Autoset 10 - does it have to be in APAP to record CSB?

[WildMtnHoney]

Hi all, been away awhile!

So, I've been using my machine for nearly TWO YEARS now! (go me!) But I'm still struggling with fatigue (boo!). It may be unrelated (recently diagnosed with Sjogren's Syndrome - big boo! -- but I have some ideas for dry mouth, my current favorite is a gel from amazon called "GC dry mouth gel" - you rub it on your cheeks and roof of your mouth before bed, and it keeps you from getting cotton mouth pretty well, the flavors can be weird, but I don't mind 'em).

Big question - my sleep doc is a neuro, and she has suspected all along that my biggest issue is centrals, not obstructives. Prior to getting to the CPAP, I was actually just on O2, because my first ever sleep study didn't show anything but low O2, but that didn't help, so the next 2 sleep studies were done, that showed both some obstructives (worse in REM) and some centrals, wherein they put me on CPAP and took away my O2.

Now we're trying to see where I'm at, and I *just now* (yeah, I'm slow!) realized that my charts have never even had the line for CSB/periodic breathing (doh!). Is that because the machine is in CPAP instead of APAP mode? When I look at other people's charts online that have the autoset, they have more "lines" one their daily details side: CSB, Large Leak....etc. I am missing both CSB and RERA -- I figured RERA was gone because I don't have the "for her" model, but doesn't CSB/pb come with both models? This is important because over the past two years I have had many charts where she and I both thought there were episodes of pb (if you remember me I probably annoyed you at some point with this, sorry), but the machine didn't label them, so they were written off as flukes/something to be considered later.

Now is later, as I see her in a few months from now.

TIA

[OkyDoky]

Tia if you are looking with Sleepyhead make sure all the flags are turned on. At the bottom of your daily graphs on the left is a box labeled Flags and on the right one labeled Graphs. If you find any that are red be sure and turn them to green by clicking on them.

[Pugsy]

It's my understanding that CSR Cheyne Stokes Respiration is available in both modes.
So I would assume since you aren't seen it flagged then it isn't happening and that's why it is absent on the SH reports.
I have the AirCurve 10 model and I don't see CSR shown on the graphs and I am fairly certain it would flag it if I had it unless you inadvertently turned the flagging off in SH..

I don't know about RERAs though. The manual states the for Her model but I have seen RERAs on software reports from the regular APAP...don't remember about the modes though.

Periodic Breathing has some very specific criteria that needs to be met before it is flagged and it has to last at least 2 minutes duration.
And not all PB is CSR...CSR is one of many forms of PB.

[WildMtnHoney]

It's my understanding that CSR Cheyne Stokes Respiration is available in both modes.
So I would assume since you aren't seen it flagged then it isn't happening and that's why it is absent on the SH reports.
I have the AirCurve 10 model and I don't see CSR shown on the graphs and I am fairly certain it would flag it if I had it unless you inadvertently turned the flagging off in SH..

I don't know about RERAs though. The manual states the for Her model but I have seen RERAs on software reports from the regular APAP...don't remember about the modes though.

Periodic Breathing has some very specific criteria that needs to be met before it is flagged and it has to last at least 2 minutes duration.
And not all PB is CSR...CSR is one of many forms of PB.

Thanks for going over the qualifications!

My confusion is that I don't even have it as an option? It's not listed under "Flags" and when I look at some other people's charts, it'll say, like CSB 0.00% on the left hand side, in a bright green bar? Like it does for "Large Leak" in a grey bar? I don't have that bright green bar.

[OkyDoky]

The manual states: The AirSense 10 reports Respiratory Effort Related Arousals (RERA), and detects Central Sleep Apnea (CSA) and Cheyne-Stokes Respiration (CSR). It doesn't specify the For Her model for RERAS.
So if flags are on you probably aren't having them. You could also check in File - Preferences - Events to be sure they are checked there.

[Pugsy]

My confusion is that I don't even have it as an option? It's not listed under "Flags" and when I look at some other people's charts, it'll say, like CSB 0.00% on the left hand side, in a bright green bar? Like it does for "Large Leak" in a grey bar? I don't have that bright green bar.

