Are these Central Apneas and what to do about them?

Hi all,

Thanks to this group, I'm finally getting leak under control. The next question I have is whether the Central Apneas being flagged are 1) accurate 2) how do I treat them? For context, prior to mouth taping and my pressure being at 12 - 13, I was way under pressure 5 - 7 and wasn't having many events flagged but the shape of my individual breaths weren't very good.

https://imgur.com/LT4w8iE

https://imgur.com/IhOOeZ0

https://imgur.com/AgYc8N5

When did you start using EPR at 3?
Do you have reports with less EPR and less number of "centrals"?

I can't tell with these reports if the centrals are asleep centrals or awake/arousal related centrals. Is it possible you were awake when they were flagged?

About all you can try with your current machine is to reduce or eliminate EPR in an effort to reduce the number of centrals and that will ONLY work if EPR is the cause of your centrals and ONLY if you were for sure asleep and not awake when they got flagged.

Some people have centrals pop up due to use of EPR or bilevel pressures. Not everyone will see this happen though.

The machine doesn't know if you are asleep or awake? It only measures air flow and it can and will flag awake pauses in breathing as some sort of apnea event. It only calls them like it sees them but sometimes what it sees isn't asleep breathing.

Pugsy wrote: ↑

Wed Apr 03, 2024 7:54 am

About all you can try with your current machine is to reduce or eliminate EPR in an effort to reduce the number of centrals and that will ONLY work if EPR is the cause of your centrals and ONLY if you were for sure asleep and not awake when they got flagged.

Some people have centrals pop up due to use of EPR or bilevel pressures. Not everyone will see this happen though.

The machine doesn't know if you are asleep or awake? It only measures air flow and it can and will flag awake pauses in breathing as some sort of apnea event. It only calls them like it sees them but sometimes what it sees isn't asleep breathing.

So helpful! I was definitely rousing (in and out of sleep) around the times that were flagged. As I've increased pressure, my first six hours of sleep tend to feel much deeper - I actually lose track of time and tend to think I've slept a long longer than I have. Last night I tried going back to bed and it appears the light sleep may be the cause, but it's hard to know how the causality works here...waking/rousing causing CA pattern breathing, which is getting flagged or CA causing waking, etc?

I did look back at older reports and I wasn't having these "events" but perhaps I just wasn't sleeping as soundly in the earlier part of night so there were no periods of much much lighter (in and out) sleep.

I guess the only variable to tinker with is EPR to see if this goes away?

I've found I can induce CA's by turning on EPR/PS at my normal therapy pressure... while awake. Try it, it's instructive. You need to be asleep to have FL's pop up... CA's only care about blood pH.

vandownbytheriver wrote: ↑

Wed Apr 03, 2024 8:20 am

I've found I can induce CA's by turning on EPR/PS at my normal therapy pressure... while awake. Try it, it's instructive. You need to be asleep to have FL's pop up... CA's only care about blood pH.

I'm not sure how people get to good CPAP results without this forum. SO HELPFUL!!!!

In at least some places, the CAs seem to be part of a pattern of unstable breathing. Deeper breathing (perhaps as part of an arousal) leads to a CA, there's some deeper recovery breathing after the CA, then the deeper recovery breathing leads to another CA, etc. You can also see some waxing/waning patterns that don't involve CAs.

Sometimes the body will adjust and breathing will become more stable. But try Pugsy's advice to see whether a reduction in EPR will help. If it does, possibly after a while you can try inching the EPR back up to see how your body reacts.

Oddly enough, sleep scientists haven't completely determined how post-arousal CAs are caused. The cause may be a drop in CO2, or it may be something called the Hering-Breuer reflex, which limits deep breathing based on signals from the chest wall.