Saw a different DR today, his intrpretation of high CA Index

cwillis · Post by **cwillis** » Mon Jan 26, 2015 5:27 pm

So I saw a different sleep Dr today, didn't get much time, so my questions had to be brief. I asked him about my significant rise in CA events since starting therapy. He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this? Of course he also is possibly concerned that it is therapy induced, but at least I'm going in a positive direction getting answers.

palerider · Post by **palerider** » Mon Jan 26, 2015 5:37 pm

cwillis wrote:He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this?

search for 'swj' or 'sleep/wake junk'

cwillis · Post by **cwillis** » Mon Jan 26, 2015 5:42 pm

palerider wrote:
cwillis wrote:He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this?
search for 'swj' or 'sleep/wake junk'

OK will do, thanks. And thanks for educating me about the leak rate vs total leak rate in SH software I was interpreting wrong.

palerider · Post by **palerider** » Mon Jan 26, 2015 5:57 pm

cwillis wrote:
palerider wrote:
cwillis wrote:He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this?
search for 'swj' or 'sleep/wake junk'
OK will do, thanks. And thanks for educating me about the leak rate vs total leak rate in SH software I was interpreting wrong.

the misunderstandings caused by the different ways of reporting leak rates (respironics total vs resmed excess) are common, you're not the first, nor will you be the last that falls into that trap.

and sleepyhead showing two leak traces on respironics machines is confusing until you know what each means

archangle · Post by **archangle** » Tue Jan 27, 2015 6:05 am

cwillis wrote:So I saw a different sleep Dr today, didn't get much time, so my questions had to be brief. I asked him about my significant rise in CA events since starting therapy. He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this? Of course he also is possibly concerned that it is therapy induced, but at least I'm going in a positive direction getting answers.

Did he look at your SD card data, or just blow off the idea of CA? If he just blew off the idea of CA, that's highly suspicious. You should look at the data and see if the CA is in a cluster as you fall asleep or wake up. You should also look and see if they happen as your pressure rises.

You might want to post some screenshots of SleepyHead.

How high is your CA?

Julie · Post by **Julie** » Tue Jan 27, 2015 6:08 am

It's very common to have a few centrals when just falling asleep and awakening... the time to worry would be if you have many more throughout the night, especially in clusters.

cwillis · Post by **cwillis** » Sat Jan 31, 2015 10:33 pm

archangle wrote:
cwillis wrote:So I saw a different sleep Dr today, didn't get much time, so my questions had to be brief. I asked him about my significant rise in CA events since starting therapy. He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this? Of course he also is possibly concerned that it is therapy induced, but at least I'm going in a positive direction getting answers.
Did he look at your SD card data, or just blow off the idea of CA? If he just blew off the idea of CA, that's highly suspicious. You should look at the data and see if the CA is in a cluster as you fall asleep or wake up. You should also look and see if they happen as your pressure rises.

You might want to post some screenshots of SleepyHead.

How high is your CA?

This is a typical night for me archangle: 34 events on this night, Ive had up to 60 on a night.

Any thoughts are appreciated.

Pugsy · Post by **Pugsy** » Sat Jan 31, 2015 10:53 pm

Do you wake often during the night or do you feel you go to bed and go to sleep and rarely wake during the night?

Ugly report and it sounds like this one is one of the "better" ones. Even without the centrals it's ugly and screams sub optimal therapy.
Do they all so show much activity in terms of the OA, Hyponea, RERA, FL and snore stuff? All those type of events mean your pressure settings are sub optimal for keeping the airway open.
If your sleep is like crap and you wake often it might be possible that those CAs flagged are related to awakening/arousals from the events you see happening that weren't prevented.
If that is the case then in theory optimizing the therapy for the obstructive stuff might reduce the CAs IF (big IF) those centrals are post arousal centrals or sleep onset centrals....remember if you wake up often during the night and go back to sleep then you also have a lot more opportunity for sleep onset centrals to happen simply because you wake up and go back to sleep often.

This report above just screams crappy sleep to me. If you tell me that you slept soundly...I have to rethink my ideas.
But if you tell me you don't sleep well and wake often...if it were my report I would look at optimizing what we know for sure needs work (that will require a little more pressure) and cross my fingers that the CAs will reduce...if they don't or they get even worse then look at other options but try simple and easy option first.

cwillis · Post by **cwillis** » Sat Jan 31, 2015 11:18 pm

Pugsy wrote:Do you wake often during the night or do you feel you go to bed and go to sleep and rarely wake during the night?

