Central mystery - New sleep study

[JimDB]

Been on CPAP for a year and my Resmed S9 APAP has been showing centrals of well over 10. I showed my info to my doctor which did have a new sleep study done (Results posted below). I have been using the new pressure with no luck, still high centrals plus my total AHI has gone up. The lowest AHI has been 9 with 3 OSA and 6 CSA. I can’t use AUTO since I get run away with AHI readings over 20 AHI.

*My question is since I didn’t have any centrals went I have my studies could this be because I’m not getting into REM sleep at the labs?

Overnight polysomnography consisting of both diagnostic, CPAP titration, and ASV titration.

EPWORTH SLEEPINESS SCALE 2

Diagnostic portion:

Sleep latency:17.5 minutes
Time in bed: 119.5
Total sleep time: 99.5 minutes
Sleep Efficiency 83.3%
Minimal Snoring was noted, NO OSA (AHI .06)

Sleep staging was notable for absent REM sleep and slow wave sleep.
Stage N1: 10.1%
Stage N2: 39.2%
Stage N3: 50.8%
Stage REM: 0.0%

SaO2
Average awake: 92%,
Minimum: 89%
Periodic leg movement index: 35.6
Limb movement arousal index: 1.2

CPAP titrated portion:
Due to presence of previously disordered breathing.
CPAP was initiated at 4 cm H2O and titrated to 5 cm of with good control of OSA during non-supine sleep.

Sleep latency:15 minutes
Time in bed: 218.5
Total sleep time: 174.5 minutes
Sleep Efficiency 79.9%

Sleep staging was notable for increased slow wave sleep.
Stage N1: 10.6%
Stage N2: 54.2%
Stages N3/4: 30.7%
Stage REM: 4.6%
Total arousal index NORMAL at 13.8
Periodic leg movement index: 1.4
Limb movement arousal index: 0.0

ASV titrated portion:
ASV was begun at 4 cm H2O and increased to 5 cm for control of OSA during non-supine sleep.

Sleep latency: 8 minutes
Time in bed: 138.5
Total sleep time: 53 minutes
Sleep Efficiency 38.3%
Sleep staging was notable for increased slow wave sleep.
Stage N1: 12.3%
Stage N2: 57.5%
Stages N3: 30.2%
Stage REM: 0.0%
Total arousal index increased at 18.1
Periodic leg movement index: 0.0
Limb movement arousal index: 0.0
*Recommend CPAP at a pressure of 5 cm H2O

Jim

[Mary Z]

Your machine records clear airway events where there is no obstruction, but these are not necessarily central apneas. The S9 cannot tell the difference. I believe it takes an EEG and those pressure belts around your abdomen and chest to accurately diagnose a central. Since you didn't have any centrals during your test they prescribed a cpap rather than an ASV. It looks at though your apnea was controlled at a pressure of 5.

[JimDB]

I was using a pressure 0f 5.8 cm H2O and getting reading of 6-15 AHI
With the setting of 5 cm H20 I'm seeing 10-20 AHI
This is why I think it could be because I didn't hit REM in the Lab.

Thanks
Jim

[archangle]

Have you looked at how long and how total the centrals are on a waveform display?

If you don't have a blood O2 drop or an EEG arousal, many people will not call it an apnea at all, and it may not be harmful to you.

You need the chest effort belt to distinguish central from obstructive. The machine will try to distinguish central from obstructive, but sometimes it will call a central apnea an obstructive apnea.

Is it possible you're not completely asleep when you have the centrals shown on your data? Apneas while awake don't count.

By the way, you CAN use auto, you just have to set the maximum pressure to a lower value.

[JimDB]

Have you looked at how long and how total the centrals are on a waveform display?

I don't know just what to look for. I do have both Resscan 3.16 and Sleepyhead 0.8.8.4 pre bata

If you don't have a blood O2 drop or an EEG arousal, many people will not call it an apnea at all, and it may not be harmful to you.

I have a CMS50D plus Oximeter on order so I can check the O2 if it drops at the same time the S9 reads a central.

Is it possible you're not completely asleep when you have the centrals shown on your data? Apneas while awake don't count.

I think I wasn't completely asleep at the lab since I had little to no REM, just may be this is way no centrals on the studies.

By the way, you CAN use auto, you just have to set the maximum pressure to a lower value.

I've tried the auto but my AHI was over 20, that was with 5 cm to 8 cm.
I didn't try 4 cm to 5.8 cm or 4 cm to 5 cm.

I did have neck surgery in '03
I did a holter monitor back in May that showed some bradycardia, so the Oximeter might answer some questions.

Thanks
Jim

[sickwithapnea17]

I had 50 centrals on my first study but I think I didn't fall asleep all night, so maybe the study was done incorrectly
I read that centrals can be caused by heart and brain problems like tumors of the brainstem and lesions in the clival region. so you should get some testing done also.
have you figured out what causes your centrals and if there is a cure?

[JimDB]

I read that centrals can be caused by heart and brain problems like tumors of the brainstem and lesions in the clival region. so you should get some testing done also.

I have a Cardiologist in Feb. and he is going to read the sleep study plus I'll have my report from the S9 and Oximeter. I need to get a nero that cares to look if my past surgery might be the problem with the brainstem area.

[feeling_better]

Well, this could be one or two of my yearly posts for this year; that is how often I visit this forum these days. Happy New Year everybody!

Regarding JimDB's original post, my pure speculations: What the machine calls central, may not be that dependable; unfortunately most all of come to view these data provided by these machines sacred --- being a software person who has done some high medical instrumentation, I have seen my fair share of bugs even in FDA approved machines.

