CENTRAL SLEEP APNEAS - HELP ?

[jglclarke]

Hello,
I am a 74 retired male and am being treated for High Blood Pressure and Coronary Artery Disease (4 stents) and have been on BIPAP for 4 months. I have been getting AHI's below 3 for the last 2 months after discovering that my higher readings were due to sleeping on my back. My concern is Central Sleep Apneas which seem to occur in clusters. My questions for a start are:-
1. Should I only be concerned when they are over 10 seconds ?
2. I am on Constant Pressure 18/14 H20. Should I be on an ASV or other machine ?
3. Are my Centrals Cheyne Stokes ? If so, where could I get more information on the treatment of these ?
Please let me know if more information and images would be helpful.
Thank you.

[greatunclebill]

PR calls them clear airway, not central apnea. i talked specifically with my sleep doctor about PR ca's and he said not to worry about them as i do not have central apnea. we have to keep in mind that the machine is interpreting everything based on our breathing back or not at the blower. if you think you have a central apnea problem, discuss it with your doc and don't lose sleep worrying about it.

[Wulfman...]

Hello,
I am a 74 retired male and am being treated for High Blood Pressure and Coronary Artery Disease (4 stents) and have been on BIPAP for 4 months. I have been getting AHI's below 3 for the last 2 months after discovering that my higher readings were due to sleeping on my back. My concern is Central Sleep Apneas which seem to occur in clusters. My questions for a start are:-
1. Should I only be concerned when they are over 10 seconds ?
2. I am on Constant Pressure 18/14 H20. Should I be on an ASV or other machine ?
3. Are my Centrals Cheyne Stokes ? If so, where could I get more information on the treatment of these ?
Please let me know if more information and images would be helpful.
Thank you.

Did that mean you've been trying to sleep in other positions besides "supine" (on your back)?

And, I agree with "greatunclebill" with regard to discussing it with your doc.


Den

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[palerider]

3. Are my Centrals Cheyne Stokes ? If so, where could I get more information on the treatment of these ?

the highlighted section certainly looks like CSR. however, they're of fairly short duration overall, and you only have them occasionally. unlike some people I've seen who are now on an ASV.

I third the advice, talk to your doctor about it.

[archangle]

PR calls them clear airway, not central apnea. i talked specifically with my sleep doctor about PR ca's and he said not to worry about them as i do not have central apnea. we have to keep in mind that the machine is interpreting everything based on our breathing back or not at the blower. if you think you have a central apnea problem, discuss it with your doc and don't lose sleep worrying about it.

Did your doctor actually look at your data? If not, he's probably one of those idiots who think data from CPAP machines is useless. Just because you didn't have central apnea or complex apnea in a one night in-lab sleep test doesn't mean you don't have it now.

Hello,
I am a 74 retired male and am being treated for High Blood Pressure and Coronary Artery Disease (4 stents) and have been on BIPAP for 4 months. I have been getting AHI's below 3 for the last 2 months after discovering that my higher readings were due to sleeping on my back. My concern is Central Sleep Apneas which seem to occur in clusters. My questions for a start are:-
1. Should I only be concerned when they are over 10 seconds ?
2. I am on Constant Pressure 18/14 H20. Should I be on an ASV or other machine ?
3. Are my Centrals Cheyne Stokes ? If so, where could I get more information on the treatment of these ?
Please let me know if more information and images would be helpful.
Thank you.

jglclarke, don't worry too much about the words "central apnea" and "CSR." While there are some very serious conditions that can cause central apnea or CSR, many "normal" people develop some degree of central apnea/periodic breathing/CSR under CPAP pressure. The pressure flushes out CO2 and inflates your lungs more fully and confuses your respiratory system.

Worry about the amount of time you're not breathing. More apneas per hour is bad. Longer apneas are worse than short ones.

Central vs. CSR vs. obstructive makes a difference in how you try to eliminate them, not in the harm it does to you.

You might try a slightly lower pressure and see what happens. Sometimes a lower pressure fixes centrals. Sometimes you have to find a balance between central and obstructive.

[greatunclebill]

Did your doctor actually look at your data? If not, he's probably one of those idiots who think data from CPAP machines is useless. Just because you didn't have central apnea or complex apnea in a one night in-lab sleep test doesn't mean you don't have it now.

my doc whom i've had since 2001 is quad board certified, internal medicine '85, critical care '89, pulmonary '88 and sleep medicine '11, but sees mostly sleep apnea patients. he has practiced medicine since 1982. he is a professor in the university's college of medicine along with seeing patients. yes he went over my sleepyhead and encore data and graphs with me and convinced me not to worry about the clear airways in my reports. i've had 3 sleep studies going back to 1990.

[jglclarke]

Thanks Archangle,
I had a Sleep study on 5/19/14 which recorded 15 Centrals in 2 hours during the Diagnostic Study and about 5 every 15 minutes until the pressure was ramped up to 16/12 when there were none. The final 32 minutes was at 18/14 where there were no Centrals and the AHI was 3.8. These were the recommended pressures for my machine.

In response to Wolfman, I now avoid sleeping on my back and consequently sleep mostly on my sides and sometimes even on my stomach. Is there an issue with this ?

