Central Apneas and Exhale Relief

Hello Again,

I have been a CPAP user since 1998 but not always compliant and a member of this board probably close to that long under various email address and user names (I have so much trouble with login from time to time) . I have recently been back using on a regular basis for about 6 months now. I just purchased in early June a new Resmed Airsense 10 APAP to upgrade much older equipment and finally found a mask that seems to work well for me (the Amara Full Face) and this is my first experiment with the full face mask that has been successful.

I have some pretty lousy numbers overall but with the aid of an oximeter for all night tracking I see I am getting enough Oxygen very seldom dipping below 90 (the worst time is the first hour after falling asleep).
The four week average for overall AHI is about 30 and the overall average for central apneas is 20.

Last night was my best night yet with an AHI of 20 and central apnea of 7. I have been supplying about 1 liter of oxygen for the first hour to help with the initial drop.

Some more information: I had heart surgery about 2 years ago with 3 stents so I imagine that increases the central apnea index. My pressure I set at 12 max, down from 20 and that has helped because it stops all the leaking I think.

My question is: does anyone think it would be beneficial to use the exhale relief that is available on this device?

Kirby Benson, Las Cruces, NM

Impossible to offer much in the way of ideas without seeing for sure what is going on in detail.

Get OSCAR and post a typical detailed report.

viewtopic/t158560/How-to-post-images-for-review.html

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

If you are having a lot of central apneas now....I don't know that turning on exhale relief is the best option. Sometimes it actually can make a person have even more centrals.

Oh...do you take any medications of any kind? If so, what?
Some meds suppress respiration and can impact centrals and that's why I asked.
Also...at what altitude do you live?

Thank you for the reply. Here is my chart from last night I lowered the pressure to 11 to see what would happen. I live at 4500 ft in New Mexico. I take several medications. I will be 82 later this month. I am not overweight - in fact, just the opposite.
Aspirin – 81 mg daily AM
Atorvastatin – 20 mg daily PM
Carvedilol – 3.125 mg daily AM (Heart)
Hydroxyurea 500 mg daily PM (Platelets)
Lisinopril 2.5 mg daily PM (Heart)
Zolpidem – 5 - 10 mg daily PM
Mirtazapine – 45 mg daily PM (Sleep)
Celexa – 40 mg daily AM (Depression)
Levothyroxin – 50mcg – Thyroid
Pantoprazole – 40 mg daily

Oh my...that is ugly isn't it.

Did you sleep soundly last night for the most part of spend large amounts of time with mask on but awake?

Tell me .....Were you awake during all that green flagged time span?

Is your doctor aware of the number of centrals?

Your probably need to go here and watch all the videos and learn how to zoom in on the flow rate...watch all the videos especially the last one.
http://freecpapadvice.com/sleepyhead-free-software

First thing we have to figure out is how much of that ugly central stuff is awake flagging or asleep flagging. We can pooh pooh off some awake flagging but can't pooh pooh off asleep flagged centrals in these numbers.

Being at your altitude...it can also be a factor. Have you ever gone somewhere and used the machine at a lower altitude to see if you still had that many centrals?

Adding in EPR right now...won't fix the central issue and will likely make the obstructive stuff worse so you would need to compensate for that with more pressure which might in turn make the centrals worse.

Thank you Pugsy. No, I was asleep during the entire night except for awake periods to pee that are shown on the chart. I do not have a sleep doc right now and am looking for one but the choices are limited here. The sleep study I did many years ago I was only able to sleep about an hour or two - just enough time to get some readings. I will do the videos like you suggest but I need to look at other areas of my life that could be causal. Or at least, some correlation. I do use cannabis as a sleep aid (licensed user) and I have not done any research in that area yet.

I appreciate your candidness and your help. You are already helping me.