I just looked...I don't have it anywhere either. I think it's simply because we haven't had it happen yet.
Unfortunately this is something I can't fake and try to make the machine show it.
I used to see PB flags when I was using the Respironics machine but they were very, very rare and barely made the 2 minute minimum and never looked like CSR at all.

I suppose you could manually look through your flow rate graphs to see if you spot any but that's a lot of work and not so easy work at that.

[WildMtnHoney]

Checked in Preferences - it is checked there. Here is a pic of where it is "missing":

[OkyDoky]

I also haven't had it show up on my AirCurve but I looked back to when I was using my Respironics 760 and the Event Flag bar is there but empty. I guess it's just the way the different machines report. And Resmed doesn't record an empty flag bar.

[Pugsy]

I am reasonably certain that the lack of mentioning of CSR is that none has happened.
I will fire up ResScan later and check to see if 0.0 CSR is ever reported in ResScan. I don't think it is though.

[WildMtnHoney]

Thanks for checking Pugsy and OkyDoky!!! I think that makes sense, that it won't show up until it happens once.

I really am starting to think my morning headaches/fatigue are related to something outside of sleep apnea. My AHI has been consistently below 3 for quite awhile now.

FWIW, we have tried other things. I tried sleeping on a wedge for 3 months with my legs elevated (slept worse, had lots of mask leaks, generally not a good time) and am now back to sleeping "flat" but with my legs elevated (due to veinous insufficiency from DVTs). Mask leaks are gone, but still waking with headaches and general fatigue.

And, like I said, a new diagnosis that is a likely contributor to the fatigue.

Probably just need to take things one thing at a time, and let the "centrals" worry go (I know *why* it's a tickle in my brain -- I have drops in O2 even when awake/alert for unexplained reasons, most recently during an ED visit for an unrelated reason and I "wonder" if whatever is causing that is happening when I sleep...bad cycle of worry, need to let it go!).

Thanks for your input!!

[Pugsy]

Have you looked at potential cervical spine issues as a contributing cause for the headaches?
I know that I have a bad arthritic neck and if I sleep weird on my pillow I will wake up with a headache...and if I go somewhere and have to use their pillow I will almost always wake up with a headache.

I used to have the O2 (or lack of) daily headaches from untreated OSA but once I started cpap those headaches went away but I still will wake up with a nasty headache caused by my neck every now and then.

If the O2 thing worries you too much you can get one of those overnight recording pulse oximeters fairly inexpensively and see for sure if the O2 is dropping very much at home.

[dorilu]

I wondered this same thing regarding the CSR flagging and posted a question asking about it a couple weeks ago.
When I was using my rental Airsense 10 AutoSet, it recorded an episode of CSR. It was in the bright green line above Large leak line in the left section that's directly above the pie chart. I've monitored it since then to see if I have any more episodes. I haven't, but the green line has always stayed there with 0.00 recorded.
Then I got my new machine 2 wks ago, which is also an identical Autoset, but the CSR line is not there nor is it available to turn on in the graphs.

We are thinking it just doesn't show up unless CSR is detected, but I'm still puzzled by the fact that I looked on my data reports from before I ever had the CSR episode and it shows the CSR line with 0.00 score.

[Pugsy]

We are thinking it just doesn't show up unless CSR is detected, but I'm still puzzled by the fact that I looked on my data reports from before I ever had the CSR episode and it shows the CSR line with 0.00 score.

It may be something that is held in SH profile data.
Once you had the CSR episode SH may have retro adjusted the prior nights reporting where you had no CSR to show 0.0 because of the time you did have CSR changed the profile data.

[WildMtnHoney]

Pugsy - no, I hadn't (yet) considered c-spine headaches, but I will now! I'll start by paying closer attention to how I sleep, etc. I already have a "special" contoured pillow, but maybe it's time for a new one? I'll start to pay more attention to my neck in the mornings. - Oh! A pulse ox , I can do that! As I recall, there are threads upon threads around here (don't worry, I'll search here and the SH wiki) about them and SH compatibility, etc. Thanks again!

dorilu - thanks for your input! That makes it sound even more likely that it just doesn't show up until it happens on whatever the "current" machine is.