Strange Issues

Background:I am having some issues with CPAP and not sure how to proceed. I started on cpap several years ago. For the first 4 years, it was great at fixed pressure of 10. I felt better the first night I used it and slept through the night right away and woke up feeling very refreshed. A new sleep doc increased the pressure to 16-18 based on their protocol. Sleep study said I had no apneas/hyponeas from pressure of 10-16 (they raised it to the highest titration level of the study). I did well initially on this pressure in terms of quality sleep and AHI under 1 but then started having aerophasia and mouth breathing. I got a new sleep study that said I did not have any apneas/hyponeas from 6-9 pressure (study says fixed pressure of 9 adequate). The doc suggested a range from 7-12 since I did not sleep very long during the study and had limited REM. This has been an issue with the 3 studies I have had since I tend to have REM late into the study, which I know can be normal, so they tend to have me on higher pressure than I seem to need to resolve the apneas they observed but they remain concerned regarding how I would do during longer periods of REM. I had no RERAs and no centrals on any of the 3 sleep studies.

Issues: I use a S9 Autoset and nasal mask. I have noticed that I have a lot of flow limitations (these seem to be related to nasal congestion) and seem to be having a lot of issues when the pressure increases since it wakes me up. I also have a couple of somewhat large leaks per night (usually it stays below 35 and rarely goes on for more than 3% of totally sleep time). Both of these issues seem to be waking me up 1-2 times per night so I am pretty exhausted. I tried to change to fixed pressure of 10 and 9.5 since that is my 95% and 90% pressure respectively. However, I started getting multiple centrals right at the edge of sleep that would jar me awake over and over. I tried to narrow the range to 8-10 but still had the centrals. I am not sure how to proceed since doc says numbers look great but I feel exhausted. He said the centrals issue is baffling since I never had any on sleep study. By the way, we tried to lower pressure before the sleep study from 16-18 to 13 to 16 since the pressure never moved off of 16. However, I was getting 20 centrals in the first 1/2 hour so we stopped. He said it makes no sense that lower pressures would cause centrals and was not sure what was causing them. I had EPR of 3 at the time and used EPR at 3 to try fixed pressure of 10 and ERP at 2 for fixed pressure 9.5 test. I turn it off when using pressure range of 7-12. He suggested I might need a BiPAP to deal with centrals. Any thoughts how I should proceed in terms of FFM to deal with leaks (doc said my mouth breathing not that bad and everything looks good). Do I need to try a BiPAP? Could ERP be the issue related to centrals? How do I start to narrow down what could be causing this issue?

By the way, I should also mention that I only have 0-3 total centrals per night when I am on pressure range of 7-12.

bayareacpap wrote:Background:I am having some issues with CPAP and not sure how to proceed. I started on cpap several years ago. For the first 4 years, it was great at fixed pressure of 10. I felt better the first night I used it and slept through the night right away and woke up feeling very refreshed. A new sleep doc increased the pressure to 16-18 based on their protocol. Sleep study said I had no apneas/hyponeas from pressure of 10-16 (they raised it to the highest titration level of the study). I did well initially on this pressure in terms of quality sleep and AHI under 1 but then started having aerophasia and mouth breathing. I got a new sleep study that said I did not have any apneas/hyponeas from 6-9 pressure (study says fixed pressure of 9 adequate). The doc suggested a range from 7-12 since I did not sleep very long during the study and had limited REM. This has been an issue with the 3 studies I have had since I tend to have REM late into the study, which I know can be normal, so they tend to have me on higher pressure than I seem to need to resolve the apneas they observed but they remain concerned regarding how I would do during longer periods of REM. I had no RERAs and no centrals on any of the 3 sleep studies.

