DreamDiver wrote:... there were no centrals at all until I got cluster just before I woke up. If it happens at all, it seems to be clustered as I fall asleep and as I wake up, with spotty centrals here and there. ...
The centrals as you fall asleep and awaken are perfectly normal. Unless they severely disturb your ability to sleep there is no real need to address those. So, this includes before or after bathroom breaks. This is - I suspect - why -SWS wondered about the timing. It's the centrals that occur throughout the night while asleep that definitely must be addressed.
Though it is heavy duty reading, you will want to read the following article titled "Ventilation is unstable during drowsiness before sleep onset
In conclusion it states:
At the start of sleep onset when drowsy, and when the PCO2 is close to or at that when awake, apneas and periodic breathing will occur with changes in cerebral state. The most ready explanation for these findings is that the PCO2 when awake is close to or at the apneic/hypopneic CO2 threshold. This explanation would also account for the apneas and periodic breathing frequently observed at the onset of NREM sleep and is likely to be most prevalent in subjects with a high-ventilatory sensitivity to CO2.
DreamDiver wrote:... If I'm really tired when I go to sleep and fall asleep quickly, clustered centrals tend to be avoided. If I sleep a long time, centrals will sometimes cluster at the end of the sleep period. Getting up to go to the bathroom, if I wake up sufficiently, I have to attempt to get back to sleep - causing a cluster of centrals as I attempt to relax. Until I have a few days more data, I'm going to say it's still when i'm 'getting in and out of the pool'. ...
I predict that staying still will have no impact. It's just the fact that your body is switching from one form of control of breathing to another. Again, as long as they do not disturb the process of falling asleep or awakening, you can safely ignore this type of cluster.
They can be so intense that it interferes with sleep. That is very rare indeed and tends to indicate an issue with the central nervous system (brain stem in particular). I do have that issue and won't recommend it to anyone.
DreamDiver wrote:... JohnBFisher - If I understand correctly, opiates were used to induced a state similar to that of people with CompSA. ...
Yes, opiates act as a central nervous system depressant. In particular it supresses normal operation of the brain stem which helps regulate the autonomic nervous system, including breathing.
DreamDiver wrote:... I generally have to avoid narcotics. When I took them for my appendectomy and my septoplasty, I was constipated for weeks. ...
This is a known result from something that interferes with the brain stem. Why do I think that? Neurological disorders that interfere with the brain stem tend to also cause poor regulation of the autonomic nervous system. Chronic problems that result often include respiratory problems, sleep apnea (both obstructive and central), urinary issues (including ED) and gastrointestinal problems (including constipation). Probably the classic neurological issue that deals with this is Multiple Systems Atrophy (MSA). You can read more about it here:
DreamDiver wrote:... I think I've got enteric nervous system issues that are not well understood. I'm wondering how/whether the ENS, along with the Vagus bundle might be involved in regulation of CO2, and whether part of the problem might not necessarily CNS, but rather ENS/vagus. ...
I am not a neurologist, so do not know if there might be a relation here. However, it is far more likely that you have two different issues. With opiates you experience normal autonomic nervous system depression. With sleep onset and awkening, you experience normal instability of breathing.
Again, unless it causes you problems, I would not worry about it. But if it is so severe that it keeps you from falling asleep or causes you to bolt awake, then it should be addressed. That's one of the problems I had. But I also have central apneas throughout NREM sleep and very few during REM sleep. That, by the way, is one of the markers of problems with the brain stem. During REM sleep the brain activity appears to reinforce the normal function of the brain stem, improving the regulation over the autonomic nervous system. I did discuss this with my neurologist who got excited that "I got it" and asked me to specifically keep tracking both the SpO2 levels and my sleep via my ASV unit.
By the way, my central apneas are so deep that the AUTO OFF feature on my BiPAP unit would turn off my unit many times throughout the night. During the resulting BiPAP titration they found that I have six times the number of central apneas as obstructive apneas.
DreamDiver wrote:... The two times I had a colonoscopy, I went unsedated. It's just easier. It's also fascinating to watch the video. ...
I can understand the curiosity. The more I learn, the more I learn that I really want to learn.
DreamDiver wrote:... I put the alarm on my oximeter last night to wake me if the O2 level drops below 85. It didn't. ...
I don't know about you, but the alarm on my pulse oximeter would not awaken me. Just not loud enough. I need it to be REALLY loud.
DreamDiver wrote:... Apparently the key is to find a doctor who believes in and understand CompSA and CSA.
Well, it also takes data that also substantiates CompSA and/or CSA. But yes, not all doctors finish at the top of their class. I had one doctor tell me that "Central sleep apnea is very rare, so you can not have it". What? How do the two relate? Do the sleep studies show central apneas? Does CPAP or BiPAP therapy address those apneas? Do I have more than 5 central sleep apneas per hour? How are we addressing those?
Of course, that was the same doctor that complained that my pulmonologist (who was my previous sleep doctor) had jumped to BiPAP too quickly. [ I was having problems with sleep and neurological issues, so I went to a neurologist who specialized in sleep issues. ] He ordered another sleep study that showed... I needed BiPAP with a slightly different pressure and the central apneas were still there - worse than previously.
So, yes. The doctor needs to believe you might have an issue with it. But as I also note, during normal sleep those centrals need to exist. Understand I am not questioning your situation. Rather I am proposing you ask your doctor if the sleep study demonstrated central apneas, if they are frequent enough to require something to address them, and if they might be contributing to ongoing day time symptoms. Essentially, you need to note if your therapy is effective or not and then guide the questions into a potential area of concern. You can also request (and probably should) the information from your sleep study.
Anyway, I hope the information helps.