Interpreting central events

[birdie22]

Hi,

I've been using my CPAP machine every day for one year now but I still feel tired (too) many days when I wake up.
My therapist initially told me it could take as much as 6 months before I can see results, so I did not bother before.
But when I look at the data from my S9 Elite, I notice clusters of central events on those days (between 10 and 20 events/hour).
I'm a bit at lost as to how I can interpret this.

Should I be concerned with these events?
Would central events have the same end results on my sleep quality as obstructive events?
If yes, is there a typical way to address this?

Thank you very much for any help.

[Pugsy]

Should I be concerned with these events?

Yes

Would central events have the same end results on my sleep quality as obstructive events?

Yes

If yes, is there a typical way to address this?

Would need more information but typically, yes a special machine possibly. Did you get copies of your initial sleep studies? Were there any centrals noted on either? What was your diagnosis? Have you mentioned the centrals to anyone? If so, what was said? What is your pressure? Do you notice clusters every night or just sometimes?

[sleepnationtv]

Usually for Central Sleep apnea you would need to use a Resmed Vpap adapt. These machines need to be set to the exact pressure which usually requires a sleep study to be performed. They are a little harder to self diagnosis but not impossible if you have rescan.

[kempo]

Does your doctor know about the 10 to 20 centrals an hour?

[birdie22]

Hi Pugsy,

Would need more information but typically, yes a special machine possibly. Did you get copies of your initial sleep studies? Were there any centrals noted on either? What was your diagnosis? Have you mentioned the centrals to anyone? If so, what was said? What is your pressure? Do you notice clusters every night or just sometimes?

I had a polysomnogram at home, which showed these events/hour : 0.8 obstructive, 1.1 central, 11.1 hypopnea.
I was diagnosed a moderate sleep apnea (13.1 events/hour).
In the first 6 months, there was not much events to mention. It only started 6 months ago.
My pressure is usually around 140/85.
I don't notice clusters every night, but when I do, they tend to concentrate from 2 to 6 am.
For example, for the past three weeks, there were 13 days for which these clusters resulted in more than 10 events/hour, for one to four hours during the night.
That being said, my average central events/hour for this period, for the whole night is only 2. And my combined apnea/hypopnea average is below 5 which, I was told, is normal.
Nevertheless, I feel something's not quite normal with my sleep.

Tanks for your advice. It's really appreciated!

[birdie22]

Usually for Central Sleep apnea you would need to use a Resmed Vpap adapt. These machines need to be set to the exact pressure which usually requires a sleep study to be performed. They are a little harder to self diagnosis but not impossible if you have rescan.

If I understand you correctly, this would replace my current S9 Elite. Right?

Thank you.

[birdie22]

Does your doctor know about the 10 to 20 centrals an hour?

No, my doctor doesn't know about it (not yet). I will see him next month.
But, as I tried to explain above, these 10-20 events an hour are not for the entire night, but only for a 1 to 4 hours period.

Thanks.

[Pugsy]

The home sleep study that you had...did they also do the EEG electrodes on the head an face to score sleep stages?
On any of your reports does it mention event being worse in REM sleep or positional like on your back?

What pressure is your cpap machine set at? Are you on any meds? Pain meds especially?

Can you post a single night of reports...all the graphs and event breakdown into cattagories.? Pick one with lots of centrals

Don't know how.. this is how I do it.


Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't

[ameriken]

Is it possible the CPAP pressure is inducing the centrals?

[archangle]

What is your CPAP pressure?

How long do the "Central apnea" events last?

[Slartybartfast]

To amplify on Ameriken's response, someone asked a similar question recently and I replied in my typical long-winded manner. Can't help it. It's my propensity. My English teacher once told me that.

Here 'tis: viewtopic.php?f=1&t=67346&p=626735#p626735

Yes, it's entirely possible, in fact it's likely that your feeling poorly rested is related to all the "centrals." I put centrals in quotes because there's no way to really say for sure whether what appears to be a central apnea, where the central nervous system fails to signal the diaphragm muscles to initiate another breath, or whether the suspension of your breathing is actually caused by what is called the Hering-Brauer reflex. I think the latter is more likely, but there's no way to know unless you have EEG information.

