An ugly night and signs of CSR/PB

[khauser]

Since it's relatively normal wake-related phenomena that many of us experience, it's usually discarded from PSG sleep study data as well. When it gets to be unrelated to wake/sleep transitions or overly prolific, then it ceases to be normal phenomena. My understanding is that at that point, the sleep tech will score it and/or note it.

"Wake related" even though it wasn't significant enough for the patient to remember awakening, right? Thanks for the info ... I can tell I will be learning here for a long time. That's a good thing ... I like learning.

[-SWS]

"Wake related" even though it wasn't significant enough for the patient to remember awakening, right?

Right. It's common to not remember brief awakenings. Some awakenings we remember, and some we don't...

Thanks for the info ... I can tell I will be learning here for a long time. That's a good thing ... I like learning.

Me too.

[NotLazyJustTired]

In that case, when present for smaller amounts of time, I wouldn't even COUNT the CA's because the device doesn't really differentiate between a pause in breathing due to CSR from a pause because the brain forgot to say BREATHE!

Since it's relatively normal wake-related phenomena that many of us experience, it's usually discarded from PSG sleep study data as well. When it gets to be unrelated to wake/sleep transitions or overly prolific, then it ceases to be normal phenomena. My understanding is that at that point, the sleep tech will score it and/or note it.

My sleep study does contain footnotes saying, "Does not contain Cheyne Stokes Breathing, Hypoventilation, or Periodic Breathing."
I take that to mean those stats were factored out, not necessarily that there weren't any.

But this all begs the question, How do I know without PSG/EEG data if this is or isn't "related to wake/sleep transitions"?

[Todzo]

In that case, when present for smaller amounts of time, I wouldn't even COUNT the CA's because the device doesn't really differentiate between a pause in breathing due to CSR from a pause because the brain forgot to say BREATHE!

Since it's relatively normal wake-related phenomena that many of us experience, it's usually discarded from PSG sleep study data as well. When it gets to be unrelated to wake/sleep transitions or overly prolific, then it ceases to be normal phenomena. My understanding is that at that point, the sleep tech will score it and/or note it.

My sleep study does contain footnotes saying, "Does not contain Cheyne Stokes Breathing, Hypoventilation, or Periodic Breathing."
I take that to mean those stats were factored out, not necessarily that there weren't any.

But this all begs the question, How do I know without PSG/EEG data if this is or isn't "related to wake/sleep transitions"?

In CSR when there is breathing it is over breathing. The truth is that the body needs some time to bring the CO2 levels back up to where circulation is enabled as well as metabolism. I am not sure if EEG as it is currently used could find the fast arousals I believe exist as more of the brain is invoked to deal with the over breathing situation each time.

I think of it as the breathing control system breaking into oscillation (feedback - periodic breathing) and then producing "square waves" (CSR).

[-SWS]

My sleep study does contain footnotes saying, "Does not contain Cheyne Stokes Breathing, Hypoventilation, or Periodic Breathing."
I take that to mean those stats were factored out, not necessarily that there weren't any.

The phenomena was either factored out as sleep/wake transitional, or perhaps the phenomena didn't occur at all.

But this all begs the question, How do I know without PSG/EEG data if this is or isn't "related to wake/sleep transitions"?

Most of my S9 ResScan data reflects nights without the phenomena. Occasionally I'll see slight periodicity and think nothing of it because it's so slight. When it does rarely present as more than slight, I'll usually remember my wife or the dogs having repeatedly awoken me from heavy sleep.

I like Pugsy's advice on page one: if it seems prolific or concerns you in the least, then show it to your doctor. I think I once read something like 3% or 4% of the night spent in PB is considered subclinical. I'm not sure if I have that percent right, though. But the gist is that a slight amount of PB occurs in the normal, non-SDB population.

[Pugsy]

But this all begs the question, How do I know without PSG/EEG data if this is or isn't "related to wake/sleep transitions"?

Ouji board or magic 8 ball???
We have zero way to know for sure unless we can remember a specific awakening during that time frame and even then there's no guarantee.
Without a sleep lab tech monitoring EEG data...it's a WAG.

I have had it show up when I know for sure I was awake. I have also had it show up like that 17 centrals in 17 minutes where I don't remember being awake but that doesn't mean anything.
Actually...given the time frame I might have been in REM sleep and having a really "good" dream and maybe having a glorious sex dream for all I know...sure wish I had remembered if if it was a dream.

