[clownbell]

I am a fairly new CPAP user, not a sleep doc nor a sleep tech nor a professional of any kind. May I suggest you read http://www.apneaboard.com/wiki/index.ph ... onal_Apnea carefully and several times. There is some great background there.

As I understand it (remember my limitations), both obstructives and hypopneas tend to occur during the exhale phase and are therefore treated by increasing EPAP. Try increasing EPAP and IPAP by 1cm every couple nights and review again.

[Needsleep54321]

Thanks, I will read it carefully. I was going to decrease my max pressure since my mask leaks at higher pressures and causes me to wake very often. If I find a mask that can handle higher pressures, I will try increasing it. Thanks again. (Max pressure currently at 11).