Newbie's first post-Sleep Onset Central Apneas & Other ?

[riley525]

Thank you to all who have created and posted on this forum, it has been a huge help for me! I just started using the sleepyhead software and have been trying to read posts to figure things out. I have been having lots of CAs, my OAs are down as long as I sleep on my side. My lowest AHI is 3.0 I have been on the bipap for a month. My average last week was around 8 AHI. Since loading my info to sleepyhead, I have noticed that most of my CAs are occurring in a big cluster just before my ramping reaching full pressure. I have my ramp pressure starting at 4. I had my DME provider lower my ramp time from 30 to 15 minutes yesterday but still saw the cluster of CAs last night. My bipap is set on 7 / 11. I am wondering if I should get an autopap to control the OAs when I am on my back but worry about the higher pressures increasing the CAs. I also saw another periodic breathing flagged last night. Is this periodic breathing a concern? I will try to post my screenshot from Ingur.... I would appreciate your input. Thank you so much!

[D.H.]

Do you really need the ramp? Frankly, I turned mine off in the first month and haven't used it since.

I suggest trying either totally disabling the ramp, lessening the time to full pressure, or setting the start pressure higher than it is. If you don't get better results, you can always revert.

[Pugsy]

Were you asleep or awake at the end of ramp?

I don't see any need to increase the pressure but I doubt that the centrals will worse with more pressure.
Higher cpap pressures don't cause centrals nearly as often as people tend to think. I routinely see pressures of around 20 cm or more and never had a problem with centrals.
Only about 10 % of the people put on cpap/apap/bipap have problems with centrals just from the pressure itself.

[riley525]

Do you really need the ramp? Frankly, I turned mine off in the first month and haven't used it since.

I suggest trying either totally disabling the ramp, lessening the time to full pressure, or setting the start pressure higher than it is. If you don't get better results, you can always revert.

I will try again without the ramp, I thought it made the process a little more comfortable at the time.

Were you asleep or awake at the end of ramp?

I don't see any need to increase the pressure but I doubt that the centrals will worse with more pressure.
Higher cpap pressures don't cause centrals nearly as often as people tend to think. I routinely see pressures of around 20 cm or more and never had a problem with centrals.
Only about 10 % of the people put on cpap/apap/bipap have problems with centrals just from the pressure itself.

I think I was asleep at the end of the ramp. This cluster of CAs has happened at the end of almost ever ramp I have had.
I thought the CA that occured more in the middle well after the ramp was pretty long.



I thought the cluster of longer CAs sometime after the ramp, that included the periodic breathing was weird. I would like to get my AHI average down consistently below 5 at least. So as long as my OAs are down you don't see a need to increase my overall, 7/11 bipap pressures? Sorry, I am new to all this. Do a lot of people have a higher than normal AHI a couple times a week? I think they are occurring when I am on my back. I am just wondering if I should change to an autopap machine to cover those higher pressure needs. Or do I wait another month to see if things level out more?

[Pugsy]

It's very possible that those centrals are what we call sleep onset centrals...sleep stage transition centrals and they actually are normal and not usually a problem unless they are so numerous that they keep bouncing a person out of sleep.

It's possible that when the machine finally ends the ramp that something weird causes a sleep onset central or maybe some semi awake breathing irregularities that are getting flagged as centrals but they really aren't centrals.

I would try not using ramp and see if that fixes the problem...if not we can maybe dig a little deeper.

I don't know if the periodic breathing is worth worrying about...you aren't having much of it but let's look at it up close to see what it looks like.
Go to the events tab and pick a central event that is flagged during the time of periodic breathing green flags...and click on that event ...the graphs on the right will change so that you are looking at the flow rate zoomed in so we can see breath by breath of that PB flagged time looks like.

Periodic breathing itself is nothing more than a general waxing and waning of the air flow and most of the time doesn't really mean much of anything. Sometimes Periodic Breathing ends up being Cheyne Stokes Respiration and that could be important if we see a lot of it. Cheyne Stokes Respiration is just one form of Periodic Breathing ...it is NOT the only form of PB.
Let's see if your PB looks CSR ish or not. I suspect it won't but let's look to make sure.

