Now have central apnea since starting CPAP therapy

[caynana]

I'm a newbie and have only been on CPAP therapy just over 2 weeks. My sleep lab AHI was 9/hr. I had no central apneas in the sleep lab. Now that I've started therapy, I have lots of clear airway/central apneas showing up. In fact, my central apneas are now more than my obstructive apneas many nights. I was told that central apneas are "not good", so I'm concerned about this new development and wonder what could be causing it and if there's anything I can do about it.

[Pugsy]

Who told you "not good" and how many centrals are you seeing?

What machine are you using? Exactly what pressures are you using?
If using some form of exhale relief...exactly what setting?

As for what is causing it....assuming they are real centrals it just happens to some people when cpap pressure gets added to the mix.
It's called complex sleep apnea and as to what can be done about it...several ways to go about fixing it and which choice depends on just how bad it is.

It might just resolve on its own with a bit of time as the body gets used to things.
You might need a different machine of some sort.

This video explains the why it happens
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be
Now it is put out by ResMed and they do on to promote their special machine for dealing with centrals...and you may or may not need that type of machine so don't jump to panic mode about thinking about a different machine.

Your doctor will decide on the appropriate therapy and he may opt for the "give it time" thing as the first option because sometimes it works.
There might also be some tweaks that could be tried with your current machine...wouldn't hurt and might help.

[Wulfman...]

I'm a newbie and have only been on CPAP therapy just over 2 weeks. My sleep lab AHI was 9/hr. I had no central apneas in the sleep lab. Now that I've started therapy, I have lots of clear airway/central apneas showing up. In fact, my central apneas are now more than my obstructive apneas many nights. I was told that central apneas are "not good", so I'm concerned about this new development and wonder what could be causing it and if there's anything I can do about it.

Highly unlikely that you've developed Central Apneas since starting therapy.
Could be that if you're awake when they're showing up, your breathing may be confusing how it categorizes the events.
The "CA" designation means "Clear Airway", not necessarily "Central Apnea".


Den

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[Pugsy]

Last I read about 20 % of the people who started cpap therapy for OSA only did develop complex sleep apnea (had centrals pop up that weren't a problem without cpap). It's not all that common but it's common enough that most people know how to handle it effectively.
Assuming the centrals are "real" and not sleep/wake/junk centrals.

So how much of a problem depends on how many and are they real or not.
They can be real though...20% (depending on what studies you read) of cpap users get complex sleep apnea just from adding cpap pressures.

[Wulfman...]

And, without having more details about what machine, what settings, what's happening during the night.......we don't know whether they may be "pressure-induced Centrals" either. Supposedly, about 15% of users may be susceptible to those.


Den

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[Biguugly]

Took 6 weeks for same situation to resolve itself with me. Time and lowering pressure did it for me. Also stopped fairly severe arrhythmia. Hope it'll work for you.

[caynana]

I have the Resmed Airsense 10 for her with settings starting at 5 and going up to 10. I have the heated hose and am now on my 3rd mask already. I'm now using the Dreamwear with gel cushion (no prongs) and it's comfortable so far. (Started with nasal pillows but my nose got really dry and sore even with humidity and was having air leaks which I thought were probably due to mouth breathing, so tried the Airtouch F20 full face mask. My AHI went up over 12 (worse than my AHI 9 in the sleep lab with no CPAP therapy). I purchased the Dreamwear on my own since I had already used up my 1 "free" mask exchange with the medical supplier. The sleepyhead results from last nite were CA 26 events, my obstructive was 8 events and RERA 1 event. AHI was 3.95.

[Pugsy]

So from last night...
how many hours of sleep...real sleep..did you spend much time awake with machine on?
EPR..exhale relief on the ResMed machine...are you using it and if you are at what setting?

Can you share an image of the detailed report from SleepyHead for last night so we can see when those centrals got flagged?
See this thread for examples.
viewtopic/t103468/Need-help-with-screen-shots.html

and for how to use imgur to host your images if you don't know how
https://sleep.tnet.com/reference/tips/imgur

[Julie]

Also, if most of the CA's are just prior to your dropping off and/or awakening, that's normal, and they're called 'sleep-wake' junk, not problematic.

[Pugsy]

AHI was 3.95.

Even if every single one of those events were central and not SWJ... that's not enough to get the doctors to worry about them unless you were having so many you couldn't fall back to sleep or you were having some serious drops in oxygen from them.

Remember...an occasional central is normal and doesn't mean much...like a sleep onset central. Sleep onset centrals are real but they are a normal part of the transition to sleep. They are only a problem when we have a truckload of them for some reason or other.

[caynana]

[caynana]

Forgot to mention my EPR is set at 3 and the algorithm is set "for her". If the "for her" algorithm is more sensitive, do you think it might be picking up more sleep/wake/junk centrals? Would there by any reason to switch to the regular algorithm? Or could I lower the max pressure from 10 to 9 to see if I get less centrals? I appreciate all the feedback.

[Midnight Strangler]

Can you click on the Events tab and post the screenshot again. It would be helpful to see how long some of the events are. You will also need to open up the events to see when they happened and how long.

[Pugsy]

How many times do you think you are awake during the night?
Are those large leaks waking you up and do you fiddle with the mask a lot during the night?

Try this for tonight if you wake up and have the presence of mind...reach over and turn the machine off and then right back on.
It will show up as a break in therapy line and if you have some centrals flagged very close to that break in therapy then there is a real good chance the centrals are SWJ.

No...the for Her mode won't necessarily cause central flags that the other mode wouldn't flag.

No...I don't think that a reduction in the max from 10 to 9 will reduce the centrals because I don't think the pressure of 10 is causing the centrals. If you look at 2:30 you had a couple of central clusters and the pressure looks to be around 8 to 9 range.

Can you include the Flow Limitation graph please? I think that is likely what is driving the pressure upwards.

If I was going to do anything...assuming these centrals are real and we can't blame them on SWJ...I would turn off EPR and see what happens.
You probably need to learn about flow rate evaluation and deciding if the event is real or SWJ.
Jason has a good video on centrals and evaluating flow rate here...especially the bottom video of the 4.
http://freecpapadvice.com/sleepyhead-free-software

[TASmart]

Great resource material Pugsy. ThANKS!