SH data / central apneas

Just started on APAP, just over a month now. Added an SD card 4 days ago, and now getting much more feedback via SleepyHead.

I started taking buprenorphine for chronic pain four years ago. I snored before that, but started developing bigger sleep problems since being on buprenorphine, based on my wife's feedback. She kept getting ready to wake me up so I'd start breathing again, and I finally got a home sleep test which showed AHIs in the 80s-90s.

The last four days are AHI of 12-24 with a big chunk of them being "Clear Airway". My conclusion is that the buprenorphine is causing CSA, and that I'm still missing a lot of oxygen. Working with my sleep doctor to move from the ResMed 10 to whatever version is ASV. That's going to take another 2-4 weeks because of insurance. Now that I'm finally paying attention to the issue, it really worries me.

I'm working on getting the leaks down by playing with the mask and now using what the sleep tech called a little diaper for it, but even with lower leaking, I've still got high AHIs.

Am I readying this data correctly? Is there anything else I should be doing?

Thanks!

SleepingBill wrote: from the ResMed 10 to whatever version is ASV.

that would be the resmed 10. specifically, resmed aircurve 10 asv.

SleepingBill wrote:Am I readying this data correctly?

looks like it to me.

SleepingBill wrote: The last four days are AHI of 12-24 with a big chunk of them being "Clear Airway". My conclusion is that the buprenorphine is causing CSA, and that I'm still missing a lot of oxygen. Working with my sleep doctor to move from the ResMed 10 to whatever version is ASV. That's going to take another 2-4 weeks because of insurance. Now that I'm finally paying attention to the issue, it really worries me.

I'm working on getting the leaks down by playing with the mask and now using what the sleep tech called a little diaper for it, but even with lower leaking, I've still got high AHIs.

While you are reading the data correctly, you also appear to have a doctor who cares enough about that data to do the necessary paperwork to get you the ASV you need.

If you are pretty sure that you'll have an ASV in 2-4 weeks, then I would suggest not getting too worried about the sleep between now and then. Keep working with the mask to fix the leak problems---whatever you learn about controlling the leaks on your current machine will help when you are dealing with leaks on the ASV when you get it. Keep in mind that some people find leaks a real issue on ASVs because of the large difference in EPAP and IPAP needed to properly treat the CAs by triggering inhalations when you are not making the effort to breathe on your own.

Hi SleepingBill,
I am new to this as well but seem to be having a similar problem. I was diagnosed Feb 2 with moderate sleep apnea AHI 22/hr. CAI of 0.7/hr. I did have a small Central component.
When I first started using my Autoset on some nights my AHI was higher than first diagnosed.(ie 36 and 27) And virtually all of them were 'clear airways'. I started to get worried.
I was told by my sleep therapist that she had seen a number of patients like me with high centrals at the beginning of CPAP therapy. She assured me that they would go down as my mind got used to CPAP. Over the last couple of months, that is what happened.
My AHI is now always under 5, usually under 1.5.
I still get 'clear airways' but they have been reduced drastically after 3 months on CPAP.
If you search Google with 'CPAP induced or CPAP emergent central apnea', you can find some studies done specific to what we are going through. They report that a certain percentage 'spontaneously' resolve.
Did your sleep study say you had a Central component? If it didn't, there is a chance that the Centrals may not be a problem in a couple of months.
Apparently, the Autoset is also not great for addressing the Centrals. A fixed pressure setting, might be better.
Sleeprider, a very experience CPAP poster, has suggestions for settings for this type of issue. He posts on ApneaBoard, I am not sure whether he posts here.

robysue wrote: While you are reading the data correctly, you also appear to have a doctor who cares enough about that data to do the necessary paperwork to get you the ASV you need.

If you are pretty sure that you'll have an ASV in 2-4 weeks, then I would suggest not getting too worried about the sleep between now and then. Keep working with the mask to fix the leak problems---whatever you learn about controlling the leaks on your current machine will help when you are dealing with leaks on the ASV when you get it. Keep in mind that some people find leaks a real issue on ASVs because of the large difference in EPAP and IPAP needed to properly treat the CAs by triggering inhalations when you are not making the effort to breathe on your own.

