Large clusters of Centrals

I was diagnosed with severe OSA, AHI 68, in August 2012. I've been sleeping with a mask ever since and my AHI has averaged around 1.5 to 3.0. Incidentally, since the beginning of CPAP my Respiratory Rate has been around 35, but frequently jumped to 50, sometimes over 60. I've been using pressures of 18/15.

Last June my doctor ordered another sleep test. Based on the test, he changed my pressures to 17/13. Immediately my Respiratory Rate dropped to around 22, with an occasional 30. But I began noticing occasional clusters of Centrals, frequently an hour after sleep began, then maybe again during the night. Sometimes the clusters last for an hour, with an event every minute or so. Six or so nights since June the AHI was over 5 (unusual for me). Last night it was over 11. Prior to the pressure change, I rarely had Centrals; mostly Apnea and Hypopnea.

Nothing has changed otherwise. No new meds, still get 7 hrs good sleep a night, I'm active and work out at the gym 7 days a week for the past four years. My wife had a stroke several years ago and I'm her sole care giver. Several months ago she almost stopped eating and now consumes less than one-half what she used to, and has lost a lot of weight. All of this has been a worry, but I can't see it affecting my OSA.

Anyone have any ideas why this is happening?

Unfortunately, I don't have much experience with Centrals. Could you change the settings back to the previous configuration for a few weeks to see if the data reverts to the older pattern? If so, I wonder if it is possible to do "half-steps" with the configuration and perhaps make smaller changes.

Good Luck!

John

Excellent suggestion, John. I'll try to work that in with life's other high priority issues I'm facing right now. Thanks.

How long do your centrals last? 10 sec, 30sec, 1min.

Do you monitor your O2 with a pulse oximeter? If so how low does it drop when you have the centrals?

If you had a breathing rate of 50, what was your heart rate. 50 is awful high.

How low can your pressures go before you get Obstructed apneas?

Can you breathe through your nose alright? What's your weight?

Have you tried dropping the expiratory pressure(when you breath out)?

borgready wrote:How long do your centrals last? 10 sec, 30sec, 1min.
Do you monitor your O2 with a pulse oximeter? If so how low does it drop when you have the centrals?
If you had a breathing rate of 50, what was your heart rate. 50 is awful high.
How low can your pressures go before you get Obstructed apneas?
Can you breathe through your nose alright? What's your weight?
Have you tried dropping the expiratory pressure(when you breath out)?

The longest Central was 30 seconds. Most are in the 15 to 18 second range. When in a cluster, about 1 per minute.
I had the pulse-ox on during one cluster and the O2 level stayed above 90%.
My usual pulse rate is in the 70's to low 80's. I have AFib.
I don't know how low before OA will commence. I was at 18/15 for 2 years and had high respiration rate. When I recently went to 17/13, resp. went to 20's.
Breathe through nose okay. 203#
Have not tried dropping the EP.

Thanks for responding.

I don't know what all kind of medical conditions you have or what meds your taking. If you going to the gym you must not be too bad off.

Do you know how to change your pressures?
I would try bringing the expiratory pressure down as low as you don't get obstructions. A pressure of 8 to 10. See how that feels.
In your sleep study do they mention the bipap titration. If you look at the detailed report you will see them doing the titration.


Are you aware of your centrals or are you in deep sleep? If your in light sleep, you will drift in and out of sleep as your O2 rises and falls.

Have you ever looked at your breathing waveforms? You say you get a central about ever minute. If you look at your breathing waveforms, do they go from rapid breathing to slow breathing to a central which is no breathing back to fast breathing.



I would try taking calcium and magnesium supplements before going to bed. These will help you deal with the stresses of irregular breathing.
You also might want to get your vitamin D checked and start taking it if its low. Low vitiamin D will mess up the the regulation of breathing in sleep.
Might as well take a good quality multi vitamin too.

I would try taking calcium and magnesium supplements before going to bed. These will help you deal with the stresses of irregular breathing.
You also might want to get your vitamin D checked and start taking it if its low. Low vitiamin D will mess up the the regulation of breathing in sleep.
Might as well take a good quality multi vitamin too.

