How to can I reduce Centrals caused by BIPAP pressure

[dennism]

Hello All,

I have been on the forum since November, have had incredible help from Pugsy, and after 2 months have reduced my AHI from 15 in my sleep study to less than 4.
I read all the daily dialogue and have benefited from it. Masks, Humidity, settings etc with Thanks To All Of You.

My sleep study, with an AHI of about 15, had all Obstructives and No Centrals. I have my BIPAP set to 10 IPAP and 7 EPAP for 6 weeks now, and as predicted my AHI has slowly come down over that time to about 4 as my body has gotten used to the new regime!

Today, about 50% of my AHI of 4 is due to Hypopneas and Flow Limitations, while the other 50% is due to Central Apneas.

Here is my question. And it is general as I am not technical to manage to post a picture of my sleepyhead report. Would need to get a computer helper over to do that and will try.

Is there a process I can try, that slowly lowers pressures, to try reduce the centrals, without increasing the hypnosis and flow limitations too much? (I know how to change machine settings)

For example, I could put the machine into CPAP mode at a single pressure and try reducing it slowly, or I could reduce BIPAP pressures slowly (say 1inch pressure at a time).

Many thanks

Dennis

[Greg Riddle]

One of the things that I did, directed by others here, was lower epap and raise the pressure support. I also changed the trigger setting. Fwiw I'm not a professional so I can't give advice just say what I did

[tan]

One of the things that I did, directed by others here, www yup lower epap and raise the pressure support

This may be counter-productive for central apneas

I also changed the trigger setting.

yes, this may help

[LSAT]

Your machine cannot control Clear Airway events. They are caused by your breathing pattern...usually just before you wake up and/or while you are falling asleep.

[Sleeprider]

Dennism, we miss seeing Pugsy since Christmas here, and hope she gets back soon.

You have flow limitations and hypopnea and this is indicative of a lack of pressure support (higher pressure). At the same time you're seeing apnea that are clear airway. They may or may not be central apnea. Many CA events can come from arousals as you turn in bed or hold your breath, and some other causes. Do you ever awaken like you just forgot to breath and take a large recovery breath? Do you see recovery breaths on the CA events? What is the duration of the CA events? Is there any suggestion of periodic breathing or Cheyne Stokes respiration in your data? If not, then you may be mistaking clear airway apnea as central apnea.

Your pressure range is quite low and if you're not experiencing difficulty exhaling, it may be you just need more pressure support, not less. One way to find out is just make an upward adjustment of .5 to 1 cm in both IPAP and EPAP and see what happens for a few days. If it drives the overall AHI higher, then that response is good to know. I think if you drop pressure, you will increase FL, H and OA, but there is admittedly no way to know without actually giving it a trial.

Most importantly, don't assume CA means central. It may or may not be. I also have had a fair number of CA events, and they seem responsive to more pressure, rather than less in my case. In fact CA in my case seems not to be related to pressure at all. The FL and H responded to an increase in EPAP of 1.0 and increase of 2.0 to IPAP, and CA was also slightly reduced...YMMV. I'm working with an auto BiPAP now, so we are puzzling out some of the same issues, and I don't have enough therapy hours data after the last change to know if the changes will continue to be an improvement. This is so much a trial and error approach, I'm not sure your original question has a right or wrong answer. Best of luck!

[dennism]

Thank you all. I really must try post some pictures and will.

But most important is the psychological impact of being on this forum and knowing you are all there.

The night after I posted my question, my AHI dropped to 1.9, the lowest ever, for the first time! Obviously because of the care you all have for new forum members!

I will let this new AHI stabilize for a week or so, (I hope it remains at this level) Then report back!

Gratefully yours

Dennis

(Any Grateful Dead fans out there? Big Concert coming up in July has just been announced!)

[archangle]

Please add your equipment to your profile as well. There are instructions in my signature line.

Don't panic over centrals, they're not necessarily more harmful than obstructive. Look and see how long and how complete they are with SleepyHead.

[Mada]

I have average AHI of 10 in the last month after a titration study showed my best pressure is 13. 1.8 is OA and 7 is CA. I can't seem to wake up refreshed in the morning. I am on a regular CPAP machine on C- FLEX not A-Flex. I wonder if CA's are mostly just a stressful active mind. My sleep doctor said they are not central apneas. The world of sleep is very tough to figure out.