[D.H.]

Do you really need the ramp? Frankly, I turned mine off in the first month and haven't used it since.

I suggest trying either totally disabling the ramp, lessening the time to full pressure, or setting the start pressure higher than it is. If you don't get better results, you can always revert.

I will try again without the ramp, I thought it made the process a little more comfortable at the time. . . .

If you do find the ramp is making you more comfortable, you probably have the option to shorten ramp time. Maybe that's your better solution.

[riley525]

It's very possible that those centrals are what we call sleep onset centrals...sleep stage transition centrals and they actually are normal and not usually a problem unless they are so numerous that they keep bouncing a person out of sleep.

It's possible that when the machine finally ends the ramp that something weird causes a sleep onset central or maybe some semi awake breathing irregularities that are getting flagged as centrals but they really aren't centrals.

I would try not using ramp and see if that fixes the problem...if not we can maybe dig a little deeper.

I don't know if the periodic breathing is worth worrying about...you aren't having much of it but let's look at it up close to see what it looks like.
Go to the events tab and pick a central event that is flagged during the time of periodic breathing green flags...and click on that event ...the graphs on the right will change so that you are looking at the flow rate zoomed in so we can see breath by breath of that PB flagged time looks like.

Periodic breathing itself is nothing more than a general waxing and waning of the air flow and most of the time doesn't really mean much of anything. Sometimes Periodic Breathing ends up being Cheyne Stokes Respiration and that could be important if we see a lot of it. Cheyne Stokes Respiration is just one form of Periodic Breathing ...it is NOT the only form of PB.
Let's see if your PB looks CSR ish or not. I suspect it won't but let's look to make sure.

[riley525]

Sorry, I am having trouble getting imgur to resize my images. The first one worked but now it won't let me pick large thumbnail...

Thanks for you help!

[Pugsy]

Still not zoomed in quite enough...go back and redo the steps but instead of clicking on the PB time click on the CA/central timed at around 00.42.45. Hopefully that will give us the CAs in front and behind that event.
At this level of zooming it doesn't look CSRish.

Yeah, imgur is still acting up when we choose large thumbnail..it's a bug in their system...just choose "huge thumbnail" instead

This is what CSR looks like.

[riley525]

Still not zoomed in quite enough...go back and redo the steps but instead of clicking on the PB time click on the CA/central timed at around 00.42.45. Hopefully that will give us the CAs in front and behind that event.
At this level of zooming it doesn't look CSRish.

Yeah, imgur is still acting up when we choose large thumbnail..it's a bug in their system...just choose "huge thumbnail" instead

This is what CSR looks like.

SO if there is a CA around it, then it is not CSR?

[Pugsy]

SO if there is a CA around it, then it is not CSR?

No. If there is a CA in it and the pattern looks like the CSR pattern above (which yours doesn't to me) and we see a lot of it and there's an unusually high CA/central index then we worry.

Even if your breathing pattern looked like definite CSR this small of a segment all by itself occurring randomly...isn't really that alarming.
But to me it doesn't look CSRish and these aren't an alarming number of centrals (or any apnea events really) so I don't think that this PB segment is particularly worrisome.

If it bugs you too much then get with your doctor about it but a little bit of PB here and there isn't a big deal and doesn't really mean much of anything.

[riley525]

Thank you so much Pugsy! I have a followup appointment coming up soon, so I will go over it with him then.

[palerider]

those don't look like centrals, he's still breathing, though not much. maybe co2 undershoot.... maybe.

[Pugsy]

those don't look like centrals, he's still breathing, though not much. maybe co2 undershoot.... maybe.

Don't look like centrals to me either. For sure not the classic Central and for sure not very prolonged.

Makes me wonder what the end of ramp CA cluster looks like up close.

[palerider]

those don't look like centrals, he's still breathing, though not much. maybe co2 undershoot.... maybe.

Don't look like centrals to me either. For sure not the classic Central and for sure not very prolonged.

my feeling is that they're flagged in error.

Makes me wonder what the end of ramp CA cluster looks like up close.

indeed.