Can I reduce Centrals and Cheyenne-Stokes?

[QueSera]

When I saw my sleep doctor last month, I was still having trouble sleeping, but I wasn't really having any CPAP problems. I had started using an HME instead of the water tank, but my numbers were still stable, and low. Even so, I was awake half the night, so she switched me from Lunesta to Belsomra. I started at 10 mg and am now up to 20, which is the max. I am sleeping much better, and for about 7 hours a night. Yay!

But since I began to increase the dosage of the Belsomra, first to 15 and then to 20, I have been getting crazy high results for AHI, Central Apneas, and Cheyne-Stokes breathing. My Obstructive Apnea numbers are still low. But where I was getting 0 centrals and 0 C-S before, and AHI numbers under 5, now I'm seeing an average of 15 AHI, 10 Centrals, and 15 C-S. Some of the Centrals and C-S are in the hour or so before I wake up, and I can dismiss those on the days I know I wasn't really still sleeping, but otherwise, I''m stumped.

All other conditions, such as mask or humidity, are unchanged, although I did go back to the water tank last night, and I slept pretty well, but there was no significant difference in my numbers this morning. And my numbers were still low and stable when I started the Belsomra.

Any thoughts, O Wise Ones? I'm sure it's not good for me to have centrals or to breathe weirdly, and I'd like to work on this and bring these numbers down, but as I said, I'm stumped. Thanks for anything you can tell me.

[ajack]

It sounds like it isn't the drug for you. I would go back to the doctor

[QueSera]

I have severe chronic insomnia, which has gotten worse with age. I've tried all sleep meds at one time or another; this is the only one that works for me now. Without it, I would probably sleep 2 or 3 hours every other day. If my only choice was between Belsomra + CPAP issues or no Belsomra, I would have to pick the former. No Belsomra would eliminate those issues only because I would never fall asleep. Input appreciated, however.

[QueSera]

Oops. It auto-corrects to Cheyenne even when I spell it correctly.

I am always surprised that more CPAP users don't have insomnia issues as well. My CPAP use is relatively new - about 18 months - but my insomnia is lifelong and common in my family.

You would think that if you are tired you will eventually fall asleep but that has not been my personal experience. I have at times been awake, yet horribly tired, for 48 hours or more, and then slept for a few hours only. Also, I do know the cause of my insomnia, which is a neuro-transmitter glitch, so to speak. Belsomra is the medication that addresses this.

I'll be investigating the central apneas and Cheyne-Stokes outside of this forum. I only started here because I thought it might be an issue others in the CPAP community had encountered.

Once again, input appreciated.

[kteague]

Maybe seeing certain details of your data would enable some of the astute data folks here to venture an opinion on if your breathing patterns look concerning. A few years ago we had a new person on the forum dealing with central sleep apnea caused by methadone. She was very clear that stopping the med was not an option. For her, an ASV machine seemed to be the best answer. Doesn't sound like you are there yet - too many unknowns. It sounds like you are in tune to what your needs and options are to get sleep. Those who have had to deal with insomnia know that our body and brain does not always give us what we need when we need it. I think you will find as much help here as anywhere, but those in the know will need data to be of more than general help.

[ajack]

do you think the CA will stop, or is it that you just won't see them?
your call, but very few people have long term success on the sleep meds. Insomnia may be treated through a sleep therapist CBT, sleep hygiene and a newer drug for regulating the circadian rhythm, called valdoxan

[49er]

Maybe seeing certain details of your data would enable some of the astute data folks here to venture an opinion on if your breathing patterns look concerning. A few years ago we had a new person on the forum dealing with central sleep apnea caused by methadone. She was very clear that stopping the med was not an option. For her, an ASV machine seemed to be the best answer. Doesn't sound like you are there yet - too many unknowns. It sounds like you are in tune to what your needs and options are to get sleep. Those who have had to deal with insomnia know that our body and brain does not always give us what we need when we need it. I think you will find as much help here as anywhere, but those in the know will need data to be of more than general help.

Excellent post.

Also, maybe as the body gets used to Belsorma, the centrals will disappear. Of course, ask your doctor about this. I would hate to have to see you switch meds since it is working so well and there is no guarantee anything else will help.

I also agree about considering CBT-I as a non-med option.

[49er]

do you think the CA will stop, or is it that you just won't see them?
your call, but very few people have long term success on the sleep meds. Insomnia may be treated through a sleep therapist CBT, sleep hygiene and a newer drug for regulating the circadian rhythm, called valdoxan

As an FYI, valdoxan is not approved in the US.

https://www.google.com/#q=valdoxan+usa

[ajack]

If the doctor thinks it's needed he may suggest that OP might have to get it from canada then? but it is one the the newer drugs used for sleep disorders and as a bonus, it also treats moods
https://en.wikipedia.org/wiki/Agomelatine
Due to its distinctive mechanism of action, agomelatine is also studied for its effects on sleep regulation. Studies report various improvements in general quality of sleep metrics, as well as specific therapeutic benefits in circadian rhythm disorders.

