Mild apnea/UARS/ASV (CPAP triggers centrals)

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Tue Feb 08, 2022 10:19 am

So....tell us about your symptoms overall...be specific if you can.
You haven't had any sort of sleep study done yet??? Is that correct?

Do you take any medications of any kind? If so, what?
Any sort of pain treatment going on? Patches or whatever???

Were you for sure pretty much sound asleep from roughly 2 AM to 8 AM or did you spend a lot of time awake?
Like were you awake or not from 7:30 to 8AM and just laying there with mask and machine on?

If you were indeed asleep for the bulk of the night then I am not surprised you feel like crap.
If you were awake for the bulk of the night we need to work on getting your to sleep.

You are going to likely need a crash course in figuring out if those centrals/CAs are awake/arousal related or the real deal asleep flagged events.
Watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software
It wouldn't be impossible for the central flags to be secondary to the OAs and hyponeas that are going untreated.
Meaning if we could reduce the OAs/hyponeas the centrals might reduce.
It also wouldn't be impossible that you have both obstructive sleep apnea AND central sleep apnea and if that's the case we need to have a discussion about machine options....which are limited for dealing with central apneas.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Tue Feb 08, 2022 11:32 am

I'm feeling pretty rough today, this might be all over the place.

Symptoms are being zoned out a lot of the time, tired but not sleepy, sleeping 10 hours and still not wanting to get out of bed, snoring and gasping, dry mouth, drop in sex-drive, laziness/lack of motivation. Not sure how specific I can be there but am happy to give more info if I think of anything.

No sleep study done yet...I'm trying believe me.

I take Vyvanse 40mg as a stimulant, doesn't affect my sleep schedule as much as you'd expect it to. No pain treatment.

I was reading with the Bleep on for an hour or so to get comfortable before turning on the CPAP near 1:30ish and fell asleep soon thereafter. Slept the whole time until 7-8ish where the pressure got too high for me and air shot out of my mouth waking me up. I was in and out of sleep after that until I removed the mask as the pressure was hurting my throat a bit.


Full story that might give more context to symptoms is below.

------

Bear with me I might be making some connections that I can't 100% confirm, more just thoughts and I can get a little rambly.

About 5-ish years ago I started putting on some weight after being admittedly pretty underweight in college and it felt like overnight I went from being a straight-A engineering student to not having the drive/energy to even show up for classes or do my homework. Spent a lot of time trying to solve things myself through various means like nootropics and supplements, but basically just spent the next 5 years in a daze. I never really felt sleepy, just fatigued most of the time with a general foggy mind and inability to do...anything of consequence. If it was important I wouldn't do it -depression hit, drive dropped, etc.

Finally after years of this I sought out help instead of trying to solve it all myself and was diagnosed with ADHD. Feeling like I was on a roll, I started getting everything more together while also getting a stimulant prescription which...helped mostly if only temporarily, but I'm still not super fond of the sides. Things had been going pretty well, but post-Christmas 2021 (things got cold and dry, finally dropping into freezing temperatures) I've kinda fallen back into the rut of fatigue, 10+ hours of sleep still feeling exhausted, dark circles, red eyes, dip in emotional feeling and drive.

I started to set up a sleep study in early November after my wife complained about not only my snoring -but also me gasping for air keeping her awake and my dentist mentioning that I have an obstructive palate. Months later I'm still waiting on it, but got tired of waiting and found a killer deal on a cpap locally and picked it up. Hope to have the study this month, I'm finally just waiting on insurance and not the sleep study company -avoid SleepMed, they're very unprofessional and slow.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Tue Feb 08, 2022 11:54 am

Your really need either an in lab sleep study or a Type 2 home sleep study...preferably an in lab study.

Can you get us a screen shot of the Flow Limitation graph included in your detailed report???

While waiting for the sleep study I have an idea to try....no guarantees but at this point anything is worth trying.

Change your pressure settings to minimum at 8 cm and max at 9 cm.
If you just absolutely can't manage 8 cm then try 7 cm but still limit the max to 9.

We have no way of knowing if these centrals we see flagged were present before starting cpap or not so we don't know if changing anything on the settings will help or not.