In response to Palerider, I have been noting CA's over 10 seconds and accept that some are inevitable but get concerned when I see 22 seconds ?
Thanks to greatunclebill and you all and note that I will definitely be discussing these issues with my Doctor within a month however want to be as informed as possible to ask the right questions. I have not been to a Sleep Specialist and suspect he might refer me to one who might want me to have another sleep Study which I am not ready for yet.

[Wulfman...]

Thanks Archangle,
I had a Sleep study on 5/19/14 which recorded 15 Centrals in 2 hours during the Diagnostic Study and about 5 every 15 minutes until the pressure was ramped up to 16/12 when there were none. The final 32 minutes was at 18/14 where there were no Centrals and the AHI was 3.8. These were the recommended pressures for my machine.

In response to Wolfman, I now avoid sleeping on my back and consequently sleep mostly on my sides and sometimes even on my stomach. Is there an issue with this ?

In response to Palerider, I have been noting CA's over 10 seconds and accept that some are inevitable but get concerned when I see 22 seconds ?
Thanks to greatunclebill and you all and note that I will definitely be discussing these issues with my Doctor within a month however want to be as informed as possible to ask the right questions. I have not been to a Sleep Specialist and suspect he might refer me to one who might want me to have another sleep Study which I am not ready for yet.

I was just trying to interpret your statement. It sort of sounded like you may be trying to sleep in other positions. Just wanted to clarify. Supine sleeping is supposed to be worse for OSA, but I don't know if it has the same effect with CSA.


Den

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[palerider]

In response to Palerider, I have been noting CA's over 10 seconds and accept that some are inevitable but get concerned when I see 22 seconds ? .

generally, you shouldn't be concerned about any single event, it's patterns, and groups...
if you sleep all night and have one 30 second apnea, central or obstructive, either one, you still probably got a pretty darn good nights sleep.

the machine will score centrals when you hold your breath, and some folks do that as they're moving around, or as they're waking up, or going to sleep...

and, like I said, a little section of what looks like csr, like you posted isn't anything to freak out about, if it keeps happening, I'd mention it to my doctor.... but it's not anything like what was happening to a friend of mine who turned out to have congestive heart failure, for example, here's most of an *hour* of constant apneas:



that's cause for alarm.

[jglclarke]

In July I upgraded to a 960 Auto ASV and am very pleased with the results particularly the illimination of CA's and an AHI of about 1.5 with mostly Hypopneas and low AHI with supine sleeping. I would appreciate any suggestions on tweaks that might reduce my hypopneas. My Sleep Study titration was 18/14 and my settings are now EPAP Min - 16, EPAP Max - 20, PS Min - 4, PS Max 9 & Maximum Pressure = 25. I am hesitant to increase the pressures any more as they seem to be very high already?
Thanks.
John

[Pugsy]

You don't have much room to change the pressures that's for sure.
In all honesty I don't see the need to reduce the hyponeas if this is a typical night.
You might try 0.5 cm more minimum EPAP only and leave everything else the same and see if that little bit helps but I don't see any urgent need to work very hard getting the hyponeas reduced further...2 per hour is quite acceptable.

[jglclarke]

You don't have much room to change the pressures that's for sure.
In all honesty I don't see the need to reduce the hyponeas if this is a typical night.
You might try 0.5 cm more minimum EPAP only and leave everything else the same and see if that little bit helps but I don't see any urgent need to work very hard getting the hyponeas reduced further...2 per hour is quite acceptable.

Thank you Pugsy. I increased my EPAP to 16.5 last night and had my normal number of hypopneas (AHI 1.53) OF 13. I no not see much sign of breathing cessation with most of these hypopneas? I will stay with this setting for a while and will report back with any significant changes.

[Pugsy]

Hyponeas aren't full blown total (or near total) cessation of breathing...if you were having that then it would be OA.

The percent of reduction of air flow dictates the event category.
OAs...definition varies a little within brands but generally 80 to 100% reduction of air flow.
Hyponeas...definition of around 50% or more reduction in air flow...up to around the 80% mark when the event would meet criteria for OA instead of hyponea.

So hyponeas are sort of OAs that haven't grown up to become full grown OAs yet and in small numbers like you are having probably aren't of any clinical significance.
Now they might have some clinical significance if the hyponeas were massively long and you had a bunch of them happen in a cluster back to back but I don't see evidence of that happening on these reports.
Like if those 13 hyponeas all happened within a 13 minute window back to back.
Spread out over the entire night they really aren't much of a big deal and I wouldn't worry about them if it were me as long as I was sleeping decently and feeling decent in general.

Sometimes people go chasing "numbers" and lose sight of the big picture. It's a unrealistic goal to try to nuke all the "events" and have the AHI be 0.0.

[jglclarke]

I understand. Yesterday afternoon I got 6 Hypopneas in1.24 hours of supine sleeping whereas before I got mostly 0.00 AHI and last night I got 4 CA's which was also unusual. As a result I have got back to my 20/16 setting and will remain there for the time being. I am comforted to know that my settings are in order and my AHI of 1.5 average with mostly hypopneas spread out are acceptable.
Thanks Pugsy.

[sickwithapnea17]

I have centrals too and a neurenteric cyst near my clivus. have you found anything that can help centrals? yes over 10 seconds is really terrible and can do damage to all your organs including your brain and heart. the brain develops lesions from long term sleep apnea