Central SA showed up in my CPAP data.. very concerned!!!

I was diagnosed with Sleep apnea using a Itamar Watch Pat that does not distinguish between central of OSA's.
Apparently my CPAP's ( PR System One REMstar Auto CPAP Machine with A-Flex) data mentioned 4-7 central sleep apneas an hour. The OSA's were close to zero.
This in turn made me concerned about underlying neurological diseases. I have a history of concussions and suffer from post concussion syndrome.
Central Sleep Apnea seems to be a secondary symptom of neurological disorders I am predisposed of.
How many of you have had CSA show up within the CPAP data or have been diagnosed with CSA in first place?

The AHI index of my original study was 32 with a 90% bloodOX2 mean.

I should mentioned that I wake up in my first sleep wake cycles (wearing the CPAP) with a feeling of not being able to breath.after a 3 hour break I sleep with the mask for an uninterrupted 2 hours)
The data only caught 3-4 hours sleep max.

I can only speak from my experience. I had an AHI of 67 during my sleep study with a Pulse Ox level that dropped to 84%. (So even worse than yours)

I see CSA's in my nightly reports all the time. In fact I have many more CSA's than I do OSA's. My over all AHI average is around 1.8 per week so I don't worry about them. I think it is quite normal for most people to have CSA's who have Sleep Apnea.

If you are just starting out, you will need a couple of months to get adjusted to it. My advice would be not to get freaked out over a couple of reports. It's the long run that counts and until you get adjusted to using CPAP your reports are likely to be quite erratic until things settle out. I know mine were.

One more thing - I only use a constant pressure of 6, (which is quite low) I did experiment with increasing the pressure up a couple of notches and noticed that my Centrals increased when the pressure was increased.

You will get a lot of helpful advice from this forum. The first thing is to find a mask that works for you, then stop any leaking you might have, then start sleeping through the night. Until you get to this point, I wouldn't worry too much about your numbers until things settle down.

Give it some time and don't get too worried about CSA's until you get into the "groove" with the CPAP. If your overall AHI average is under 5 - that is considered good therapy.

arburtus wrote:I was diagnosed with Sleep apnea using a Itamar Watch Pat that does not distinguish between central of OSA's.
Apparently my CPAP's ( PR System One REMstar Auto CPAP Machine with A-Flex) data mentioned 4-7 central sleep apneas an hour. The OSA's were close to zero.
This in turn made me concerned about underlying neurological diseases. I have a history of concussions and suffer from post concussion syndrome.
Central Sleep Apnea seems to be a secondary symptom of neurological disorders I am predisposed of.
How many of you have had CSA show up within the CPAP data or have been diagnosed with CSA in first place?

The AHI index of my original study was 32 with a 90% bloodOX2 mean.

I should mentioned that I wake up in my first sleep wake cycles (wearing the CPAP) with a feeling of not being able to breathe after a 3 hour break I sleep with the mask for an uninterrupted 2 hours)
The data only caught 3-4 hours sleep max.

Well, I raised that question in your first post (as to what type of apnea you had) and you indicated that the type of sleep study you had couldn't differentiate. I guess you now know what kind and maybe the answer to your original question.

How do you have that machine configured? Pressure settings, Flex settings, etc., etc.


Den

arburtus wrote:Apparently my CPAP's ( PR System One REMstar Auto CPAP Machine with A-Flex) data mentioned 4-7 central sleep apneas an hour. The OSA's were close to zero.

As digitaleagle said, an AHI under five is considered good therapy, so in terms of overall numbers, it sounds like you're not doing too bad. And sounds like you are doing way better than you were with no therapy!

That said, I completely understand how seeing the CSA on your data would be disturbing, especially with a history of an underlying neurological disorder. BUT, there is treatment, which is a good thing.

arburtus wrote:How many of you have had CSA show up within the CPAP data or have been diagnosed with CSA in first place?

Some people have complex apnea, which is when someone developes CSA as a result of the CPAP therapy. And others have CSA in the first place for various reasons. I am in the latter group.

I think some people have CSA and the numbers are so low that it isn't a big deal. I think I remember reading that having CSA events as you fall asleep is not all that abnormal. And for people with a high enough number of CSA events, or with complex apnea, BiPAP, as opposed to CPAP, therapy is more effective.

Deborah

Back in this thread:
viewtopic.php?p=604717#p604717

arburtus wrote:

Wulfman... wrote:
You didn't specify whether you have Obstructive Sleep Apnea (OSA) or Central Sleep Apnea (CSA) or Complex Sleep Apnea Syndrome (CompSAS), which is a combination of both. CSA is more neurological in nature (the brain essentially fails to tell the body to breathe) and your "post concussion syndrome" suggests to me that is what you might have. If you have a copy of your sleep study, I would suggest looking it over carefully. If you don't have a copy, I would suggest getting one and studying it. Otherwise, it's hard to answer definitively.......however, various types of this therapy can help if administered and configured properly.