When you do get schedule for the sleep study...don't use the cpap for at least 3 nights prior to the sleep study.
Want to eliminate any chance of a hangover effect clouding the study.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Tue Feb 08, 2022 11:59 am

Flow.PNG
Flow.PNG (7.8 KiB) Viewed 844 times
It'll be an in-lab study fortunately, not sure if there's nuance there or anything I'd need to request. 11+ is about my limit at least when trying to fall asleep with it, the machine read 12 when I woke up -can definitely try to change my settings.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Tue Feb 08, 2022 12:15 pm

Thanks for the FL graph...it looks like I expect it to look and likely part of what is driving your pressures up a bit.

Since we don't know for sure if it is the cpap use that is causing the centrals (it can in about 10 to 15% of the people who start cpap) or if you had the centrals prior to even starting cpap (this is also a possibility) about all we can do is try what we known might help (no guarantees) should cpap use itself be the cause of the centrals.

Sometimes auto mode with full auto isn't the best option and it can trigger centrals.
Hence my idea to run cpap at a really tight range...very little auto adjusting.
I know you will likely max out the pressure with the limitation at 9 cm but we have to start with the basics and see what happens. A lot of that pressure changing going on is from the FLs and right now the centrals are a bigger problem than the FLs.

While centrals can happen at any pressure...the chance of the pressure being a trigger increases as the pressure goes up and you seem to have more centrals at 10 cm and above. So that's why I want to limit the max to see if the number of centrals changes at all.

I have on a very rare occasion seen centrals essentially go away just by changing from auto mode to a more fixed mode or at least a really tight range auto mode.
To be honest it's really about all we can do for centrals with this machine unless we make the machine a bilevel and use EPR which might help or might even make things worse.

I don't like making too many changes at one time so lets try this change first and see what happens...if anything.

If your centrals are something you had prior to starting cpap....it's really unlikely that we can do much and you might need a different machine. That is something the sleep study would help figure out though.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Tue Feb 08, 2022 12:34 pm

Yeah, the more I've dug in the more I've seen the recommendation to not use the autoset functionality. I'll try it on a very narrow range this evening and see what happens.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Tue Feb 08, 2022 1:07 pm

Most of the time the auto adjusting mode actually works out great for most people.
But there are a few who find that it doesn't work out so great and nothing wrong with it.
Auto mode doesn't always cause a problem....and it might not be causing your problem either.

At this point without any sleep study data to draw upon I am just making educated guesses based on the report alone.

I use Auto adjusting mode myself...I have since 2009 when I started cpap. Works great for me because in REM sleep I need a lot more pressure than in non REM sleep. Much nicer to use the higher pressures only in REM when I need them than all night long just to cover REM.

So I don't know that auto mode is a problem for you but with your machine we don't have a lot of options to try to reduce those central apneas.
I figure might as well try what little options we have available...might get lucky. It happens sometimes...couple of months ago on another forum I ran across a woman with a high central apnea only count...a bit higher than yours but not any real OA/hyponeas to speak of. We tried all the usual options and nothing worked so on a lark I suggested fixed cpap pressure. Didn't really expect any success and told her that right up front but it was the last option available to try.
Low and behold it worked...pretty much all her centrals went away. Could have knocked me over with a feather as I really was 99.99 % sure it wouldn't help ....but it did.
I guess that proves why people get put on cpap first even with central apnea.....because sometimes it works. It might be a rare "sometimes" but it certainly is worth trying especially when we don't have a lot of choices and are waiting on even getting a sleep study to know exactly what is going on.

I would much rather you be able to use this $40 machine if at all possible.
The machine that can treat both obstructive apneas and central apneas will run well north of 2 K for even a used machine and that's not counting all the hassles involved to get it even with insurance helping out.

So all we can do is offer options that might or might not work but anything is fair game to try. We might get lucky.
Might not ...but at least we tried.

So right now based on what we see here and how you feel and assuming the bulk of the night you actually slept...
We see a combination of enough apnea events to meet the diagnosis of complex sleep apnea.
That's when a person has both obstructive sleep apnea and central sleep apnea.
What we don't know is if you had the central sleep apnea prior to starting on the cpap or not. We can't know that without a sleep study.

But we can proceed with what options you do have available to try to reduce the centrals.
Granted not many with this machine but there are a few.