When your blood CO2 level drops below a certain point, by reflex action you will fail to take a breath. That happens just about every time you yawn or take a deep sigh. You'll skip a breath or two afterwards, then start breathing again.

If your S9's pressure is set too high, you will blow off enough CO2 (meaning your blood is fully saturated with O2, if all is well) to trigger the Hering-Breuer reflex.
http://medical-dictionary.thefreedictio ... r+reflexes

Lower the pressure a bit, maybe 1cm or so and those "centrals" should diminish or go away entirely. With a CPAP that's one way to determine whether your pressure is too high or too low. If your pressure is too low, you'll have obstructive apneas and hypopneas. If your pressure is too high, you'll have "centrals." When it's just right, you'll have very few of either obstructive or "central" events.

Look at the wave shape as described in the link. If you see the rounded flow peaks following what ResScan scores as "centrals" then that indicate you might be awakening after each event.

[birdie22]

Hi Pugsy,

The home sleep study that you had...did they also do the EEG electrodes on the head an face to score sleep stages?
On any of your reports does it mention event being worse in REM sleep or positional like on your back?

No, there was no record of sleep stages.
Proportionally, there was twice as much events/hour while sleeping on my back, even though that night I slept in that position only 15% of the time.

What pressure is your cpap machine set at?

Pressure is set at 10.

Are you on any meds? Pain meds especially?

I've been taking Cymbalta for 8 months now. I went through a burn out from nov. 2010 to march 2011.

Can you post a single night of reports...all the graphs and event breakdown into cattagories.? Pick one with lots of centrals

Hope this is the graph you were talking about.





Thanks again,

[birdie22]

Hi,

What is your CPAP pressure?

How long do the "Central apnea" events last?

My CPAP pressure is set to 10.

Central events typically last for 1 to few hours (see my post above). Each event lasts around 18 seconds, on average.

Thank you

[Pugsy]

Holy crap...can we just erase that last half of the night? Then you would be in great shape..
Forgot to ask...Do you use EPR? If so, what setting.
Alas we can't, so need to figure out what is going on.
Way too many centrals in that last half of the night. Way too many to blame on sleep onset unless you remember being awake very frequently during that time frame? Odd that the first half of the night is quite acceptable which makes me wonder what was so different about the last half. Is this report typical for you? Have you had reports for all night that look like the first half or do you always have this many centrals or more?

If you have some "normal" nights that look like the first half of this report then perhaps we can look at positional cause for the wild half. If you always have half the night like this report I would suggest a visit with the doctor. If these are a sometime thing then you can spend some time trying to investigate what is going on.

Don't know about sleep stage effect since you had a home study. It is common for REM stage sleep to see an increase in whatever events a person has. Something interesting to explain away some things but in reality since we can't control REM not much we can do about it. If the increase in events is related to position then perhaps that is something you can investigate to see if it makes any difference at all. It is common for more events to occur when supine. Do you normally sleep on your back? Is it possible that sleeping on your back is a factor in the wild half of the night?

If this were my report I would investigate possible supine position making things worse if I had some nights where my report looked like the first half.
I would seriously consider talking with doctor about the number of centrals if I was having them every night like this.
And finally since I am a bit of a wild thing and prone to experimentation I might try something really off the wall....reduction in pressure on the small remote off chance that those centrals are pressure induced. It is a wild thought but if we can't blame position or sleep onset or being awake and fooling the machine we don't have much left to blame. I don't think Cymbalta is a factor.

If you consistently have long periods of time where these many centrals are present and you cannot isolate a causative factor and you can't reduce them...you may need to discuss a different type of machine.

[Slartybartfast]

"It is true that there is a thing here which I cannot understand.
There is a pain between my ears."

-- Dirt On The Nose from Little Big Man

Something changed around 0400. Find out what changed.
Was the Cymbalta maybe wearing off around 0400?