Agomelatine does not alter daytime vigilance and memory in healthy volunteers. In depressed patients, treatment with the drug increased slow wave sleep without modification of REM (Rapid Eye Movement) sleep amount or REM latency. Agomelatine also induced an advance of the time of sleep onset and of minimum heart rate. From the first week of treatment, onset of sleep and the quality of sleep were significantly improved without daytime clumsiness as assessed by patients

[49er]

If the doctor thinks it's needed he may suggest that OP might have to get it from canada then? but it is one the the newer drugs used for sleep disorders and as a bonus, it also treats moods
https://en.wikipedia.org/wiki/Agomelatine
Due to its distinctive mechanism of action, agomelatine is also studied for its effects on sleep regulation. Studies report various improvements in general quality of sleep metrics, as well as specific therapeutic benefits in circadian rhythm disorders.

Agomelatine does not alter daytime vigilance and memory in healthy volunteers. In depressed patients, treatment with the drug increased slow wave sleep without modification of REM (Rapid Eye Movement) sleep amount or REM latency. Agomelatine also induced an advance of the time of sleep onset and of minimum heart rate. From the first week of treatment, onset of sleep and the quality of sleep were significantly improved without daytime clumsiness as assessed by patients

Ajack,

I understand your enthusiasm for a drug. But I wish I had a nickel for everytime a drug was the latest greatest thing only to find that the risks were a lot more than what the initial studies showed. And if the OP is doing well with Belsomra, it would make more sense to try troubleshooting the issues that would enable her to keep taking the drug vs. switching to something else that she might not do as well on.

[QueSera]

Thanks all, especially kteague, whose replies are always well-stated and thoughtful.

I think my goal is to reduce or eliminate C-S and/or Centrals, if I can. From my reading, I need to start first with my sleep doctor and then see a neurologist, perhaps.

One of the conditions associated with C-S is brain injury/brain tumor, something I did not previously know. I had a brain tumor removed long ago - 25 + years - and having had a brain tumor has left me with a permanent, harmless anomaly in my EKG, an anomaly consistent with having had a brain tumor. I'm wondering now if this is similar, so I'll have to have doctors confirm or deny. If it's that, it may be something I can ignore, nothing can be done about it but it's not harmful or a symptom of something else.

It's a process, folks. Every day is a new adventure.

[kteague]

Interesting to think about. Could the disordered breathing be from prior damage, or could it have caused the brain be more susceptible to the effects of meds... Hmm. Since our machines are sensing breathing and not brain waves, I guess we can only go with that info. I'd want to know if those episodes are disrupting sleep stages or affecting oxygen. Would be interesting to see the results of a sleep study done while using CPAP and on the med. Maybe some oxygen monitoring at the very least is in order.

[QueSera]

I agree. Low oxygen saturation was the single most alarming aspect of my apnea diagnosis, and was the thing that made me agree -- want -- CPAP therapy. Yet I haven't found a good way to monitor this at home, and my doctor feels I don't need to.

It doen't appear to disrupt my sleep; I'm always surprised when I see it on my chart in the morning because I know I was sleeping well when it happened. (Although sometimes I see it in the last hour of sleep when I know I was in-and-out anyway.)

Yet another medical mystery to investigate.

[Julie]

There's an easy and common way to monitor your 02 overnight... it's called a pulse oximeter (a small device with one of those things you clip onto your finger... and the one you'd be interested in has an overnight recording feature so you can see what took place overnight. Others only show you results as you go - e.g. if you're a walker and want to know how your 02 does while walking, or exercising somehow, but those don't save data overnight. I have a link to a place many here ordered from, but for some reason the link doesn't work today... don't know if they went out of business or what changed, but in any case you can find others I'm sure with help - as your pharmacist for a recommendatoin and don't forget the overnight recording feature. I can't find where you said just what low levels your 02 sats went to or how often, but if all it was turned out to be 1-2 instances in a whole night of e.g. a number in the mid 80's that didn't last very long (coupla seconds) I would not worry too much about those... stuff happens that doesn't necessarily need jumping on immediately and you'd be just as ok to continue monitoring with SH unless the desats become routine, long, and low.

[Woody]

I realize this won't apply to most of us but I read an article about heart failure patients who also had
sleep apnea. It said that after doing the standard cardio rehab program if the patient just had OSA
there wasn't much if any change in there AHI BUT if they had a lot of centrals these were reduced
by about 50% ! I wonder if such an exercise program would help someone without heart failure too?