The OAs and hyponeas...that's the obstructive sleep apnea events. You were still having more of those than we would like to see but for now I am putting them on the back burner as they are easy to deal with.
Problem is that what fixes the OAs easily can sometimes cause more centrals so we proceed with caution.
Baby steps when we are so limited in what we know and we sure don't want to make things worse.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Wed Feb 09, 2022 11:06 am

Apnea2.PNG
Apnea2.PNG (67.01 KiB) Viewed 803 times
Definitely better, still feel pretty exhausted but I kinda blame myself for messing up how I put on the bleep. Pressure was getting under the adhesive and they ballooned out over the night -I taped them down but once again eventually took them off a couple of hours before waking up.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Wed Feb 09, 2022 11:12 am

Were you sort of awake and fiddling with the Bleep that last hour where the green flagging is happening??
If so then we can ignore that stuff and the overall AHI and number of centrals would be less.

Lets see what happens tonight and hopefully you can get the Bleep to stick better.
Remember skin prep is critical. Do an extra good job of washing and then wiping with alcohol or whatever astringent you are using.
I attempted to cheat the other night....tape came loose at the bottom of my nostril in a tiny spot....but it was sure hugely annoying. I cheated...attempted to just use the alcohol and blew off the washing.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Wed Feb 09, 2022 11:19 am

For me it was putting it on out of the shower -prepped and everything right but sweat a little afterwards under the adhesive. I was in and out for the last bit fiddling with it; I'm surprised it didn't appear to leak, but I did use plenty of tape.

I have a face-mask sizing kit coming my way soon that I plan on trying as well, maybe that'll work out better for me.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Wed Feb 09, 2022 11:45 am

Not all leaks that are big enough to annoy us will show up on the leak graph itself.
Part of it probably has to do the sampling size and time. Like if it is 5 seconds and we stop it...it might not even show up.
I forget the sample recording times for leaks.

I know I have woke up to very brief and big leaks and thought for sure I would spot them on the leak graph but they just aren't there.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
zonker
Posts: 11011
Joined: Fri Jun 19, 2015 4:36 pm

Re: New Airsense 10 User

Post by zonker » Wed Feb 09, 2022 11:49 am

Pugsy wrote:
Wed Feb 09, 2022 11:45 am
Not all leaks that are big enough to annoy us will show up on the leak graph itself.
just want to quote this to underline the truth of the statement. had some leaks myself last night with my p10 mask. was fiddling with it off and on. thought sure i'd see a large leak this morning, but no.
people say i'm self absorbed.
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Sat Feb 19, 2022 3:26 pm

Apnea3.PNG
Apnea3.PNG (136.39 KiB) Viewed 715 times
Took some time off of the machine while I waited for a more traditional face mask to arrive. Actually plan on trying it again tonight followed by the bleep a couple of nights in a row to compare. Thinking I might need to lower the pressure slightly? Basically obstructive has become a complete non-issue -feel great today compared to yesterday when I didn't use the machine but am afraid that the pressure still might be causing centrals.

ophiuchus
Posts: 34
Joined: Fri Jan 28, 2022 1:30 pm

Re: New Airsense 10 User

Post by ophiuchus » Mon Feb 21, 2022 10:35 am

Slept awful with and without the machine this weekend -basically all centrals unfortunately...Fiddled a little with pressure and made it worse by adding obstructives back in.

If it's the pressure potentially causing 'some' centrals, would a device like the iNap suit me better? Obviously an ASV would be ideal and my sleep test is set for the 5th, but just kinda looking around at everything out there.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: New Airsense 10 User

Post by Pugsy » Mon Feb 21, 2022 11:01 am

ophiuchus wrote:
Mon Feb 21, 2022 10:35 am

If it's the pressure potentially causing 'some' centrals, would a device like the iNap suit me better? Obviously an ASV would be ideal and my sleep test is set for the 5th, but just kinda looking around at everything out there.
The problem is that we don't know if those centrals are caused by cpap pressure itself or you would have them anyway even if you weren't on cpap.

If you would have had them anyway....iNap clearly states an exclusion for central sleep apnea
https://www.inapsleep.online/
Exclusion criteria



Patients who have been diagnosed with predominant Central Sleep Apnea.

Patients under 21

Permanent nasal blockage

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.