Issues: I use a S9 Autoset and nasal mask. I have noticed that I have a lot of flow limitations (these seem to be related to nasal congestion) and seem to be having a lot of issues when the pressure increases since it wakes me up. I also have a couple of somewhat large leaks per night (usually it stays below 35 and rarely goes on for more than 3% of totally sleep time). Both of these issues seem to be waking me up 1-2 times per night so I am pretty exhausted. I tried to change to fixed pressure of 10 and 9.5 since that is my 95% and 90% pressure respectively. However, I started getting multiple centrals right at the edge of sleep that would jar me awake over and over. I tried to narrow the range to 8-10 but still had the centrals. I am not sure how to proceed since doc says numbers look great but I feel exhausted. He said the centrals issue is baffling since I never had any on sleep study. By the way, we tried to lower pressure before the sleep study from 16-18 to 13 to 16 since the pressure never moved off of 16. However, I was getting 20 centrals in the first 1/2 hour so we stopped. He said it makes no sense that lower pressures would cause centrals and was not sure what was causing them. I had EPR of 3 at the time and used EPR at 3 to try fixed pressure of 10 and ERP at 2 for fixed pressure 9.5 test. I turn it off when using pressure range of 7-12. He suggested I might need a BiPAP to deal with centrals. Any thoughts how I should proceed in terms of FFM to deal with leaks (doc said my mouth breathing not that bad and everything looks good). Do I need to try a BiPAP? Could ERP be the issue related to centrals? How do I start to narrow down what could be causing this issue?

That's alot of mixed information to try to digest.......
If you had good results at 9 and 10, why are you using ranges of pressures? ( Doctor said to? )
Did they use EPR in your titration? (I seriously doubt it.)

First of all, I would quit listening to the doctor, study your reports and use your own intuition (listen to the little voice in your head).
Could be the pressure changes are disturbing your sleep and leaving you feel exhausted.


Den

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Thanks Den...I thought the pressure changes might be the issue also. Doctor said to use range. But when I tried fixed pressures of 9-10 on my own, which I need to deal with OSA, I start getting a lot of centrals. This never used to be a problem when I was on fixed pressure of 10 several years ago so it is a new issue. So not sure what to do since cant use lower fixed pressure due to OSA but the centrals at 9-10 wake me up over and over as I go to sleep.

The ERP issue is only at home (not during sleep study). I only mentioned it as I have heard some people get centrals when they use it.

bayareacpap wrote:Thanks Den...I thought the pressure changes might be the issue also. Doctor said to use range. But when I tried fixed pressures of 9-10 on my own, which I need to deal with OSA, I start getting a lot of centrals. This never used to be a problem when I was on fixed pressure of 10 several years ago so it is a new issue. So not sure what to do since cant use lower fixed pressure due to OSA but the centrals at 9-10 wake me up over and over as I go to sleep.

The ERP issue is only at home (not during sleep study). I only mentioned it as I have heard some people get centrals when they use it.

I'm not sure how many you're talking about, but "sleep onset Centrals" or Centrals just before awakening can be fairly common for some folks. Are either of those times when you are having them?
Are you sure you're asleep when they're showing up in your reports? People don't breathe the same when they're awake as when they're asleep.
Quite a few people have "a few" Centrals......and that ain't no big deal.

As far as the EPR thing, some people are prone to apneas at the point where they complete their exhale cycle and begin their inhale cycle. So, some do better with or without EPR and at different settings......including Off.


Den

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In general, they are stacked in the first 1/2 hour after sleep onset. I typically have 10-15 of them during this time (but it can be as few as 2). If I wake up 1 time per night then I will have a total of 20-30 centrals at sleep onset for the night etc (10-15 when I fall asleep and 10-15 when I go back to sleep in the middle of the night). Other than that, I will typically have a total of 0-3 centrals for the rest of the night (outside of the sleep onset times). I need to look closer at the flow rate data to see if I am asleep during the times that most of the centrals show up (It is a little bit hard for me to determine). I have had the situation where I am definitely awake for an hour as I try to go to sleep and when I check the data I have had 5-10 centrals (Junk data from the way I breathe while I am awake I guess - I hear this can happen).