How to get rid of centrals

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 11:10 am

I've more or less completely eliminated any obstructive apneas with a tongue restraining device. According to sleepyhead, my obstructive AHI is between 0.0 and 1.0 per night. My centrals are more of a problem, causing my AHI to be up to 3.0 every night. I wake up feeling awful and still have symptoms of untreated sleep apnea. How can I reduce these centrals? My pressure is 16-20. Would lowering the pressure have any effect on them? I don't use EPR and my original diagnosis was purely obstructive sleep apnea. At this point I'd rather have a tracheostomy than be strapped to a CPAP for life. Perpetual turtlenecks are a small price to pay for good sleep.

LSAT · Post by **LSAT** » Tue Apr 10, 2018 11:23 am

If your AHI is 3.0 your centrals are not real...they are what is called sleep/awake junk. Changing your pressure will not affect them.
Generally, Centrals that are numerous (Higher AHI) and appear in clumps can often be reduced by lowering pressure. If yours are not really centrals and you reduce pressure, you may increase real apnea events.

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 11:26 am

LSAT wrote: ↑
Tue Apr 10, 2018 11:23 am
If your AHI is 3.0 your centrals are not real...they are what is called sleep/awake junk. Changing your pressure will not affect them.
Generally, Centrals that are numerous (Higher AHI) and appear in clumps can often be reduced by lowering pressure. If yours are not really centrals and you reduce pressure, you may increase real apnea events.

They most definitely are not SWJ. They appear as a few dense clusters at different points throughout the night. I inspected the flow rate on sleepyhead and confirmed them to be centrals. It doesn't matter that my AHI is "only" 3.0. Sleepyhead is thick with them, they are visibly ruining my quality of sleep.

chunkyfrog · Post by **chunkyfrog** » Tue Apr 10, 2018 11:27 am

Ouch!
The very thought of a tongue restraining device makes me cringe!
One would certainly keep me awake!
I cannot imagine how you do it.
Or why.
It appears that the centrals may be a side effect of the device.
Experimentation might reveal the facts.

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 11:30 am

chunkyfrog wrote: ↑
Tue Apr 10, 2018 11:27 am
Ouch!
The very thought of a tongue restraining device makes me cringe!
One would certainly keep me awake!
I cannot imagine how you do it.
Or why.
It appears that the centrals may be a side effect of the device.
Experimentation might reveal the facts.

What kind of experimentation might you suggest, chunky? I don't see how the tongue restraining device could cause centrals. Those are probably CPAP induced. What sort of pressure change could take care of them?

chunkyfrog · Post by **chunkyfrog** » Tue Apr 10, 2018 11:31 am

Spit it out, and just use cpap.
Cpap alone is way less invasive.
How do you know that the device is stopping the apneas--not the cpap?

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 11:34 am

chunkyfrog wrote: ↑
Tue Apr 10, 2018 11:31 am
Spit it out, and just use cpap.

I'd really like to, but without it my obstructives jump up and I have to use higher, central inducing pressure. It's not so bad. I had to make some modifications to it so it would stop raping my tender mouthflesh, but it's fine now.

Pugsy · Post by **Pugsy** » Tue Apr 10, 2018 11:35 am

They might be sleep onset centrals (assuming real) or a sleep stage transition central and if that's the case they are normal and nothing you can do about them nor need you do anything about them with numbers this small even if in small clusters.

You can't fix centrals with pressure changes (reductions) unless the pressure is causing them and unless they are happening all night long when you are at your whatever pressure...it's unlikely that pressure is the cause.
Not every central that is real is caused by cpap pressure high or low.

Sleep onset centrals...normal part of sleep and most doctors won't do anything about them unless the count is a lot higher than what you are seeing (and that's assuming that is what is being flagged in your case).
If they bug you too much then you need to consult with your doctor and get his input and what, if anything, can or needs to be done.

raisedfist · Post by **raisedfist** » Tue Apr 10, 2018 11:36 am

Try lowering your minimum pressure for a night and see what happens. Try 10 min / 20 max. Who knows if with this tongue restraining device, if you need 16 as your min pressure? It may not change a thing, but it's an easy thing to try.