Thanks, I feel very fortunate to have a doctor that is fighting for me. I'm still having some leak problems, but it's getting better every night. I'm going to post the latest data, because the improvement in AHIs in just a few days is pretty dramatic. Does it really go from 30s to less than 5 in a few days? And those are Centrals that are dropping.

Mogy wrote: Did your sleep study say you had a Central component? If it didn't, there is a chance that the Centrals may not be a problem in a couple of months.

I just jumped to the conclusion that the Centrals where already there, and caused by the buprenorphine. I'm going to ask for the sleep study and find out.

Mogy wrote:Hi SleepingBill,
I was told by my sleep therapist that she had seen a number of patients like me with high centrals at the beginning of CPAP therapy. She assured me that they would go down as my mind got used to CPAP. Over the last couple of months, that is what happened.
My AHI is now always under 5, usually under 1.5.

This has already happened in a few days. Last night I had AHI of 2.48 with a total of 12 Centrals, which was 100+ Centrals and TTIA above half an hour just a few nights ago. I'm hoping this keeps up, makes me wonder if ASV is needed.

SleepingBill wrote:

robysue wrote: Thanks, I feel very fortunate to have a doctor that is fighting for me. I'm still having some leak problems, but it's getting better every night. I'm going to post the latest data, because the improvement in AHIs in just a few days is pretty dramatic. Does it really go from 30s to less than 5 in a few days? And those are Centrals that are dropping.

Some people have their AHI drop from the 60s to less than 5 as soon as they start CPAP.

As for the decrease in your CAs: Some people have an significant increase in CAs when they first start CPAP therapy. For many of these people, the problem resolves itself after a few weeks. In other words, while the CAI > 5 for first couple of weeks, as their body starts to learn how to regulate the CO2 levels in the blood in the presence of CPAP, the pressure induced CAs start to disappear. And within a few weeks, the CAI is nice and low and the total AHI is less than 5, and often significantly less than 5. That's why many sleep docs and most insurance companies will not immediately move a person to an ASV machine if there were no CAs (or very few CAs) recorded during the initial, diagnostic sleep study.

If, however, the number of CAs does NOT start to decrease within a few weeks of starting CPAP therapy and the CAI continues to be high (over 5), the problem might indicate the person has complex sleep apnea and another in-lab titration study to document whether the machine recorded CAs are real CAs may be needed before insurance will pay to switch the patient to an ASV machine, which will treat the CAs as well as the OAs and Hs.

Hi robysue,
Thanks for the explanation on CAs at the beginning of CPAP therapy.
As SleepingBill and I have said it can be worrisome for newbies with this problem. A couple of months ago I went searching on this forum and elsewhere but did not find an explanation like you have just given.

Thanks again.

robysue wrote:As for the decrease in your CAs: Some people have an significant increase in CAs when they first start CPAP therapy. For many of these people, the problem resolves itself after a few weeks. In other words, while the CAI > 5 for first couple of weeks, as their body starts to learn how to regulate the CO2 levels in the blood in the presence of CPAP, the pressure induced CAs start to disappear. And within a few weeks, the CAI is nice and low and the total AHI is less than 5, and often significantly less than 5. That's why many sleep docs and most insurance companies will not immediately move a person to an ASV machine if there were no CAs (or very few CAs) recorded during the initial, diagnostic sleep study.

This is exactly what's happened. I checked my take home sleep report, and it didn't show any CAs, so I appear to be the group of getting CAs starting up with CPAP.

A week ago I was at AHI 18, TTIA 36:27 and it was almost all CA with a total of 136 CAs:


Last night, AHI 5, TTIA 9:20 and total of 5 CAs:


I seem to have a problem with leaks at higher pressure. Is the leak leading to apneas, which leads to higher pressure? Or apneas means the pressure increases which leads to leaks? If I can get the leaks down, will I see a decrease in the remaining AHI?

I've got an interesting dichotomy in terms of how I feel: it's much easier for me to get out of bed in the morning now that I'm on CPAP, but I'm actually even more tired during the day. I'm even more likely to fall asleep during an overly engaging (NOT) afternoon meeting. My AHI from the take home sleep study was 89.

It just doesn't make sense to me going from AHI 89 to 5 that I'm more tired. I likely had severe untreated OSA for a number of years. Has anyone else had this experience? Does it take a long time to recover from that, and do you actually recover?