Den

Den,, I do not know the type of my apnea, the testing was done at home ( i was equipment with an oximeter by my health provider).
The results showed 35 apneas with oxygen saturation as low as 86%.
I immediately had to requested a formal sleep study in a hospital setting, I am awaiting the date...
Kaiser Permanente, my provider is not very proactive in this regard, kind of a cooky cutter approach here. I had to be persistent. said that that, the do want to outfit me right away with CPAP.
I doubt that I suffer from CSA. this form apnea seems to originate from the brainstem and is seen in traumatic brain injury event. my injuries were multiple mild concussions over many years. Further, I do have a very narrow pallet and huge tonsils and a crowed in tongue.I awake once a night with a sensation something is stuck in my throat. I expect this to be the source of my apnea... but who know, in the end you may be right.If so, I hope that CPAP will address CSA as well as OSA.

Do keep pushing for a date for a "real" full PSG sleep study, arbutus.

You're right -- that you'll be the one who has to proactive in getting that scheduled. Keep calling them.

It's very possible that the centrals showing up in your CPAP data are not a problem at all. But since they are showing up, and you were not given a full sleep study/titration in a sleep lab, and with your medical history of post concussion syndrome... that's good enough reason to have a real sleep study.

rested gal wrote:... You're right -- that you'll be the one who has to proactive in getting that scheduled. Keep calling them.

It's very possible that the centrals showing up in your CPAP data are not a problem at all. But since they are showing up, and you were not given a full sleep study/titration in a sleep lab, and with your medical history of post concussion syndrome... that's good enough reason to have a real sleep study.

As always rested gal, that is wonderfully positioned.

Though I would normally tell people with a AHI of less than 10 that the CA may not be an issue, you clearly have an underlying neurological condition that requires paying attention to it. After your sleep study, Your doctor might show you that the central apneas are within the range of "normal" events. That is, the AHI value is less than 5, does not cluster and does not seem to lead to problems with sleep. If that's the case, you can then rest assured that your therapy is doing the job you need. But let a doctor tell you that. And don't be afraid to ask specific questions about it. Though to a layman (us) it appears to be well managed, in your shoes, I would push for that sleep study.

Keep us updated. And best wishes as work toward that sleep study.

not relevant

del

avi123 wrote:fresh PSG sleep study would not do a reliable job of the detection of a CSA syndrome.

A full attended PSG study/titration could do a much better job at that than the only study arburtus has been given so far -- which was an at-home study using a WatchPat.

avi123 wrote:See this clinicians' post for a testimony:

I'm not impressed with that sleep tech's opinion from 2009.

I am really impressed by the support of this message board!! Thank you very much for all your thoughts!

I really had a difficult night. Even so I logged in so far my longest time with CPAP, I had also the most fragmented sleep so far. Generally I do not arouse and sleep 8 hours straight.
Of course, with my sleep apnea I never felt truly rested.
I noticed many events this nights in were I awoke not breathing (when wearing my cpap mask). I assume that these events were all central. This happens mostly when the cpap machine was at a seemingly higher pressure.
Notably, when I saw my report yesterday the CSA's were not clustered but more or less equally read through my cpap sleeping period. ODdly, the chart, unlike the summary, did not reveal more than 2-3 CSA's an hour.

This is all very confusing!

Welcome to the board, arburtus.

Please fill in the equipment list on your profile for this board.

https://www.cpaptalk.com/ucp.php?i=prof ... pment_info

How is your machine set up? Is it in auto mode? What's the pressure range? Do you use ramp or flex?

When you're in the "can't breathe" mode, before you take off your mask or turn off the machine, look at the display and note what pressure it's displaying. Look at the pressure when you first turn the machine on and when you wake up not feeling suffocated.

This is something your doctor or other medical professionals should discuss with you. Unfortunately, many of them are just looking at the cash register and only check that you're using the machine enough to get paid by insurance. Your machine records a lot of data on the data card. Your doctor should study this, but many simply glance at it.

As I understand it, a central apnea can be dangerous. It can also be unimportant. "Central apnea" means your airway is not blocked, but you're not inhaling or exhaling. Your machine attempts to identify these separately from "obstructive apnea."

The problem is that a "central apnea" is not a "yes or no" question. Do you stop breathing for 15 seconds or 3 minutes? Has the machine actually tagged an obstructive apnea as a central? Is it something wrong in your brain, or do you simply have enough oxygen in your lungs at the moment?

It's been suggested that if your CPAP pressure is too high, it may cause you to have central apneas. It's not clear to me whether or not these "apneas" are actually something to worry about that much. You do want to reduce the excess pressure if this is happening.

What software do you use to display your data? Have you looked at your waveforms during the CA's? How long do you stop breathing? What is your pressure during the events? What is the range of pressures you get?