Ugly report and it sounds like this one is one of the "better" ones. Even without the centrals it's ugly and screams sub optimal therapy.
Do they all so show much activity in terms of the OA, Hyponea, RERA, FL and snore stuff? All those type of events mean your pressure settings are sub optimal for keeping the airway open.
If your sleep is like crap and you wake often it might be possible that those CAs flagged are related to awakening/arousals from the events you see happening that weren't prevented.
If that is the case then in theory optimizing the therapy for the obstructive stuff might reduce the CAs IF (big IF) those centrals are post arousal centrals or sleep onset centrals....remember if you wake up often during the night and go back to sleep then you also have a lot more opportunity for sleep onset centrals to happen simply because you wake up and go back to sleep often.

This report above just screams crappy sleep to me. If you tell me that you slept soundly...I have to rethink my ideas.
But if you tell me you don't sleep well and wake often...if it were my report I would look at optimizing what we know for sure needs work (that will require a little more pressure) and cross my fingers that the CAs will reduce...if they don't or they get even worse then look at other options but try simple and easy option first.

Hello Pugsy, yes I sleep crappy. I just had a titration so I'm waiting for the results, and I have an appt mid Feb to prob adjust my pressure accordingly. This is what my report looks like nightly and I'm ready for a change in my pressure settings to see if I can optimize my therapy. As it is I sleep in 2 hour increments but as far as I can tell these Centrals happen at different times usually when I'm sleeping and not so much sleep onset centrals although I need to investigate more thoroughly. So your suggestion would be to increase my Max IPAP and EPAP the same amount?

Pugsy · Post by **Pugsy** » Sun Feb 01, 2015 12:06 am

cwillis wrote:So your suggestion would be to increase my Max IPAP and EPAP the same amount?

Actually since you are already in auto mode with a higher IPAP being available if needed all I would change if it were me would be EPAP minimum and leave all other settings the same.
By default if you increase the EPAP minimum the starting IPAP will also increase due to PS setting...and then any further increases will be driven my apnea events and their warning signs.

I would only change EPAP minimum...from 8 to 9 and leave everything else the same...it will be a tight auto bilevel range since right now the max IPAP is 14 but there is room...9 EPAP plus the starting PS of 2 means IPAP will be 11 instead of 10 but could go up to 14...so there's still a little room for movement.
While it looks like you do reach the max of 14 briefly I don't really think that more IPAP is an urgent need or would make that big of a difference.
It's EPAP minimum that is the most critical setting in this situation. Really tis no different than what we do with APAP minimums...have the machine have a more optimal baseline (minimum) pressure to hold the airway open more effectively and then hopefully the machine doesn't have to work so hard at trying to fix what collapses do occur.

So I don't know if your crappy sleep is related to what is shown on the reports but that's a pretty ugly report and thus it wouldn't be impossible for that to be a significant factor in sleep quality.
All I know to offer is to try to fix what obviously needs fixing that we can try to fix...and see what happens.
No guarantees...at least it's a possible explanation and offers some options to at least try.
What is frustrating is when people have nice clean reports and nothing is screaming out "fix me" and they complain of crappy sleep and they don't take any meds I can blame it on ....I don't have much to offer except the standard stuff like not all crappy sleep is related to sleep apnea and the machine can't fix something that isn't related to sleep apnea..

Will my idea help the centrals or make them worse? I have no idea at this point.
I have seen centrals go away when the therapy is optimized so we assume post arousal centrals that are reduced because the arousals get reduced.
I have also seen centrals increase when more pressure is added...which also at least tells us that the centrals seem to be related to pressure and then we consider options along the lines of limiting the pressure or potentially a different type of machine.

I don't know if a 1 cm increase in EPAP will get job done totally on the obstructive stuff but since centrals are present I would want to proceed with caution and see what happens.

Since you are currently in follow up and had a recent titration study I don't know how you feel about going the DIY route and I don't blame you if you wish to hold off. All I am offering is what I would do if this was my report and try to explain to you my reasoning behind it so that you can maybe have an understanding of the whys behind some of my ideas.
I don't ever want anyone to make a change to anything unless they understand what they are trying to do and the possible results that might occur so that people make an educated decision as to what they want to do...not because I told someone "go do this"

cwillis · Post by **cwillis** » Sun Feb 01, 2015 12:42 am

Pugsy wrote:
cwillis wrote:So your suggestion would be to increase my Max IPAP and EPAP the same amount?
Actually since you are already in auto mode with a higher IPAP being available if needed all I would change if it were me would be EPAP minimum and leave all other settings the same.
By default if you increase the EPAP minimum the starting IPAP will also increase due to PS setting...and then any further increases will be driven my apnea events and their warning signs.

