Inconsistency with Centrals from night to night?

Has anyone seen their Centrals or Clear Airway Apnea's increase or decrease dramatically from one night to another?

The first night of my sleep study resulted in 13 OSA's and 33 Centrals with an AHI 34.
The second night, titration, I done much better with CPAP with 0 OSA's and 8 CA's with AHI of 9 but I was given 10mg of Ambien which I believe impacted the resulting low Centrals

Now that I'm home on CPAP (6.0 pressure), I have no OSA'a but my Clear Airway Apneas will go through the roof some nights (>35) but not the next (<5). The nights that they're high, I feel as if I'm smothering.

I don't drink, smoke or do drugs...I'm maintaining a good diet though I do tend to eat late sometimes. I'm just trying to find a correlation with lifestyle and these events. I suspect my Dr. is about to prescribe a titration with BIPAP.

If anyone has noticed this type inconsistency, please let me know.

Thanks,
Paul

Almost everyone gets some CAs. When you lie in bed trying to get to sleep...when you get up to go to the bathroom...when you grunt when you turn over in bed. I have been on CPAP for 6 years and even on my best nights, I have a couple CAs.

Please add your equipment to your profile.
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What machine exactly are you using?
If you are having a truck load of centrals/clear airway now and you had a truckload during your diagnostic sleep study....maybe you aren't using the right machine for treating centrals.

partialpaul wrote:The first night of my sleep study resulted in 13 OSA's and 33 Centrals with an AHI 34.

Is that 33 per hour or 33 total over the entire sleep period centrals? If the entire sleep period...how long was the sleep period?

Any mention of complex sleep apnea or central sleep apnea in your diagnosis anywhere on your reports?

partialpaul wrote:Now that I'm home on CPAP (6.0 pressure), I have no OSA'a but my Clear Airway Apneas will go through the roof some nights (>35) but not the next (<5). The nights that they're high, I feel as if I'm smothering.

Are you sleeping soundly without a lot of wake ups...or are you having a lot of wake ups on the nights with the high central count?
Sometimes awake breathing can get flagged by mistake (the machine doesn't know if you are awake or asleep) and the difference is just awake breathing vs sleep breathing.

Can you post an example of a report with high and now central count?
If you don't know how we talk about it here
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

That's a very good point...the nights with higher centrals I have more trouble falling asleep to the point I eventually remove the CPAP. I don't have a prescription for any sleep aid but I'm thinking that would greatly impact the number of centrals I'm seeing. I'm on a RESMED S9 Autoset set to CPAP at 6.0 pressure with no ramp.

A good night (night before last):



A bad night (last night):

A sleep aid may or may not impact the central count. It all depends on if the centrals are awake events getting flagged by mistake and if so a sleep aid may decrease the central count if you sleep better.

Right now I would be concerned with overall hours of sleep and your sleep quality.
Is the poor sleep and/or fragmented sleep something new that just started with the cpap therapy or is it something you had before starting the cpap therapy?
Are you having mask leak or comfort issues?
Or is it just that you are waking up from the alien being on your face?

When you have a bad night and don't sleep well and are awake for prolonged periods of time there's a good chance the central count will increase because of awake events getting flagged. The feeling like crap could just be from having crappy sleep and not from centrals because the centrals might not be the real deal.

So...primary goal right now is fix the bad sleep...those short hours and the wake ups causing fragmented sleep. Even 4 hours of decent sleep isn't enough to expect to feel better and less than that is a recipe for feeling horrible.
It's not always easy though because it can be difficult to isolate the cause.
If the wake ups are related to just the onset of cpap therapy and getting used to having the alien on your face...it should improve as your brain comes to look at the mask and machine as friends but if the wake ups are something you had prior to cpap therapy it may be difficult to fix.

Sometimes sleep aids help get over the "adjustment to cpap alien on my face therapy" so they can have their place in the grand scheme of things. They don't have to be RX...they can be OTC for some people.

If you had insomnia (either sleep onset or sleep maintenance) prior to starting cpap therapy and that insomnia wasn't caused by the apnea events we can't expect the machine to fix something that is unrelated to sleep apnea. Not all bad sleep is from OSA or CSA.

So...big question for now....why the bad sleep?

Pugsy,

Thank you for your detailed reply.