Sometimes they'll give you a machine set at auto 4-20 and never try to figure out the right pressure.

arburtus wrote:I am really impressed by the support of this message board!! Thank you very much for all your thoughts!

I really had a difficult night. Even so I logged in so far my longest time with CPAP, I had also the most fragmented sleep so far. Generally I do not arouse and sleep 8 hours straight.
Of course, with my sleep apnea I never felt truly rested.
I noticed many events this nights in were I awoke not breathing (when wearing my cpap mask). I assume that these events were all central. This happens mostly when the cpap machine was at a seemingly higher pressure.
Notably, when I saw my report yesterday the CSA's were not clustered but more or less equally read through my cpap sleeping period. ODdly, the chart, unlike the summary, did not reveal more than 2-3 CSA's an hour.

This is all very confusing!

It would be VERY helpful if you would tell us how your machine is configured. If it is set up in a range of pressures, that could be contributing to a higher "Central" count. Most APAPs are supposed to have logic in their algorithms to avoid Central Apneas, but that's no guarantee they will not trigger some before they can back off. Until you and your medical team can get a better handle on your therapy, it would probably be beneficial to set your machine in CPAP mode at a fixed pressure......like 10 or less. Statistically, it's been reported that pressure induced Centrals occur at pressures over 10 cm.

We're all just trying to help.


Den

my pressure range is between 6-9, below 10 in the first 3 nights. I used the newest and greatest Remstar. Last night the gave me the previous model, since the can not let me use the newest as a loaner for too long. the pressure seemed much higher, even so it was set at the same strength. I did not check the pressure after my arousals.

I found this studie:
The Significance and Outcome of CPAP Related Central Sleep Apnea During Split Night Sleep Studies.
{Objective To determine whether central sleep apnea (CSA) occurring during CPAP titration in patients with obstructive sleep apnea (OSA) reflects subclinical congestive heart failure (CHF) and whether these events will improve with CPAP therapy. Design Cross sectional analysis of patients with suspected sleep related breathing disorders referred for a split night polysomnography (PSG). Patients and methods Forty-two OSA patients with and without CPAP related CSA were analyzed. All CSA patients (n=21) and controls (n=21) had echocardiography, pulmonary function tests (PFTs) and arterial blood gas (ABG). Repeat PSG on CPAP was obtained 2-3 months after adequate CPAP therapy in CSA group patients. Results Demographics, Epworth Sleepiness Scale, PFTs, ABG and baseline diagnostic PSG were similar in both groups. There was no difference in the prevalence of subclinical left ventricular systolic dysfunction in CSA group vs. controls. CSA patients had decreased sleep efficiency (SE), increased sleep stage 1 percentage, sleep stages shift, wake time after sleep onset (WASO), and total arousals compared to controls. Twelve out of 14 patients (92%) in the CSA group demonstrated complete or near complete resolution of CSA events on follow-up PSG and showed improvement in SE, WASO and total arousals compared to their baseline study. Conclusions CSA events occurring during CPAP titration are transient and self limited. They may be precipitated by the sleep fragmentation associated with initial CPAP titration and are not associated with an increased prevalence of occult CHF compared to OSA patients without CPAP related CSA.}

Unfortunately there is no mentioned at what pressure range the cpap fired in this study.

I just checked the settings at my Remstar Auto M Series. They only detected 36 Minutes ( ?!?) Theraphy time, the matter of fact is that I used the machine for about 4-5 hours)
the cmh2o was 10. and system leaks are l/min 27.2 and AHI average over the last 7 days was 18.2!
puzzling...
th

If you've got a REMstar M series, that's the wrong entry in your profile.

arburtus wrote:my pressure range is between 6-9, below 10 in the first 3 nights. I used the newest and greatest Remstar. Last night the gave me the previous model, since the can not let me use the newest as a loaner for too long. the pressure seemed much higher, even so it was set at the same strength. I did not check the pressure after my arousals.

I just checked the settings at my Remstar Auto M Series. They only detected 36 Minutes ( ?!?) Theraphy time, the matter of fact is that I used the machine for about 4-5 hours)
the cmh2o was 10. and system leaks are l/min 27.2 and AHI average over the last 7 days was 18.2!
puzzling...
th

Arburtus, what do you mean by "they"?

When you wrote: They only detected 36 Minutes ( ?!?) Theraphy time, the matter of fact is that I used the machine for about 4-5 hours)
the cmh2o was 10. and system leaks are l/min 27.2 and AHI average over the last 7 days was 18.2!

It's hard to understand it.

In my opinion you need to tell us your recent history. Who told you to do the PAT study and why?

Do you have a physician who could first check you and decide if you should do a complete sleep study in a sleep clinic?

By the way, a leak of 27.2 L/min is too hi for the machine to distinguish events.