Are these really centrals

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Bennnyp
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Are these really centrals

Post by Bennnyp » Sat Apr 19, 2014 5:40 am

http://s743.photobucket.com/user/Bennny ... 0.jpg.html

I have been lowering my pressures and almost no obstructive apneas they are almost all centrals. Can I keep lowering my pressure down until the obstructive apneas show up. I am at 24/13 right now.

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JDS74
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Re: Are these really centrals

Post by JDS74 » Sat Apr 19, 2014 8:28 am

Benny,
Your PhotoBucket points to the HTML not to the IMG link.
You'll need to go back to PhotoBucket and get the IMG link and edit this post with that link.
Otherwise, we can't see what you intend.

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Pugsy
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Re: Are these really centrals

Post by Pugsy » Sat Apr 19, 2014 9:04 am

I think he means last night's report.


Image

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Bennnyp
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Re: Are these really centrals

Post by Bennnyp » Sat Apr 19, 2014 9:22 am

Thanks Pugsy. Yes i meant last nights report.

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Todzo
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Re: Are these really centrals

Post by Todzo » Sat Apr 19, 2014 12:45 pm

Well to see what is going on better I would love to see a “close up” of the time between about 1:40 a.m. and 2:00 a.m. To obtain the charts looking at that specific time just choose any chart and drag (place the cursor at the start of the time, hold down the left mouse button and move to the end time and release the mouse button) across the time space. All charts except the top “events summary” chart will show the same time and the top chart will have it highlighted. To go back to looking at the whole night drag across the entire top chart.

In general I note that you seem to have two modes. Breathing at about 6 liters per minute, and breathing at about 17 liters per minute (looking at the waveform and the summary). Simply I kind of doubt that breathing three times as much air continuously for you will do anything but result in you breathing off too much carbon dioxide and create the need for you to stop breathing or slow your breathing to compensate. This is how hypocapnic central apneas and hypopneas occur and looks to be a likely candidate for what is being detected as “Clear Airway Apneas” by your machine.

What exactly makes them become long term facilitated (talking about the high air volume use) is not understood at this time but everybody has a theory. What is nice to see in your case is that both kinds of breathing seem to be quite stable and even more that you convert back to more normal rates on your own apparently without an awakening.

That said hyperventilation is not good for you. Some lifestyle things that may help:

1. Check your vitamin D3 levels and correct if below 50 or above 80. See The Vitamin D Counsel for details as to the proper assay. D3 just tends to make the respiratory control system run better.

2. Try to lessen the stress in your life. Stress is another “gain factor” where the respiratory control system is concerned.

3. Pursue metabolic health. If your cells work better everything works better. This means learning to eat well and move well. Dietitian, personal trainer, three years or so. As you move toward an active lifestyle I do believe you will find your respiratory control systems working better along with a whole bunch of other things as well. After doing this for a couple of years I was able to half my CPAP pressure – which also reduces the respiratory control loop gain as CPAP pressure tends to raise it.

FWIW I have been contending with such events for years – with a lot of success!!
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Todzo
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Re: Are these really centrals

Post by Todzo » Sat Apr 19, 2014 1:12 pm

Bennnyp wrote:http://s743.photobucket.com/user/Bennny ... 0.jpg.html

I have been lowering my pressures and almost no obstructive apneas they are almost all centrals. Can I keep lowering my pressure down until the obstructive apneas show up. I am at 24/13 right now.
I use and have always used CPAP (10+ years).

I did about two years ago I end up doing a self titration (few doctors here) where I simply dropped pressure about 1 cm/H2O at a time looking at the results over the next week to ten days and where I did indeed stop after three days of seeing obstructive events at the lowest pressure used then going back up a cm/H2O.

It took me over 60 days to find the new pressure.

Currently I am dealing with some disease which causes inflammation and am running about 1 cm/H2O above that pressure. I will look at my data in a hour or two.

I believe that our bodies change constantly and so titration should be a more or less a constant thing - but - moving very slowly and with planning. In my case this summer I will be again dropping pressures to find the lowest likely in June (lost weight, better shape). I will be thinking about what to do in the hot times of July and August. I know that November thru February are always the worst. I am looking at ways to determine inflammation in my body and may use those to adjust pressure. At the same time I am looking into more ways than EERS[1,2] to deal with the breathing instability issues such as you show since those are the worst in November (traumatic event occurred in a November past).

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721
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Pugsy
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Re: Are these really centrals

Post by Pugsy » Sat Apr 19, 2014 1:17 pm

Did you sleep soundly for most of the night? If the answer is yes...then yes, those are very likely real centrals and they are numerous enough to be a problem.

If those centrals are related to pressure...maybe we might get lucky with further pressure reductions...
Did you ever talk to your doctor about them? This isn't the first time they have reared their ugly head.

Maybe EPAP at 11 or 12 and IPAP max at 16 or 17 or a little less? It might help and it might not but wouldn't hurt to try.
If you can get the pressures low enough that the centrals aren't so numerous without allowing a bunch of obstructives it might work...sometimes it does and sometimes it doesn't.
Your IPAP max may be 23 but it never comes close to it...the highest your IPAP went last night was 17.88.
I would drop EPAP to 11 and drop IPAP max to 18 or 19 as it probably won't go there anyway and leave Pressure support at 4.

