Question about CPAP-induced Centrals

So lets start with a discussion about what a CPAP induced central apnea is. The pressure of CPAP makes it easier to inhale. Our exhale muscles are usually strong due to talking and all so the usual result is that we use more air while using CPAP. If we have some “nerve” issues going into the night (in my case “nerves” say from the anniversary of a traumatic assault upon my person) this adds to the tendency to breath more. At a certain point it would appear that this tendency “runs away” to the point were an arousal occurs likely due to the excessive respiratory effort from all that breathing. By this point we have breathed too much oxygen into our blood stream and blown off too much carbon dioxide. There is no reason to breath and good reason to not breath and so we do not breath for a time.

One of the issues brought into the picture by the above event is that with the arousal comes an increase in our stress hormone levels. So it is more likely that there will be another event.

A second issue that I have noticed for myself is that breathing too much tends to stuff up my nose, it tends to make my mouth dry and to otherwise cause inflammation in my upper airway. So I tend more toward obstructive events.

If obstructive events occur they ratchet up the stress hormones, which tends more toward over breathing. If the start of the tendency to over breath is caused by an obstructive event then increasing pressure will tend to help. But increasing pressure will tend toward using more air and causing hypocapnic central apnea events (like the CPAP induced apnea events) to be more intense.

So then, the major factors involved:

Chemoreflexes

Stress levels

Inflammation

Lets start with those little things we can do to help with inflammation:

Eat less inflammatory foods and more anti-inflammatory foods

Raise the head of your bed a few inches (less blood pressure in the airway passage due to gravity).

Next lets look at Stress Level control:

I moved away from a high crime city. I have found this a very wise choice

I have found it useful to use music or audio books to help with the process of going to sleep. If the early night goes well the rest of the night is helped.

Many find meditation useful. I find that seeking beautiful things (in sight sound taste or smell) to be helpful.

And finally some little things to help with chemoreflexes:

Aerobic exercise and especially doing 85% of your maximum heart rate interval training seems to help me with this (note: you need to get in shape to try the interval training stuff).

Spending time with the machine during the day, learning to breath quietly as you should be while sleeping at night and with light distraction such as a book, light TV, music can help get the body used to what is going on and help to develop good response.

I have found pulse oximeter guided eucapnic breathing helpful.

HTH

Todzo

rd1978 wrote:

avi123 wrote: Avi,

As a matter of fact, I did undergo a sleep study last night. It was an ASV titration. The results, however, won't be in for a few days. I'm using the time between now and then to experiment a little with my settings to see if I can make the Centrals go away (or at least diminish in number). Given that I had no Centrals at all until after starting PAP therapy, and have absolutely none of the medical conditions that can cause Centrals, there's virtually no doubt that they are PAP-induced . In all likelihood, I'm one of the small percentage of folks who have Complex Sleep Apnea, in which case the correct treatment will be a machine with ASV capabilities. But, again, since I have a few days to play around, it's worth experimenting to see if perhaps my Centrals might only occur above a certain pressure.

If setting my S9 Autoset in CPAP mode with a relatively low pressure (i.e. 6cm or 7cm) can give me a low AHI with no Centrals, that would be great. The question is, should I use the EPR or not? Frankly, since I would have no trouble at all exhaling against such a low pressure, I'm inclined to turn the EPR off.

Reply,

To show you that experimenting with the S9 in order to find an optimal therapeutic pressure to treat my condition of plain OSA was a waste of time, and leading to nonsensical results, take a look at my efforts to go thru it when I started CPAPing at the beginning of 2011:

Indulging in nothingness





Just compare the above to the results of my treatment during the last year(there is NO comparison):

(all the values are Medians of the 362 days period)

avi123 wrote: . . . waste of time . . . nonsensical results . . . Indulging in nothingness . . .

I think my tongue is bleeding.

jnk wrote:

avi123 wrote: . . . waste of time . . . nonsensical results . . . Indulging in nothingness . . .

I think my tongue is bleeding.

Is it b/c you're holding the pic in your mouth?

This player's tongue was NOT bleeding:

Yeah. That must be it.

https://www.youtube.com/watch?v=BGeHWBcZ6D8

jnk wrote:

avi123 wrote: . . . waste of time . . . nonsensical results . . . Indulging in nothingness . . .

I think my tongue is bleeding.

I feel your pain!

DoriC wrote: I feel your pain!

That's okay...I had to go to the ER to have the tip of my tongue sewed back on because I bit it off trying to keep my mouth shut.