My sleep disorder first presented itself when I was in northern Afghanistan in 2011, 6000' above sea level so I passed it off as altitude adjustment. Over there, I would sit straight up in the bed for many nights after my arrival...gasping for breath. I would be so sleepy during the day, working long hours but that eventually subsided. Since being back in the states, I've depended on an OTC sleep aid like ZzzQuil. Perhaps I've had some type of sleep problem for years but I was unaware. My kids have commented on the dark circles under my eyes for years.

Recently, I went in for a sleep study due to what I had decided was hypnic jerks while slipping from awake to asleep. That process would repeat itself over and over until I would eventually fall asleep. As oddly as it may sound, those onset "jerks" eventually led to some type of visual recall upon jolting awake (brief hallucinations) so I was definitely motivated to see what was causing that.

I've attached a summary of my first night's study and my 2nd night titration study. I'm not an expert on all these readings but am very suspicious since they're not based on the same hours of sleep per night so the numbers would be skewed. The first night recorded only about 2 hours sleep while the titration night was about 5 hours.

Thanks again,
Paul

Let's get you to sleeping better, longer....first. Then let's worry about the centrals. 8 centrals during the titration study of 5 hours isn't bad.

33 centrals in the 2 hours of the diagnostic study means about 15 per hour...and I assume they were real or they wouldn't have been mentioned.

I assume you were in the service??? And that's why you were in the mountains of Afghanistan?? Did you experience any sort of head injury while over there?
Maybe just a coincidence that the symptoms started while in the mountains but if it was just altitude related they should have gone away when you returned to lower altitudes.

At this point though...it is what it is and we have to deal with what is in front of us and right now with the highly fragmented sleep and poor hours of sleep and such....we are unable to know for sure if the centrals are real centrals in numbers that you need a different machine. Normally if that were the case you wouldn't have times with no centrals to speak of.

We need 4 or 5 hours of solid sleep to be able to have a better idea just how important those centrals are.
We have to be able to remove the potential awake/semi awake centrals getting flagged by mistake before we start worrying about centrals. We can only infer so much with the data from the machine.
So I always say fix what needs to be fixed first and see what's left over. In your case we know that your sleep quality is in the toilet...not nearly enough hours of sleep and what little you get is fragmented way too much.

Big question right now is how can we improve your sleep quality in general and get you more hours of solid sleep so that we can evaluate the centrals better.

Do you take any meds of any kind? Even the OTC zzzzquil counts. If so, what and dose and when?
How is your sleep hygiene? Good/bad? Do you know about good sleep hygiene vs bad things we do that are bad for sleep?
Any other health issues?
Is your bed comfortable?
Any issues with the mask itself in terms of comfort or leak....or any issues with the pressures used?

Pugsy,

No, sorry...I didn't mean to infer I was military but I deployed for 14 months as a contractor for the military and, thankfully, I did not have any type of head injury while deployed.

The ZzzQuil I take as the package instructs...I believe it's 2 tablespoons about 30 minutes before bedtime. I take no other medications or vitamins of any kind and my overall health is good at 58. I've been taking ZzzQuil since my return from Afghan. I've read that centrals get worse at high altitude but I no longer have the source. Even prior to going to Afghan, my wife had noted my sudden jerking during the night as well as loud snoring...though I was under the impression that people who suffer from Central Sleep Apnea don't necessarily snore much.

Yes, my bed is very comfortable and the P10 Airfit Nasal Pillows don't bother me...on the bad nights, I feel as if I'm smothering with the CPAP therapy though. I've not noted any substantial leaks.

I couldn't agree more that the sleep should be fixed first though I'm not familiar with good "sleep hygiene" other than things like don't drink coffee at night, etc.

For the past 3 years, I can't remember a better night's sleep than the night of my titration with 10mg of Ambien. While I don't want to get hooked on anything like that, I am very anxious to see what my readings are with a week or 2 of Ambien at home on CPAP and maybe even without CPAP.

I'm hesitant to have another titration, now with BIPAP...this may very well be a neurological disorder that, like you said, a machine can't fix.

Call me crazy but what would be interesting to me is a sleep study with Ambien but no CPAP.

Thanks again,
Paul

partialpaul wrote:I'm hesitant to have another titration, now with BIPAP...this may very well be a neurological disorder that, like you said, a machine can't fix.

No, no....if it is neurological as in central apneas because your brain is mixed up about the breathing...a machine can fix it but just not your current machine. That's where those high dollar fancy ASV type of machines come in.
At this point I am not sure that your centrals require going down the ASV road though. It's just impossible to figure out with such sporadic and short hours of sleep reports since the machine can and will flag awake breathing irregularities and we have no way to know for sure which is what from what we see here.