The only reason I ventured to reply to this thread is that, I was recommended very low pressures of about 4.5 initially, and I had used for over 18 months. Yes there were some improvements, AHI dropping from 30 to about 6-8. But later tests (because I never felt all that better) indicated some mild possible centrals, but increased the pressure to 9.5. I have now been around this higher pressure for about a year; I have done minor tweaks on my own 8.5-10. The results have been nothing but dramatic!! My AHI on most days is less than 1, many days 0.1 or sometimes none at all!! I sleep so well for 8+ hours, and those rare nights if I get less than 5 or 6 hours, I feel it badly next day almost telling me to take a nap by 5PM. I am not sleepy late in the evening anymore, my energy level has gone up, all around better. So just speculating that you may just need a higher pressure, or may just need to experiment with your doc's approval.

The reasoning: In all these type of vary a parameter (pressure) and find the optimal type of methods, it is not uncommon for many times to find a false, sub optimal area, where the optimal requires having to climb a hill with worse case results before finding the real optimum again. That was what had happened to me during the first 18 months of cpap therapy!! Most likely my history of experience are in many threads here, I used to be a very regular visitor here.

HAPPY NEW YEAR EVERY ONE!

Cordially,
feeling_better

[archangle]

Quite a few "normal" people develop some central apneas under CPAP pressure even without any significant other medical causes. There's no need to panic that you have some horrible medical condition that's causing central apneas. It just means it's more difficult to make your CPAP work. You may not find a pressure that gets your combined obstructive and central apnea under control. If it's bad enough, you might need some more complicated form of CPAP machine.

If you have centrals without CPAP, then it's much more likely that you have some other underlying problem.

[M.D.Hosehead]

Jim, something here isn't computing for me.

On the diagnostic study your AHI was 0.6, yet they prescribed CPAP at 5 cm. Why?

At home your machine records AHI of 6 to 15 or 20, depending on pressure. Are these all centrals? You didn't have any obstructions during the study.

I think I wasn't completely asleep at the lab since I had little to no REM

Very unlikely. They recorded 51% N3 and 40% N2 during the diagnostic portion. They read this from your EEG, which should be very reliable.

The way it looks, you might be having central apneas induced by CPAP, but it isn't clear why you need CPAP in the first place.

[JimDB]

Jim, something here isn't computing for me.

On the diagnostic study your AHI was 0.6, yet they prescribed CPAP at 5 cm. Why?

I was asking myself the same question, just because on a past study it was 60 AHI.

At home your machine records AHI of 6 to 15 or 20, depending on pressure. Are these all centrals?

About 2/3

I think I wasn't completely asleep at the lab since I had little to no REM

Very unlikely. They recorded 51% N3 and 40% N2 during the diagnostic portion. They read this from your EEG, which should be very reliable.

This is good to know, THANKS

The way it looks, you might be having central apneas induced by CPAP, but it isn't clear why you need CPAP in the first place.

My first study 18 months ago showed a AHI of 60.

I was thinking what I was doing when I had the study that I didn’t do at home. I have asthma and sometimes use an inhaler and take Buspirone and Trazodone for anxiety. I used all three the night of the study. The last two nights I have done the same and my AHI has come down to 2.2 AHI, 0.4 OSA and 1.8 CSA with a pressure of 4 cm to 5.8 cm. The max and 95% pressure reads 5.8 cm.
Thank
Jim

[JimDB]

Buspirone as a Potential Treatment for Recurrent Central Apnea
http://clinicaltrials.gov/ct2/show/NCT00746954
The hypothesis is that buspirone is a safe, effective drug to reduce the occurrence of recurrent central apnea and irregular breathing found in the setting of heart failure. A secondary hypothesis is that its effect will be similar to that or acetazolamide.

I’m posting this because of my Sleep Study- Central mystery.
This seems to answer some of my questions and hopefully it will be helpful to someone else.

Jim

[Mary Z]

If you don't have a blood O2 drop or an EEG arousal, many people will not call it an apnea at all, and it may not be harmful to you.

I continue to have an AHI in the teens, but since I have no O2 desats (measured in the lab and overnight twice at home) the doctor said my apneas would not hurt my heart.

[M.D.Hosehead]

Jim, something here isn't computing for me.

On the diagnostic study your AHI was 0.6, yet they prescribed CPAP at 5 cm. Why?

I was asking myself the same question, just because on a past study it was 60 AHI.

Still doesn't make sense to me. Plus, I have to correct myself. You wrote that in your diagnostic phase, the AHI was 0.06 not 0.6 as I mistakenly quoted. If 0.06 actually what they reported, you don't have central apnea, in fact you don't have any apneas at all. The central apneas reported by your machine could be caused by cpap.

Also you say you had an AHI of 60 in a study 18 months ago but only 0.06 recently. This is a 1000-fold difference; there could be a logical explanation, but there could also be something wrong with one of the study reports.

I'm glad your doctor will be looking at your study. If he/she's not a sleep specialist, a consultation with one might answer these questions. It would be a good idea to get a hold of copies of both studies to take to your doctor. If you could post them here before you see your doctor, you might get some good ideas about what questions to ask.

The oximetry data is a good idea, too, IMO.

[JimDB]

To M.D.Hosehead,
I'm sorry, I'm the one that missed typed it reads .6 AHI. I need to look for my first study or request another copy. I just seen my pulmonologist, sleep specialist, last Wednesday but I don't think she read .6 AHI. If I have seen the report before hand I would have question the NO OSA and why test with CPAP. This study was done by the VA. I am going to bring this up with my PCP. It looks like that you might be right.