Lots of Centrals - New to CPAP

Hi All

I had a sleep study done and had a really high AHI of almost 100... using CPAP I'm getting around 12ish now, but most of these are central apneas.
Any help on making tweaks etc would be greatly appreciated.

https://imgur.com/a/9eD74lJ

Have included 3 days, and the sleep study.

Cheers

Was the sleep study done in a lab with tech watching or was the sleep study a home study?

What altitude are you at?

It appears that you are having approx the same number of centrals using the machine as you had with the sleep study.
How long have you been using the machine?

Sleep study done in a lab

I live in Melbourne, Australia, so elevation of 31m (according to google)

Been using it for a week

You need to be talking to your doctor about those centrals.
You had them prior to starting cpap therapy so we can't blame cpap therapy for causing them.
Your altitude isn't excessive so we can't blame altitude.

There's really nothing on your machine in terms of settings, that we can tweak, that will do anything to help reduce those centrals. This model machine was never designed to treat central apneas. A different kind of machine that can deal with both central apneas and obstructive apneas is needed because the other machine can actually breathe for you when you have a central apnea. This current machine simply can't do it.

Now sometimes (not very often) central apneas can be resolved (or at least markedly lessened) with just cpap but most of the time when people have central apneas during the diagnostic study that are too numerous (yours are too numerous) they end up on an ASV type of machine.

The only thing that comes to my mind that you might try ....and it's a long shot for sure....is to try fixed pressure instead of auto adjusting pressure mode. Worth at least trying though. Miracles do happen and I have seen it twice now where fixed cpap eliminated centrals for someone who had too many centrals on the diagnostic sleep study.

1....make an appt to have a chat with your doctor about those centrals
2....try fixed pressures....you can keep auto mode but just set the minimum and maximum to the same setting.
Like minimum 6 or 7 and maximum 6 or 7 (whichever is more comfortable).

A footnote to Pugsy's post: I don't know how it works in Australia, but in the U.S. it's common to prescribe a regular PAP machine for people with central or mixed apnea (central + obstructive) to see whether by some wild chance it works. If it doesn't, the next step is often to have the patient use a bi-level machine. Only if that doesn't work is the patient prescribed an ASV machine (adaptive servo-ventilation), which is designed to help people with central or mixed apnea. ASV machines are a lot more expensive than regular or bi-level machines.

This is a ridiculous system, in my opinion. Sometimes a sleep doctor will instead have the patient come into a sleep lab for a titration study. The patient uses a mask and machine, and the machine's settings are changed throughout the night to see what works best. The machine can emulate a regular PAP machine, a bi-level machine, and an ASV machine. This makes a lot more sense to me.

So by all means talk with your doctor about the centrals, and if he/she wants you to try a bi-level at home, ask about a titration study that includes an ASV mode.

I hope, though, that you're that rare person Pugsy wrote about who benefits from a fixed pressure!

I am one of those that fixed pressure helped to reduce centrals a lot. Initial AHI 58, now its around 3. Still not happy but thats another story. So I would give it a shot.

And get your heart and brain checked thoroughly for a potential root cause of the centrals.

Herbert wrote: ↑

Sat Jul 15, 2023 8:43 am

And get your heart and brain checked thoroughly for a potential root cause of the centrals.

Amen, Amen ..... need to rule out neurologic and cardiac causations.