Newbie cpap fixed pressure x central

[marcio_br]

Hello everyone
I've been following this forum for a long time and it has helping me a lot.

So, five years ago I was diagnosed with OSA, I don't remember how many events but something like moderate to severe, and I bought a fixed pressure cpap and many masks later I ended up giving up, because I didnt adapted do the treateament.

But this year, because of the awful nights of sleep, I decided to go back to the doctor and do another sleep study in a lab.

I had an ahi of 32 during my test. All of them was Hypoapnea, 0 centrals and 0 obstructive.

I'm still getting use to the therapy and until now I couldn't use for a whole night. I've tried a higher pressure, but above 10 I have aerophagia

My problem is, Although the time of use with CPAP is increasing day by day, I always wake up and Im a bit worried with the central apneas because sometimes I feel out of breath while sleeping and using the cpap.

This have to do with the fact that I'm using a fixed pressure cpap, insteado of an auto?

Could you guys please analise my numbers and give some advice.

These two were the last two nights

P.S. Sorry for my convoluted text. English is not my native language.

[Pugsy]

It's normal to have a few central apneas even when asleep. No big deal and the number you are having falls into that category.

First of all it's normal to have what we call sleep onset centrals that happen during the transition from awake to asleep. Unless they keep bouncing us out of sleep or so numerous they cause desats the doctors won't do anything.

Second it is entirely possible that your flagged centrals are arousal/awake breathing related false positives. If you weren't asleep they don't count.

You can go here and watch the videos and learn how to zoom in on the flow rate and try to figure out if what you see flagged is awake related or just normal sleep transition centrals.
http://freecpapadvice.com/sleepyhead-free-software

More pressure won't fix centrals anyway....so get the idea that you need more pressure and can't use it because of aerophagia out of your head. You don't need more pressure.

You aren't having enough centrals to worry about. If you were having enough to worry about the first thing to try would be reduce EPR because sometimes EPR causes centrals but I seriously doubt that is your issue because if it was you would see a lot more centrals than you are seeing.

First thing to do IMHO....go figure out of those centrals flagged were even asleep centrals. I am betting on false positive flagging due to being awake.
Now why you were awake...we have no way to know but it is normal to wake after REM stage sleep and when you are having those centrals certainly seems to coincide when a person might normally be in REM stage sleep. Google "sleep stages" and look at normal hypnograms and you will see what I mean.

[marcio_br]

Hey Pugsy,

Thanks for your attention.
Very informative video.
In my graph, some "flagged centrals" don't look like false positive.

[mper!?]

Hi,

_ Pugsy, interesting points on the centrals and REM stages;

_ actually, waking up just following REM stages is one of my residual problems after my 22 months of therapy and so many adjustments. Sometimes I am able to complete the stage, sometimes not, quite often truncated in the midle, somewhere, or close to the end; hate this! Even though the wake up is just for a few minutes, quite often I trip to toilet (most of the time unecessarily). Rigth these days, I am working on those wake ups, which I am associating with anxiety;

_ this case does not appear one more of untreated UARS, trying to succeed with the non-tailored machine (Autoset also would not work, very likely; better chances with the BiPAP)? ...marcio, I could hypothesize your "out of breath" while sleeping would be due untreated Fow Limitations, in particular during REM stages.

all the best and good luck

[Pugsy]

some "flagged centrals" don't look like false positive.

Some do look like real asleep and some do look like arousal related. When we evaluate flow rate flagged events we also evaluate the breathing pattern prior to the flagged event.

It is normal to have a few real asleep centrals flagged....normal and expected.
In the US...at least 5 per hour central average every night before anyone gets excited about the number of centrals.
Obviously you aren't having enough centrals throughout the night to warrant doing anything about them.

If they bug you though....talk to your doctor about them but here in the US the doctor's won't even raise an eyebrow with what you are showing.

Now you could try turning off EPR or just reducing it and see if the centrals still happen. I suspect they will but it hurts nothing to reduce EPR or turn it off and see what happens as long as you are comfortable with the change and sleep well with the change.

[marcio_br]

...marcio, I could hypothesize your "out of breath" while sleeping would be due untreated Fow Limitations, in particular during REM stages.

Good point mperl. I will keep this in mind.

I'll follow Pugsy advice and reduce the EPR a bit and see what happens.

Thanks for your comments!