Many Centrals at the end of the night

[ty845]

I'm about 8 weeks into therapy now and I'm finally starting to get my mask issues and sleep routine issues dialed in. Many nights I'll have an AHI below 8 (down from 59) until the morning when I'll have an extraordinary amount of centrals.



Digging deeper, the whole group of centrals appears to look roughly the same, like this:



My experience with these is that I've already woken up from sleep but am kind of dozing--not fully asleep and not fully awake. So I can't say whether this is a conscious or unconscious breathing pattern.

Any similar experiences? If so, what was the solution for you? I'll ask my sleep doctor about them during my follow-up appointment in two weeks, but I figure the more information I have ahead of time the more intelligent questions I can ask at the appointment.

[BlackSpinner]

If you are awake/dozing then you can be having what is called transition centrals. They happen when you are drifting from one sleep stage to another but especially the first stages.

[Pugsy]

If those centrals are indeed sleep onset centrals they may not mean much despite looking so ugly especially since coming at the end of the night and not the beginning.
Something to talk over with your doctor.
If you are sleeping well, feeling decent, feel like your sleep is restorative...happy with therapy...might not be anything to worry about.
The machine doesn't know if you are awake or semi awake or asleep...it just calls things like it sees them and sometimes what it sees isn't a problem.
Sleep onset centrals are a normal happening and normally not a problem unless they are keeping you from falling asleep or causing low oxygen levels. We all have them from time to time. The fact that you admit to dozing means that you likely had a lot of sleep stage transitions from awake/semi awake state to sleep stage and the frequent changes in stages also increase the chance that you also have the sleep onset centrals.

Do you see these often or just occasionally?
How are you feeling?
Morning headache?

[ty845]

Thanks for the input, everyone.

Do you see these often or just occasionally?
How are you feeling?
Morning headache?

So far this month I've had them 7 mornings out of the 12, so roughly half of my mornings.

After 10 weeks, I'm finally feeling roughly the same as I did before therapy. (I hadn't noticed a problem at all, but my wife convinced me to see a doctor.) So I'm feeling fine--a bit of morning grogginess and a bit of afternoon sleepiness. No morning headaches. No more energy than I did before treatment, either.

Most surprising to me is how regular the centrals are. I figured that if they were sleep onset apneas I would see different time periods between them, instead of the fairly regular 30-second pattern I'm having of 15-seconds of no breathing, 4 breaths and repeat. But I certainly can't say if the apneas are causing the dozing sensation or the dozing is causing the apneas. (I should note that there's nothing preventing me from going back to full sleep--no alarms, no discomfort, no sleep-preventing thoughts, and still tired enough to sleep more--it just doesn't happen.)

Thanks for your thoughts!

[Pugsy]

Do be sure to bring this up with your sleep doctor at your next appointment.
They may not mean anything but they do have the CSR appearance and there are a bunch of them and enough of them with enough duration back to back that there might be some desats involved.
If it was 1 or 2 nights out of 12...maybe let it slide but if they persist...do discuss them with your doctor to see if he feels that they are worth a concern. He/she knows your history so much better.
Especially since you are still symptomatic and haven't felt the "miracle" that we all want and so few achieve.
Always best to discuss concerns with the doctor in this situation...that's why he gets the big bucks.

I have had a few clusters that sort of half assed looked like CSR but never very many and extremely rare...so I don't worry.
But mine don't look so ugly and they might happen once a month if that. Yours are a bit ugly.
You may just need more time for things to settle down some more but do talk to your doctor about them.
Not an emergency as in make the appointment for next week but if you have a follow up appointment schedule be sure to keep it and if you don't have one scheduled go ahead and make one because it will likely be a little bit of time before you can get in to see someone anyway.

In the meantime...try to avoid the dozing sporadically like that if you can. I once helped a guy who was having stuff like you are seeing...all night long though. Scared the devil out of me. Come to find out he was doing a lot of laying in bed tossing and turning and half way sleeping so before panic mode set in we decided to just try not laying in bed for prolonged periods of time...can't sleep..get up.
His AHI went from in the 20s with almost all centrals down to about 3 per hour and more importantly pretty much all the "centrals" went away. Gradually he got in the habit of sleeping through the night and the reports became nice and boring.
Maybe you will be in the same situation.

[ty845]

In the meantime...try to avoid the dozing sporadically like that if you can. I once helped a guy who was having stuff like you are seeing...all night long though. Scared the devil out of me. Come to find out he was doing a lot of laying in bed tossing and turning and half way sleeping so before panic mode set in we decided to just try not laying in bed for prolonged periods of time...can't sleep..get up.
His AHI went from in the 20s with almost all centrals down to about 3 per hour and more importantly pretty much all the "centrals" went away. Gradually he got in the habit of sleeping through the night and the reports became nice and boring.
Maybe you will be in the same situation.

Thanks Pugsy,

This is what I'm hoping for and, indeed, I've had 4 nights with an AHI below 5 (one at 1.77) since the beginning of the month, so this certainly seems like a possibility for me, too. But I will keep my follow-up with the doctor and bring up what I'm seeing. Thanks for the help!