I do not know how much cannabis might be impacting things...but I know pain meds can for sure. I have never researched cannabis and the impact it might have on respiration suppression.
Centrals happen because of an unstable breathing pattern sometimes brought on my suppressed respiration.
We get an imbalance in the blood gases and the carbon dioxide levels stay below the threshold for the brain to send the breathe signal.
It's actually carbon dioxide levels that cause the brain to send the signal to breathe.
When you see the central apneas you simply aren't breathing. Hold your breath for 10 seconds...that's essentially a 10 second central apnea. The airway is open but no air is moving because you aren't trying to breath. We pause our breathing all the time...sleep or awake but its sporadic and rare. A handful of centrals when asleep isn't a big deal but you are having a lot more than a handful. It's going to make you feel like crap because it can disturb sleep just like the obstructive stuff and disturb sleep and they can also cause desats as well which we both know isn't good.

If you don't already have one...get one of those overnight recording pulse oximeters so you can at least monitor your oxygen levels. Your number of centrals warrants concern for sure. CMS 50 D Plus or higher...and it's compatible with OSCAR...50 to 100 bucks depending on which model you get. I like the looks of the CMS 50 F myself...if I was going to get one that would be it. Not horribly expensive and does what I would want it to do.

If you get a chance to go visit someone at a lower altitude....you can check to see how much altitude might be a factor.
I know people who have a truckload of centrals at your altitude and none at lower...so that's also something to check out.

See if the cannabis is a factor...it's not impossible.

If we can't figure out a solution...you need a different kind of machine. One of those ASV machines because you need more pressure for just the OAs and hyponeas you are seeing and more pressure will very likely make the centrals worse and they are already pretty bad.

Pugsy,

I have been monitoring the O2 for a month now since I got the new ResMed APAP. Here is a typical one from last night. I am actually feeling pretty good most of these days since I got the ResMed. But the high number of central's has me concerned. Interestingly, cannabis has been approved in our state for the treatment of apnea even though the AASM recommends against it. Go figure. There is definitely a correlation between the central apneas and the O2 drops as one would expect. Interesting to look at this stuff isn't it?

You don't spend much time below 90% with your O2....so at least the centrals aren't causing a huge prolonged drop but they are obviously causing a drop.
I haven't had time to try find any research (if there is even any) about cannabis and centrals sleep apnea as opposed to obstructive sleep apnea and respiratory suppression and then we have your altitude added in the mix.

Obviously you need an experiment without cannabis in your system to see if there is any impact.
It might be fine for obstructive apnea and not good for central apnea...or it may make no real difference once way or the other.

You also need an experiment at a much lower altitude to see just how much altitude is a factor for you with the centrals.

Or we just find you an ASV machine and go the DIY route... It will deal with both your obstructive apnea and central apneas quite nicely.

OK..The one is easy to do but getting to a lower altitude is not in the cards. It will take awhile to gather enough data to make an educated shot at seeing if the Cannabis is causal in anyway. In the meantime, I am going to do some research on the ASV machines. One thing I have read is that for patients with heart disease (me) there is some risk using an ASV pap if the disease is severe enough. I can live with the OSAs if lowering the pressure can do away with the CSAs. We can't always have everything we want but we can try. There seem to be many trade-offs in this apnea world. It should not be too difficult for me to get one if I decide to go that route. In the meantime...thanks again Pugsy. Keep the faith!

Your heart disease....how bad is it? Do you know the ejection rate by chance?

There are some new studies that have been done that sort of negate that first poorly done study that scared the hell out of some people on ASV with congestive heart failure..
It wasn't a good study but it sure scared people. They took really, really sick people who didn't even use the ASV 4 hours a night or even every night ...and not a large number either....and then they were surprised when really, really sick people who weren't compliant with ASV usage for central apneas up and died at a slightly higher rate....duh....and it was a big surprised they died. Sure wouldn't have been to me.
It's entirely possible that they would have died anyway and it wasn't related to ASV at all.

I don't know the data on my heart but I have three stents but no restrictions on activity, diet, etc, etc. Not a complete recovery since there is some dead tissue in one small area. So, given that information I may be a good candidate for the ASV machine. Getting one will be no problem. Thanks for letting me know about the study.

It's people who have a history of congestive heart failure with ejection rates less the 45 that were of concern in that original study.
Just because you had the stents doesn't mean you had/have congestive heart failure.
Minor heart damage doesn't necessarily mean congestive heart failure either. People can have congestive heart failure with no history of heart attacks.