Just Started my CPAP - Getting odd results

[RodgerDodger]

Hi everyone,

Maybe you can help me. I have been using my CPAP machine for about a month now, but only yesterday got an SD card for it. Using it last night revealed some interesting results. I have been lurking on this board for a month or so and have been doing all kinds of research. I have a ResMed AutoSet9. I have attached a screen shot of my session report last night using the Sleepy Head software.

If the image below is too big to fit in the screen, here is a direct link to it: http://imagizer.imageshack.us/a/img910/8632/tZjChw.jpg



According to this report I seem to be having a lot of central apnea. This is odd because my sleep study did not reveal a great amount of central apneas. It did say that I experience some central apneas, especially in REM sleep, but not nearly the amount being reported here. This could be because my sleep study used a full face mask, which I cannot tolerate whatsoever (I can pretty much only use a nasal pillow). I was also extremely uncomfortable and only got a handful of hours of sleep. It could also be that the machine just doesn't know what to make of it.

This particular report is abnormally long for me. I got to sleep in because I have the day off work. I was in and out of sleep from about 8am to 10am, sort of a dream-like lightish coma, lol. Usually I sleep midnight to 6am. Although my AHI isn't terrible, I still feel very fatigued and tired.

Can you wonderful people provide any clues as to what may be going on here?

[Pugsy]

Your centrals do seem to increase in the time period where a person normally would expect to have more REM stage sleep.
Especially those wee hours of the morning. I don't know why a person might have more centrals during REM (mentioned in your sleep study) but you might want to talk to your doctor about your concerns.
I doubt that the doctor will be alarmed as the number is not horribly high but part of the night you don't really have any centrals so the average is lowered by those hours with no centrals.

Are you for sure asleep during those periods of time when you see the centrals want to cluster?
and are you taking any medications that might suppress respiration?

[RodgerDodger]

I don't really have a sleep doctor here. I have just been seeing an ENT at the moment. My insurance paid for the sleep studies and ENT, but that's it. I purchased the CPAP myself and I am self treating. I get new insurance January 15th with a much more robust network of doctors so I will have a lot more options. I definitely plan on seeing an actual sleep doctor at that time. Until then I am on my own.

I am not taking any medications that would affect respiration at this time.

Are most people in REM around 6am? 6am is usually when I wake up for work. I usually get 6 hours of sleep. Are you suggesting that I go to sleep earlier so that my own interal 'wee hours' would be around 4am instead of 6am?

I could try going to bed earlier but it is extremely difficult for me. I also have environmental problems. My girlfriend gets home around midnight and usually wakes me up (light sleeper). If I go to sleep before that and am woken up, I usually cant go back to sleep for hours.

I can try sleeping in a separate room for a week though, to get some experimental data and see what happens, if you think its a good idea.

[Julie]

Are you overtightening your mask to stop leaks? Maybe try loosening it a bit to let the thin 'cushion' inflate. And if you're sleeping on your back, do whatever you can to avoid it as it provokes more events. Have you tried wearing a soft cervical collar (from a full service drugstore) to help keep your jaw closed and your head up to keep your airway open? It's surprising how much difference that can make for some people, tho' not sure how it impacts centrals of course.

[Pugsy]

Actually I am not suggesting that you change your sleep times because the end result will be the same...more REM sleep towards the latter part of the sleep period no matter when you go to sleep. The cycles are the cycles no matter when you start them.
Google "sleep stage" and see the hypnograms that you get and/or look at this link and scroll down a bit to see the hypnogram
http://en.wikipedia.org/wiki/Sleep
The sleep stages are more in relation to hours of sleep than when you go to bed and I wouldn't be trying to prevent REM if it were me because we need all the sleep stages for the restorative powers of the various sleep cycles to work their magic.

At this point those centrals aren't horribly numerous and maybe with time they will sort of reduce on their own anyway.
Since you don't have a doctor right now that could likely explain the cause and/or address the "is this cause for alarm" thing and won't have one until the new insurance...I would just sit back and watch them for the time being.
They don't seem to be related to pressure as best I can tell here.

It's possible that these are post arousal sleep onset centrals..meaning that maybe you wake up after a REM cycle (which wouldn't be uncommon at all and you may or may not remember it) and thus after the arousal you go back to sleep and a sleep onset central happens (which is a normal occurrence) and may not be anything to worry about.

If you are concerned...the only concern I might have if this were my report would be what was happening to my oxygen levels during those clusters and you can easily check that out with one of those overnight pulse oximeter reports.
http://www.coopermedical.com/category.php?id_category=6
You have to make sure that they will record overnight though. Sleepyhead will work with pretty much all the CMS overnight recording pulse oximeter...and you might check EBay for less expensive models than what is shown at the above link. I use that link because it is where I bought mine and it offers most of the models.

I doubt that the clusters of centrals are impacting your Oxygen levels much (if any) but it is something you could maybe do to reassure yourself.

I wouldn't change my sleep routine though....I think it would cause more problems in terms of how you might feel than having these centrals might cause. The numbers here...aren't anything near where I might say "OMG go see a doctor now". They are more of in the numbers of "I am scratching my head here and maybe just keep an eye on them for now since you really can't do much about them anyway and I am not so sure that there is any urgent need to do anything about them anyway".

Are most people in REM around 6am?

Maybe, maybe not...it's not about the clock time at all...it's about the cycles themselves no matter what the clock time says.

[Nick Danger]

You say you usually wake up around 6 a.m. and that's right about when a big cluster of CA's happened. Any chance you woke up then and were about half awake for 30 to 45 minutes? Another big cluster happened about 30 minutes before you turned off the machine? Any chance you were half awake then? When we're awake our breathing is less regular than when we are asleep - the machine doesn't know you are awake and scores the half-awake irregularities as CA's. My wife gets up before I do and wakes me up when she does - I lie there until I fall back asleep. It is not unusual to see a number of CAs around the time she gets up.

If it weren't for those two clusters, the AHI would be much lower (and it's already under 5).

[archangle]

Zoom in on some of your centrals and see how long and how complete they are. If they're longer or more complete, they're more concerning.

You can go to the "Events" tab and click on individual events to zoom in.