Now if you showed me a 5 hour report and told me "I only woke once that I remember" and that report showed a truck load of centrals then we have a problem but until you get more sleep and consistent solid reports we just have to sit here and scratch our heads.

Good sleep hygiene is more than just the no caffeine thing...google good and bad sleep hygiene and you will get lots of reading.
One of the no nos is using the computer or watching TV right before bed time (and another no no is watching TV in bed) and while I don't have a TV in the bedroom...I watch TV and use the computer right up to the time I go to bed.
Do some reading to see if you do other stuff that might be "bad sleep hygiene".

ZZZZQuill's primary active ingredient appears to be Diphenhydramine....Benadryl is the same thing just name brand...and the reason it is often found in "sleep aids" is because of the drowsiness side effect.

I don't know what you pay for it but you can likely buy a lot more Diphenhydramine pills/capsules for what you are paying for ZZZQuill.
It looks like 50 mg is the standard dose. That's really a relatively small dose in the grand scheme of things. We used to give people 100 mg when we saw them with allergy reactions.

partialpaul wrote:on the bad nights, I feel as if I'm smothering with the CPAP therapy though. I've not noted any substantial leaks.

What pressure are you using? 6 cm I see in the stats...are you using EPR at all?
You know some of that suffocation feeling on some nights might simply be not enough air moving through the P10 nasal pillows.
Especially if you are using EPR.
You might try going up a size in the nasal pillow if you can because it will allow a little more air movement or increasing the pressure 1 cm (6 cm is really relatively low) especially if you are using EPR. Or if you are using EPR you might try turning it off.
Maybe sometimes the P10 sort of tries to collapse and causes a bit of suffocation ...I had that happen until I went up a size.

Ambien has it's place in life....as do other sleep aids.

Pugsy, what a great recommendation to try the Large Pillows vs. the Medium Pillows I'm using. My DME didn't give me those but I know they ship with that mask so I can get them. Also, my EPR is set to 3. Now that I've learned how to post a screenshot, I just grabbed the night showing my longest duration on the CPAP to date which was on 8/15/14. I'll attach here here...I had taken ZzzQuil that night as well. I suppose Ambien wouldn't have helped much that night from the looks of it.

Thanks,
Paul

Still at least 4 wake ups that I can see in this last report. I see the breaks in therapy line so I know you woke up a lot.
Are you waking up because of the centrals or are the centrals showing up because you woke up? We don't know yet.

Get that larger nasal pillow and see if you still have periods of problems with suffocation feeling during the night and if you do then we try something else.

When do you have your follow up scheduled with your sleep doc?

Pugsy,

My DME just sent my ENT (my sleep Doctor) the first report this past Friday and they said they feel he'll go ahead and prescribe a new titration with BIPAP..probably ASV.

I'll still visit my DME Monday to get the larger pillows that came with the Airfit P10.

Thank you so much.
Paul

partialpaul wrote:My DME just sent my ENT (my sleep Doctor) the first report this past Friday and they said they feel he'll go ahead and prescribe a new titration with BIPAP..probably ASV.

That's good. They will know for sure if the central is a real "my brain forgot to tell me to breathe" vs an "awake/semi awake or sleep onset central". That's much better than my trying to use my magic eight ball.

And yes, won't hurt at all to try the larger sized nasal pillow and might help your overall comfort and sleep quality.

I have used or tried almost all the nasal pillow masks and I normally can use both the XSmall and Small size in any of them but the XSmall in the P10 was causing some suffocation feelings because the pillows were trying to go up into my nostrils a little too far and would collapse a bit and then no air moved. With the Small size it never happens. Now I don't know that is what is happening in your situation but you were complaining of the suffocation feeling all the time...just part of the time...which makes me wonder if that was happening with you. My issues were just "some of the time" also.
Anyway....hurts nothing to try the next size up and it's a simple fix if it does help a little.

Do keep me posted though as to how things go. If you end up on the ASV type of machine and stay with Resmed then you most likely would get the S9 Adapt ASV like I am using now. It's a sweet little machine. I tried it on a lark and fell in love. I don't really have issues with centrals but it does a darn good job treating my OAs very well. If I had issues with centrals it would cover those as well.

Be sure to look at the detailed data on your centrals. See if they're short and see if they are "total." There's a number in the "events" tab for each event, and you can click on that to zoom in on the waveform to see if you're completely stopping breathing.

Thanks...yes, most events appear to be about 15 seconds in length though I had a few longer with the longest central (flat line) being 24 seconds.