central sleep apnea concern.

[Tsubs]

Hi there everyone. I have been on CPAP for the past four months and have been enjoying my revitalized days since then. My sleep lab AHI score was about thirty without CPAP. Now, with my ResMed S9 Elite, my AHI averages about 4, but am concerned that I average about 3 centrals per hour, some lasting up to 40 seconds. Should I be concerned about this? When I asked the local facility, I was informed that they don't have machines that can analyze and deal with central apnea. If this is such a concern, should I make the trip to a hospital with such a facility?

[Mary Z]

Tsubs, since you're feeling revilatized I would not be concerned about these clear airway events (which we assume to be central apneas). If you want to you can try and tweak your pressures a bit to see if you can get them lower. What is your prescribed pressure?

[TheLankyLefty]

Since you're feeling great you don't need to worry about it at all. Those "Centrals" are likely position changes, yawns, sighs etc. You'll notice several false positives with data capable machines. Even if they were true centrals, 3 per hour isn't in the diagnosable range. Most likely is what I mentioned above.

If you're feeling great, what are you doing "clock watching" the data?

[Lizistired]

I would be concerned about anything lasting 40 seconds. If you can post a screenshot of some of these with the flow, leak, minute ventilation, pressure and event lines maybe there is something else going on.

[avi123]

Hi, when I was using the S9 Elite, about 10 months ago, I got these nightly data of events:






To check if any of those Central apneas indicated a Periodic Breathing, Cheyne Stokes Respiration, etc. , I used the ResScan softwear and set it in a slow mode of 1 0r 5 minutes for a full window, to see the Flow Waves.

The following graphs indicated to me that I have none of the above central sleep apnea syndromes. Notice that I adjusted the the time wave segment to the end of the the 22 sec Central Apnea event.



Here is a sample of Central Sleep apnea indication:



Notice the creschendo/decreschendo flow curve following the Central Apneas.

Central apnea syndrome usually accompanies other underlying medical conditions than just sleep. Read this excellent report on it:

http://emedicine.medscape.com/article/304967-overview

[jamiswolf]

Lizistired wrote: I would be concerned about anything lasting 40 seconds. If you can post a screenshot of some of these with the flow, leak, minute ventilation, pressure and event lines maybe there is something else going on.

I agree that a 40 second CA should be investigated. The big concern is that it could be causing a serious Oxygen desaturation. Monitoring overnight pulse ox will tell you to what degree your O2 levels are dropping...if at all.
Jamis

[archangle]

Hi there everyone. I have been on CPAP for the past four months and have been enjoying my revitalized days since then. My sleep lab AHI score was about thirty without CPAP. Now, with my ResMed S9 Elite, my AHI averages about 4, but am concerned that I average about 3 centrals per hour, some lasting up to 40 seconds. Should I be concerned about this? When I asked the local facility, I was informed that they don't have machines that can analyze and deal with central apnea. If this is such a concern, should I make the trip to a hospital with such a facility?

Look at your waveforms. Look at the 40 second apnea. Do you stop breathing completely, or for only part of the time period? On PRS1 machines, it will score a long apnea, but you may actually be breathing at least a little for much of the time period in question.

By the "local facility," do you mean a doctor, or just someone at the DME?

Also, remember, centrals are no more harmful than obstructive apneas, they're just harder to treat.

[Bright Choice]

IMHO I would not ignore those centrals. I was desaturating while on s9 autoset (cpap mode) and never thought I was getting appropriate therapy. I had repeat sleep study and titrations at a lab capable of doing ASV titrations.

It made a huge difference in my case. Now on ASV with no desats and sleeping much better. If you decide to check it out, make sure you go to a lab capable of doing ASV titrations.

[moresleep]

Tsubs, first, congratulations! Even without fine tuning, your Cpap therapy is already successful enough to mean you have taken a huge step in the right direction, in terms of your health.

I don't think you need to go in for another lab sessions just yet; but, I would try to find out more about those centrals, if I were you, since some are>40s. If you post your pressure settings and, if you have them, charts of your flow data, people here will be able to help you interpret the data. It could be that the charts will suggest that lowering the pressure slightly will help. Do you have Resmed's version of Flex on or off? Not intuitive, but sometimes changing it to the opposite state will help.

[Tsubs]

Hi everyone. Thank you for your replies. They are very much appreciated.

My machine is an S9 ResMed Autoset set at 12-20 cmH2O, with EPR set at 1, using a ResMed Mirage Quattro Full Face Mask. Unfortunately for now, I can't seem to attach an image of last night's applicable graphs. Whenever I click on the attach image button above, nothing happens. I've tried clicking and dragging but that doesn't work either. Any additional advise will be greatly appreciated. Thanks again in advance.

Tsubs

[TalonNYC]

Any additional advise will be greatly appreciated. Thanks again in advance.
Tsubs

Hi Tsubs, I'm stealing this instruction set from Pugsy:

Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[Tsubs]

Can't seem to make this thing work. However, I did upload my graphs' image on photobucket, so here's the link.

http://s1224.photobucket.com/albums/ee3 ... graphs.png

Thanks for the tip, TalonNYC

Tsubs

[Pugsy]

Here you go.
Just copy the last line in the address box...paste the entire line here....no need to do anything else

[sickwithapnea17]

I'm not sure why I have centrals too on bipapst. One doctor said it could be the brain cyst I have in my clivus but the neurosurgeon told me the cyst is not the cause (but maybe the ns is not a sleep expert).

[Lizistired]

Tsubs, I wouldn't worry about the centrals in particular. It looks like you are having just as many obstructives. If you are fighting the machine, or the hose or moving around, you can hold your breath by not breathing or closing your airway, thus centrals or obstructives. Since you are showing both with deep breathing just prior, I wouldn't worry too much about it now.
I would be interested in seeing a screenshot of the whole night and the cluster of obstructives between 530 and 600 with flow limitations. I'm wondering what your pressure did then.
Sometimes minor adjustments to pressure, EPR and Ramp can make a world of difference. Some of us do better on cpap than apap, or without ramp and EPR. But as long as you are feeling better you are headed in the right direction.