No evidence whatsoever to support this. A neurologist has had anecdotal reports of patients' obstructive apnea disappearing when vitamin D has been between the range of 60-80 but has admitted that long term studies are needed to support what she has observed. Nothing has been noted regarding central apnea.

49er

I have no clue what is causing the rapid breathing. Is it shallow (tachypnae) or deep (hyperventilation)?

On the Central Apnea, my hunch is that the slight increase in differential pressure is causing you to breathe deeper, possibly stripping your blood of CO2 (hypocapnia) which in turn is telling your brain to slow your breating down which is in turn causing the central apnea. It is basically an unstable feedback loop. It is kind of like trying to adjust the shower temperature. The water comes out cold, your turn the hot way up, by the time the water is hot, it is too hot, so you turn the hot water way back down, but soon the water is too cold... rinse lather repeat.

Obviously you respiration control is highly dependant on pressures and differential pressures. I wonder if you are a good candidate for ASV.


As best I can tell, your Central Apnea breathing pattern is called "non Cheyne-Stokes periodic Respiration with non-specified cause" (NCSR). The pattern is similar to Biot's respiration, but you are not about to die.

49er wrote:

I would try taking calcium and magnesium supplements before going to bed. These will help you deal with the stresses of irregular breathing.
You also might want to get your vitamin D checked and start taking it if its low. Low vitiamin D will mess up the the regulation of breathing in sleep.
Might as well take a good quality multi vitamin too.

No evidence whatsoever to support this. A neurologist has had anecdotal reports of patients' obstructive apnea disappearing when vitamin D has been between the range of 60-80 but has admitted that long term studies are needed to support what she has observed. Nothing has been noted regarding central apnea.

49er

Hey 49er,

No evidence....really...You wouldn't know evidence if it smacked you in the face. You want evidence then do it yourself and see what happens. Get your vitamin d as low as it will go. See what kind of problems you get.

borgready wrote:

49er wrote:

I would try taking calcium and magnesium supplements before going to bed. These will help you deal with the stresses of irregular breathing.
You also might want to get your vitamin D checked and start taking it if its low. Low vitiamin D will mess up the the regulation of breathing in sleep.
Might as well take a good quality multi vitamin too.

No evidence whatsoever to support this. A neurologist has had anecdotal reports of patients' obstructive apnea disappearing when vitamin D has been between the range of 60-80 but has admitted that long term studies are needed to support what she has observed. Nothing has been noted regarding central apnea.

49er

Hey 49er,

No evidence....really...You wouldn't know evidence if it smacked you in the face. You want evidence then do it yourself and see what happens. Get your vitamin d as low as it will go. See what kind of problems you get.

You totally took what I said out of complete context but that isn't a surprise based on your posts. I didn't say that it isn't important to have an optimal vitamin D level. I said it had nothing to with central sleep apnea.

I think PR pretty much described you in his previous messages.

Hey 49er,
PR is a troll aka Azz Hole that has nothing useful to say but pick fights.

What you said is pretty clear. Like I said if you want your evidence, then go get it.

borgready wrote:Hey 49er,
PR is a troll aka Azz Hole that has nothing useful to say but pick fights.

*lol* just because I point out that your posts are full of nonsense and crazy, does not make me a troll, at least not in the real world.

inside your dream world of delusions, however, only you would knows.

and I think that 49er knows me better than you do

Mr. palerider,
Your are quite the critic. Nothing useful to say. Just bitch and moan.

So tell me what I have posted that is soo out there that it disturbs you to the point you target me for your trolling.

Was it the Robin Williams?

borgready wrote:Mr. palerider,
Your are quite the critic. Nothing useful to say. Just bitch and moan.

So tell me what I have posted that is soo out there that it disturbs you to the point you target me for your trolling.

Was it the Robin Williams?

ask 49er

borgready wrote:Mr. palerider,
Your are quite the critic. Nothing useful to say. Just bitch and moan.

I may be asking for trouble here, but I have to disagree. PR has been very helpful in many many posts I've read, and has helped me in a few issues I had too. He calls them like he sees them. Nothing wrong with that...