[NotLazyJustTired]

I'm probably just the typical noob, over reacting to a bad night. Just a little unsettling after 3 weeks to get an AHI that is over 200% higher than the sleep study. But I will hang in there.

As far as that last sentence of your post Pugsy, I will have to call TMI on you!

[Todzo]

FWIW: OSA tends to also promote TMJ http://doctorstevenpark.com/expert-inte ... -disorders

[blueh2o]

In that case, when present for smaller amounts of time, I wouldn't even COUNT the CA's because the device doesn't really differentiate between a pause in breathing due to CSR from a pause because the brain forgot to say BREATHE!

Since it's relatively normal wake-related phenomena that many of us experience, it's usually discarded from PSG sleep study data as well. When it gets to be unrelated to wake/sleep transitions or overly prolific, then it ceases to be normal phenomena. My understanding is that at that point, the sleep tech will score it and/or note it.

My sleep study does contain footnotes saying, "Does not contain Cheyne Stokes Breathing, Hypoventilation, or Periodic Breathing."
I take that to mean those stats were factored out, not necessarily that there weren't any.

But this all begs the question, How do I know without PSG/EEG data if this is or isn't "related to wake/sleep transitions"?

A couple of comments:
1. I had Complex Sleep Apnea before I ever saw a CPAP machine. My first two sleep doctors diagnosed me with OSA and told me to ignore the central apneas. I wish they hadn't because the centrals were a significant part of my problem at the time. Maybe it didn't matter because the centrals were eventually resolved with continuous use of APAP. I can thank Dr. G for switching me from ASV to APAP. I just would have liked to be more educated and informed by the first two sleep doctors who discounted the centrals.
2. It really bugs me when people describe central apnea as your "brain forgetting to tell you to breathe". This leads to a false perception for newbies that somehow their head is all f.... up. Your brain is just reacting to CO2 levels in the bloodstream and attempting to adjust them based on respiration rates. The brain isn't forgetting to do anything but rather reacting to the appropriate stimulus. As Dr. G explained to me, if you can prevent the increased work of breathing associated with a hypopnea or flow limitation then you can prevent the central apnea.

[NotLazyJustTired]

Just for gits and shiggles, I put my data into an Excel spreadsheet. As you can see from the following graphs, the residual events from my treatment thus far have been far outweighted by CA events; 70% of all events recorded by the machine to date are CAs:



The computed apnea indices also show that CA events are the predominant factor:



This final graph shows how utterly unusual last nights events were:

[Todzo]

Just for gits and shiggles, I put my data into an Excel spreadsheet. As you can see from the following graphs, the residual events from my treatment thus far have been far outweighted by CA events; 70% of all events recorded by the machine to date are CAs:



The computed apnea indices also show that CA events are the predominant factor:



This final graph shows how utterly unusual last nights events were:

1. Impressive! Please start thinking about how this data could be analyzed and diaplayed for the average man. A simple one chart display that tells the story of treatment effectiveness somehow. You may be the one to do this.

2. To me "Clear Airway events" mean breathing stability issues mean most likely stress. I am glad you have found some good relaxation projects.

Have a great week!

Todzo

[NotLazyJustTired]

So it looks like my numbers are coming back down. For the last three nights, my CAs were 40, 27 and 14. That's still above average for me, but I like the trend. I do see PB around these events, but it is a much shorter duration. On that first night the PB would run for 30 minutes or more. I will keep an eye on it, but for now, I am going to blame this on aliens. I am starting to feel a little better too, so that's good!

Thanks again for the education and support.

[Drowsy Dancer]

I have nothing truly useful to add, but I do love those charts you made up.

[NotLazyJustTired]

I have nothing truly useful to add, but I do love those charts you made up.

Oh, thanks! Not terribly difficult if you know your way around MS Excel. Kind of right down my alley; I am a propeller head!

[avi123]

IMO, you most likely have Central Sleep Apnea Syndrome.

If it is found to be correct after doing a sleep study with RIP sensors, then an APAP mode machine would be contra indicated.

I would switch to CPAP mode only right away.

Your graphs remind me of this poster who ended up with ASV:

(These graphs are in ResScan and you can see the shape of the waves besides their frequencies.

The first graph is typical to CSR. The second graph is typical to Periodic Breathing.)