Ron AKA · Post by **Ron AKA** » Tue Apr 10, 2018 11:51 am

How long have you been using a CPAP? I say that because it is not uncommon to see centrals increase for a while after starting treatment, and then in about 75% of those that have the issue it reduces again by 6-8 weeks. Here is a bit of info about it from Fisher&Paykel.

The True Prevalence of Central Apneas in CPAP Patients

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 11:54 am

Ron AKA wrote: ↑
Tue Apr 10, 2018 11:51 am
How long have you been using a CPAP? I say that because it is not uncommon to see centrals increase for a while after starting treatment, and then in about 75% of those that have the issue it reduces again by 6-8 weeks. Here is a bit of info about it from Fisher&Paykel.

The True Prevalence of Central Apneas in CPAP Patients

Four months

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 11:56 am

I'll post a screenshot from sleepyhead later this afternoon and hopefully someone can help me decide what type of centrals I'm having.

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 1:31 pm

: Screenshot (12).png (102.85 KiB) Viewed 681 times

: Screenshot (11).png (113.26 KiB) Viewed 681 times

Here is the overview of my night. And here is a central apnea up close; is this a typical wake/sleep stage transition central or is it pressure induced? Looking at the overall pattern of centrals throughout the night, would I benefit from lowering the minimum pressure of 16?

Pugsy · Post by **Pugsy** » Tue Apr 10, 2018 1:49 pm

DankShroud wrote: ↑
Tue Apr 10, 2018 1:31 pm
is this a typical wake/sleep stage transition central or is it pressure induced? Looking at the overall pattern of centrals throughout the night,

Looks like a post arousal central to me....SWJ.
Look at the flow pattern immediately preceding the flagged event and after the not flagged air flow reduction....see how irregular it is?
My suspicions....the non flagged reduction in air flow was real and it caused an arousal (partial wake up or full wake up that you may or may not remember) and then you paused your breathing while awake or halfway awake.

Now why the non flagged air flow reduction happened or why it wasn't flagged. Dunno....unless maybe it was just short of 10 seconds in duration. I am thinking probably an OA that didn't quite meet the 10 second criteria because the machine didn't use any FOT on it.

Look at this example below...see the nice asleep breathing regular air flow...then look at the irregular air flow and the flagged events during the irregular air flow....every single one of those flagged events is SWJ...none are real.
And I ran this by a sleep lab tech just to confirm my suspicions.

DankShroud · Post by **DankShroud** » Tue Apr 10, 2018 2:19 pm

Pugsy wrote: ↑
Tue Apr 10, 2018 1:49 pm

DankShroud wrote: ↑
Tue Apr 10, 2018 1:31 pm
is this a typical wake/sleep stage transition central or is it pressure induced? Looking at the overall pattern of centrals throughout the night,
Looks like a post arousal central to me....SWJ.
Look at the flow pattern immediately preceding the flagged event and after the not flagged air flow reduction....see how irregular it is?
My suspicions....the non flagged reduction in air flow was real and it caused an arousal (partial wake up or full wake up that you may or may not remember) and then you paused your breathing while awake or halfway awake.

Now why the non flagged air flow reduction happened or why it wasn't flagged. Dunno....unless maybe it was just short of 10 seconds in duration. I am thinking probably an OA that didn't quite meet the 10 second criteria because the machine didn't use any FOT on it.

Look at this example below...see the nice asleep breathing regular air flow...then look at the irregular air flow and the flagged events during the irregular air flow....every single one of those flagged events is SWJ...none are real.
And I ran this by a sleep lab tech just to confirm my suspicions.

So I need more pressure? How am I supposed to get rid of these!!

How to get rid of centrals

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Machine	Mask

Additional Comments: Pressure of 17-20, soft cervical collar, chin strap