Did you ever see this video
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be
If those centrals are related to cpap pressure then this may be what is going on with you and sometimes it happens with just the least amount of pressure and isn't always tied to higher pressures.
I don't know for sure that is what is going on here but it sure is suspicious for it and needs to be considered until proven otherwise.

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avi123
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Re: Are these really centrals

Post by avi123 » Sat Apr 19, 2014 3:37 pm

I would go to have a serious sleep study in a lab where they use the proper equipment and not rely on laymen guesses.

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Bennnyp
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Re: Are these really centrals

Post by Bennnyp » Sat Apr 19, 2014 7:30 pm

Thank you for the replies. I have a new sleep study on may 5th.

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Bennnyp
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Re: Are these really centrals

Post by Bennnyp » Sat Apr 19, 2014 8:36 pm


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Mabutu
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Re: Are these really centrals

Post by Mabutu » Sat Apr 19, 2014 9:06 pm

when i ask sleep physicians if CPAP can induce central sleep apnea they usually become evasive and deflect the question

The fact is we are woefully ignorant of neuro-respiratory physiology and sleep medicine is still in its infancy

There are no long term studies showing the 20 year effects of cpap. None . To reassure us they say only a minority of CPAP users go on to get cpap induced centrals . But what about them ? Are they being condemned to one day developing permanent alterations in respiratory control? And why are so many people in the western world getting sleep apnea anyway? . It wasn't that long ago you could travel to the third world to see reams of people, of advanced age, sitting there with beaming smiles on their faces and dropping dead over the age of 100 without knowing what sleep apnea was

What is going on with our society that there is such an epidemic of obesity , diabetes and sleep apnea?


We are told its caused by our tongues falling backwards in deep sleep. So be it . Seems plausible to me. Yet i have to ask myself , why my best friends daughter , age 3 months has no sleep apnea. She has NO mandible. A huge tongue that protrudes from her mouth . A neck so fat she'd pass for the michelin blimp . She sleeps on her back . We attached a pulse oximeter to her finger and her sats in deep sleep consistently hover around 100%

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Todzo
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Re: Are these really centrals

Post by Todzo » Sun Apr 20, 2014 12:10 am

The initiating event is likely obstructive.

I am glad you are getting a study.

How is your heart?
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Bennnyp
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Re: Are these really centrals

Post by Bennnyp » Sun Apr 20, 2014 7:05 am

http://s743.photobucket.com/user/Bennny ... a.jpg.html

As far as I know my heart is good. I talked with my doctor about my heart and he said it is fine. So I lowered my pressures last night to 19/11 and this is what I got. Still no or very minimal obstructives.
This is very confusing to me as I was tritrated at 22/18. It will be interesting to see the results of my sleep study that I am doing on may 5th. I will leave these settings where they are now for a week
and then see where I am at. Comments please.

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Pugsy
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Re: Are these really centrals

Post by Pugsy » Sun Apr 20, 2014 7:13 am

You wouldn't be the first to have a titration study that came up with wrong pressure settings for some reason or other.

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Todzo
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Re: Are these really centrals

Post by Todzo » Sun Apr 20, 2014 11:48 am

Bennnyp wrote:http://s743.photobucket.com/user/Bennny ... a.jpg.html

As far as I know my heart is good. I talked with my doctor about my heart and he said it is fine. So I lowered my pressures last night to 19/11 and this is what I got. Still no or very minimal obstructives.
This is very confusing to me as I was tritrated at 22/18. It will be interesting to see the results of my sleep study that I am doing on may 5th. I will leave these settings where they are now for a week
and then see where I am at. Comments please.
In the close up I note that there is a pause in breathing before the high volume breathing starts. The pattern of the high volume breathing looks to be similar to Cheyne–Stokes respiration which is why I asked about your heart. In the research I have read Cheyne–Stokes respiration tends to be associated with heart problems although I see it simply as an indication that the gain of the system has moved past oscillation (periodic breathing) and into square waves (Cheyne–Stokes respiration).

You seem to be able to remain in the pattern for many minutes and to convert back. I think that your respiratory control system gain during this night was high but arousal threshold was likely low.

If I saw this in my data I would plan a good walk. Fairly long (compared to what I normally do which currently is about 9000 steps a day) for me say 14000 steps. Most of it would be kind of lumbering and enjoying the surroundings. Some of it would be up hill and I would make my heart work which I hasten to add I do all the time. You go easy on that heart, but put a little bit of strain on it.

I would also make sure that I did not consume more than 40 grams of added sugar in my day. My normal “limit” is 100 grams a day. I think that added sugar tends to contribute to both breathing instability (respiratory control system gain) and inflammation (a cause of obstruction).

I would also be seeking out anti-inflammatory foods and anti-oxidant foods. The anti-inflammatory foods do seem to help keep obstruction away and I think that what happens with you is that a single obstruction occurs, raises your stress hormone level apparently quickly, and so raises your respiratory control loop gain to the point where it moves past periodic breathing (an over compensation of high or low levels resulting in a sine wave looking flow levels waveform) into patters which look similar to Cheyne–Stokes respiration. The anti-oxidant foods tend to limit the damage from the events.

I would be looking for beauty and hoping for good conversation. Frankly there seems to be nothing better for breathing control than finding what you love of doing what you love. This time of year for me it is taking pictures of flowers.

I might also consider some good professional foot reflexology and/or acupressure. While recovering from an assault I found that a good session of foot reflexology and acupressure would stabilize my nighttime breathing for a month!

Talk with your doctors about [1,2].

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721
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