I would only change EPAP minimum...from 8 to 9 and leave everything else the same...it will be a tight auto bilevel range since right now the max IPAP is 14 but there is room...9 EPAP plus the starting PS of 2 means IPAP will be 11 instead of 10 but could go up to 14...so there's still a little room for movement.
While it looks like you do reach the max of 14 briefly I don't really think that more IPAP is an urgent need or would make that big of a difference.
It's EPAP minimum that is the most critical setting in this situation. Really tis no different than what we do with APAP minimums...have the machine have a more optimal baseline (minimum) pressure to hold the airway open more effectively and then hopefully the machine doesn't have to work so hard at trying to fix what collapses do occur.

Thank you for your advise I know a lot of people on this forum value it. Nighttime I'm in a little bit of a fog, so it has to be tomorrow that I might make that change. Hope I can keep you posted....

So I don't know if your crappy sleep is related to what is shown on the reports but that's a pretty ugly report and thus it wouldn't be impossible for that to be a significant factor in sleep quality.
All I know to offer is to try to fix what obviously needs fixing that we can try to fix...and see what happens.
No guarantees...at least it's a possible explanation and offers some options to at least try.
What is frustrating is when people have nice clean reports and nothing is screaming out "fix me" and they complain of crappy sleep and they don't take any meds I can blame it on ....I don't have much to offer except the standard stuff like not all crappy sleep is related to sleep apnea and the machine can't fix something that isn't related to sleep apnea..

Will my idea help the centrals or make them worse? I have no idea at this point.
I have seen centrals go away when the therapy is optimized so we assume post arousal centrals that are reduced because the arousals get reduced.
I have also seen centrals increase when more pressure is added...which also at least tells us that the centrals seem to be related to pressure and then we consider options along the lines of limiting the pressure or potentially a different type of machine.

I don't know if a 1 cm increase in EPAP will get job done totally on the obstructive stuff but since centrals are present I would want to proceed with caution and see what happens.

Since you are currently in follow up and had a recent titration study I don't know how you feel about going the DIY route and I don't blame you if you wish to hold off. All I am offering is what I would do if this was my report and try to explain to you my reasoning behind it so that you can maybe have an understanding of the whys behind some of my ideas.
I don't ever want anyone to make a change to anything unless they understand what they are trying to do and the possible results that might occur so that people make an educated decision as to what they want to do...not because I told someone "go do this"

Well it's been difficult for me to get my current Drs to find any urgency in my treatment, so I am reay to make the DIY route. I know many people on this forum value your advise. Tonight I'm going to leave be as I get into a slight fog. Tomorrow I'm going to use your suggestion and raise my minimum EPAP, give it a few days obviously. I hope to share my results with you. Thanks for your input very much.

archangle · Post by **archangle** » Sun Feb 01, 2015 8:46 pm

cwillis wrote:
archangle wrote:
cwillis wrote:So I saw a different sleep Dr today, didn't get much time, so my questions had to be brief. I asked him about my significant rise in CA events since starting therapy. He told me that a lot of Central Apnea is not scored on your sleep test because they are a response to your transition to arousal or waking, has anyone else heard this? Of course he also is possibly concerned that it is therapy induced, but at least I'm going in a positive direction getting answers.
Did he look at your SD card data, or just blow off the idea of CA? If he just blew off the idea of CA, that's highly suspicious. You should look at the data and see if the CA is in a cluster as you fall asleep or wake up. You should also look and see if they happen as your pressure rises.

You might want to post some screenshots of SleepyHead.

How high is your CA?
This is a typical night for me archangle: 34 events on this night, Ive had up to 60 on a night.

Any thoughts are appreciated.

I'm going to say your CA doesn't look like sleep wake junk, unless you were awake much of the night. However, your CA number isn't enormously high.

Click on events, then break out the CA events and see how long and how complete they are. Short ones are not nearly as worrisome as long ones.

BTW, I suggest you talk about AHI or CAI numbers, not the count per night. The count of the number of nights confuses people.

cwillis · Post by **cwillis** » Sun Feb 08, 2015 1:35 am

just received my Titration and Prescription, it's calling for a new machine: Resmed Aircurve 10 VAuto, IPAP max 17 EPEP min 12 PS of 4, can someone explain just a little. And won't that make my Centrals worse? Heres another Central dominated night:

Pugsy · Post by **Pugsy** » Sun Feb 08, 2015 2:22 am

Scratching my head here...the AirCurve VAuto is like the S9 VPAP Auto and the PR S1 Bipap Auto.
Could have got the same settings on the Bipap Auto.

archangle · Post by **archangle** » Sun Feb 08, 2015 2:30 am

Go into the events tab and click on some of your centrals and post the zoomed in airflow waveforms you get. Some centrals are worse than others.

Bilevel sometimes helps centrals, sometimes makes them worse. I think sometimes, insurance requires you to try bilevel before getting an ASV.

Saw a different DR today, his intrpretation of high CA Index

Saw a different DR today, his intrpretation of high CA Index

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Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

Re: Saw a different DR today, his intrpretation of high CA Index

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