Question about self-titrating and Central Apneas?

Hi, I'm new to this forum and to CPAP therapy in general. I've had bad sleep for as long as I can remember; I could never stay awake in lectures and would constantly fall asleep behind the wheel on the way to work. I recently learned about sleep apnea and decided to take a sleep study. However, the sleep study results came back saying that there was no OSA. After more research I learned about UARS, which has the same symptoms as sleep apnea but not detectable through an at home sleep study. However, I did not want to wait another 3 months for a doctor appointment and dealing with insurance so I decided to just purchase a CPAP on my own and see if it would help at all. I purchased the Resmed Autosense 10 for Her as I have heard that it could be good for people with UARS as it can detect flow limitations.

I'm about a week into CPAP therapy and am a little confused. In terms of OSA and flow limitations the data on sleepyhead looks fine, but It appears I am getting periods of time where I am having many central sleep apnea events. So now I am thinking again that I might not even be having UARS, but actually central sleep apnea? Or it could be that the CPAP is not good enough to detect UARS and the central apneas I am having is just my body getting used to the pressure settings?

If it is the second, then I am wondering if I need to change my pressure settings at all? Right now I have min pressure set to 5.6 and max pressure set to 10, with an EPR of 3. I've read that its usually high pressure settings that cause central apneas, which is why I'm confused that I could be having so many. If anyone could provide some insight that would be great.

The big questions to answer right now, is how well are you sleeping? When I see clusters of CAs, i think of sleep/wake junk (SWJ). When you are sleeping lightly, or dozing in and out of sleep, your breathing is not regular, and your machine often flags it as CAs. My wife had this problem when she first started, and even now when I look at her information, I see clusters of CAs that correspond to the periods of the night when she is not sleeping soundly because of back pain or other reasons.

You can try reducing the EPR level and see what happens

So last night I tried changing my APAP to CPAP mode (since I don't seem to be having OSA so the changing pressure is probably not necessary), raised my min pressure to 7, and lowering EPR to 2. But I ended up with worse results and couldn't wear the mask longer than 2 hours. I tore the mask off before falling asleep again and woke up feeling terrible. I also woke up having difficulty breathing through one nostril, so maybe that could play into it? I also want to try lowering EPR more, but I start feeling aerophagia and find it hard to exhale without the pressure difference. I try setting an EPR of 1 tonight and see if it helps. Here is my data from last night.

I certainly don't claim to be one of the experts here, but it doesn't look to me like you have a problem that is OSA related. All of those centrals are either a result of the machine that you don't appear to need, OR you do have an issue with CSA itself.

I would highly suggest seeing a good sleep doc, and bring these records with you. Good luck.

ETA: You should probably zoom in on some of those centrals so that the experts here can tell if they appear to be real, or just SWJ.

chromaz wrote: ↑

Sun Jul 08, 2018 4:57 pm

So last night I tried changing my APAP to CPAP mode (since I don't seem to be having OSA so the changing pressure is probably not necessary), raised my min pressure to 7, and lowering EPR to 2. But I ended up with worse results and couldn't wear the mask longer than 2 hours. I tore the mask off before falling asleep again and woke up feeling terrible. I also woke up having difficulty breathing through one nostril, so maybe that could play into it? I also want to try lowering EPR more, but I start feeling aerophagia and find it hard to exhale without the pressure difference. I try setting an EPR of 1 tonight and see if it helps. Here is my data from last night.

hi and welcome aboard. i'm no expert either(aren't you lucky to just get people with opinions? ) but i would recommend that you don't change more than one thing at a time. it makes it harder to figure what one thing works and what doesn't work.

we are each of us different in our xpap needs. and so we have to take slightly different approaches. be patient and someone will be along directly to give real and sound advice to help you tune in your therapy.

good luck!

Home sleep studies can be pretty good at proving someone has a sleep problem. They are incapable, however, of proving someone does not have a sleep problem.

If there are indications of problematic sleep, it takes a PSG at a lab to investigate it thoroughly.

Be aware that sometimes bad breathing disturbs sleep, but sometimes bad sleep shows up as breathing problems. Only the results from a quality PSG can keep you from mistaking chickens for eggs.

chromaz wrote: ↑

Sun Jul 08, 2018 1:51 am

Resmed Autosense 10 for Her

Resmed Airsense 10 AutoSet for her (getting the name wrong makes it harder to get the right answers sometimes.

chromaz wrote: ↑

Sun Jul 08, 2018 1:51 am

as I have heard that it could be good for people with UARS as it can detect flow limitations.

No more than the regular AutoSet does.

The difference in the AutoSet and AutoSet for her are:

The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:
 Reduced rate of pressure increments designed to help prevent arousals.
 Slower pressure decays.
 Treats apneas up to 12 cm H 2 O and continues to respond to flow limitation and snore up to 20 cm H 2 O.
 Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas: If two apneas occur within a minute, the pressure reached in response to the second apnea will become the new minimum treatment pressure until the next treatment session

I don't know where the myth going around about it being 'better for uars' 'faster something' 'detects FL' started, but it's annoying, and unfounded.

chromaz wrote: ↑

Sun Jul 08, 2018 1:51 am

I'm about a week into CPAP therapy and am a little confused. In terms of OSA and flow limitations the data on sleepyhead looks fine, but It appears I am getting periods of time where I am having many central sleep apnea events. So now I am thinking again that I might not even be having UARS, but actually central sleep apnea? Or it could be that the CPAP is not good enough to detect UARS and the central apneas I am having is just my body getting used to the pressure settings?

All the machine can detect are abnormalities in the respiratory flow... whether it's 'uars' or something else, no cpap on the planet has any way of knowing. You are having a significant number of centrals.

chromaz wrote: ↑

Sun Jul 08, 2018 1:51 am

If it is the second, then I am wondering if I need to change my pressure settings at all? Right now I have min pressure set to 5.6 and max pressure set to 10, with an EPR of 3. I've read that its usually high pressure settings that cause central apneas, which is why I'm confused that I could be having so many. If anyone could provide some insight that would be great.

I second the notino, turn down the EPR.

A small minority of people (5-15%) have complex sleep apnea, ie, when they get enough pressure to alleviate their obstructive apnea, then central apnea starts to appear because the pressure messes with their respiratory drive.

Another minority of people have ventilation induced centrals, where the pressure difference between the inhale and exhale pressure causes them to breath more deeply, and that causes them to blow off more co2, and since it's the co2 in your blood that's the primary respiratory drive, less co2 = less 'urge to breathe', and so they just don't for a bit... and that's a central apnea.

It's very easy to see if you're one of these people, turn down EPR, that'll reduce the ventilation, and raise your co2 to a more normal level, and see if your centrals decrease.

Also, take a look at the links in my sig, and fix your charts. They're missing good info, and presenting redundant and useless stuff as they are now.

palerider wrote: ↑

Sun Jul 08, 2018 6:42 pm

I don't know where the myth going around about it being 'better for uars'

I believe that belief may be based squarely on . . .

Reduced rate of pressure increments designed to help prevent arousals.

Slower pressure decays.

. . . since it is held by some that general sensitivity to pressure changes is inherent in the UARS phenotype.

I'm just guessing, though.