Very High CA/CSR - Very Low AHI

[deepsleep66]

I am an apparently healthy male age 66 who has been using Resmed Airsense 10 for 4 years after being diagnosed with OSA. Up until April of this year I had very good results - AHI rates consistently below 1 - and no daytime drowsiness. Just looked at my stats and was surprised to see that my AHIs were very high (10 to 35) in recent months - with almost all of the increase due to Central Apneas. Looking at sleepyhead, see an interesting pattern - onset of high AHIs was April of this year, and its not consistent. I have very high days interspersed with very low days. Also the high CAs are accompanied by significant amounts of Cheyne-Stokes respiration. Attaching a screen shot of a particularly bad night - (CSR was 60%). [attachment=1]screenshot-20190729-22234 ... ttachment]

Here's a shot of last 3 months activity showing huge variation in AHI which high AHI also accompanied by high CSR.[attachment=0]screenshot-20190729-22322 ... ttachment]

Oddly - I don't feel like I'm missing out on sleep when I have the high AHIs. Would appreciate input from anyone who has seen something like this. One potential explanation would be that the CSR is caused by Hyponatremia resulting in not getting enough sodium after exercising heavily in the heat. (My work is no longer requiring 50% overnight travel, as it was until April and I'm working out and eating better that I was when I was on the road).

[Grace~~~]

Hi DeepSleep66,

If you're eating better and excising more and were surprised to see these stats, does that mean you have felt the same since April? You haven't been experiencing any negative symptoms ~~~ at all?

[Miss Emerita]

I think the experts will find it helpful if you post a chart with a zoomed-in view of a segment of your flow rate. Aim for a 5 minute segment from a CSR area, and include multiple CAs. If they want further views zoomed in or out they will let you know.

[Pugsy]

Welcome to the forum.

What does your doctor say about these results? If you haven't brought it to his/her attention then you need to.

Any change in medications or dosages that might coincide with the central increase?
What meds do you take?

[deepsleep66]

Thanks for all of the replies.ta
Here is more Info:
1. Don't feel different / since April other than being in better aerobic shape, and have lost 10 - 15 lbs (still have 15 - 20 to go).
2. Have not seen my MD - as I just happened to look at stats late yesterday. Last Physical was Aug 2018. Have another scheduled in 2 weeks. Normal labs. Wife is nutritionist and is advising that I refrain from very heavy workouts in heat and take more sodium (challenge because I was never into salty foods).
3. Medications - Zirtech and Flonase (OTC) at night for allergies. Have been doing this since 2014. Baby aspirin also taken in evening. Vitamins daily - Centrum Silver, Vitamin D and Fish Oil.
4. For those interested - Here is a 5 minute detail of when I was showing repeated CAs / CSR. [attachment=0]screenshot-20190730-04280 ... ttachment]

[Pugsy]

The zoomed in section shows what I expected to see and that is pretty much classic CSR breathing.
It would be the very first thing that I brought up to the doctor on the up coming doctor's visit in 2 weeks.
If you didn't already have that up coming appt I would be telling you to make an appt ASAP.

Did you ever have a regular sleep doctor in the picture? Anyone managing your OSA?
Is the doctor you are going to see someone familiar with evaluating the machine data?
Does your regular doctor that you are going to see have any specialty in his practice or is he more of a family practice type of doctor?

This could be idiopathic (no known reason for it) CSR but you need to be evaluated for potential heart related problems just to make sure the CSR isn't from some sort of hidden or unknown heart problem that has cropped up.

Don't let anyone try to put off or reschedule that appointment.

[deepsleep66]

Pugsy
Thanks so much for looking at the Zoomed in section. I'm definitely keeping the DR appt. In the mean time, my wife ( nutritionist and highly educated CPAP user herself) thinks this the CSRs result from Hyponatremia (low salt levels) induced by heavy exercise, with excess hydration.

To test this out, I had some salty snacks before bed and woke up to these very different results. AHI .21 CA 0, OS 0, CRS 0%

So over the next two weeks I will be adding salt to my diet and monitoring results closely.

My MD is an internist - and my original sleep specialist is not in my network, so I will need to scramble if another sleep study is recommended.

[Pugsy]

Your wife may well be on to something.
Sodium is an electrolyte and the proper levels of all electrolytes are needed for our organs and muscles to function properly.
Too low or too high and things short circuit and go whacky.
CSR showing up unfortunately points to something whacky maybe going on with the heart.

You still want to rule out potential heart issues. Mainly rule out heart damage so you know the old ticker is okay now and not sick.

I would still have a lot of questions if you were my husband.
Like what were those low levels and why were they low besides just not having salt in the diet. Most people can get enough salt just from a normal diet that really doesn't include much added salt. Salt is present in what we eat or drink to some extent even before we add extra salt. For most people that is enough salt.
Why does your body not seem to be using it properly?
Low sodium levels are also found in people with congestive heart failure and it's because the body isn't metabolizing the sodium correctly more than the amount of salt that they ingest. High CSR breathing is known to be associated with heart failure. I don't mess around with heart related stuff. I will mess around with a lot of stuff but heart, ears and eyes I don't mess around with.

Your internist should be able to get it sorted out and be familiar with the CSR stuff. I don't see the need for a new sleep doctor at this point.

I will cross my fingers that the fix is something as simple as just adding more salt to your diet but I would still be wondering why you need it in the first place. That's how I am...I want to know "why".
And since the "why" points to a potential heart related issue I would want to for sure know that the old ticker is nice and strong.
Rule out heart damage before just going on a diet with added salt.
I suspect your doctor will likely order a battery of tests to check cardiac function just to be on the safe side.

Good luck and keep us posted. We care and I for one not only care but I am very curious because this is something new that I have seen which means I am learning something new and I always like to learn new stuff. Never know when I might need to use that new knowledge.

[deepsleep66]

Thanks - Very good point about Why I would have low sodium. By vigorous exercise, I mean very vigorous - Sunday was 35 miles of road biking in 2.5 hours with 3000 feet of climbing - and I perspired at least 3 pounds . HOWEVER- and to your point - I have 4 years of history and I do not see anything like this pattern until April of this year. I have contacted my internist to see if I should come in right away or wait for the appt. in 2 wks on this and will let you know what comes of this.

[ajack]

I would see a general doctor now, to rule out anything serious. You need an appointment with your sleep doctor. A physical, bloods, heart check and another sleep study. You may be switched over to another machine. An ASV, I would ask for the resmed one. Most prefer that one, when they have tried both brands.

[palerider]

stuff

And, since you're new, I'll offer two pieces of advice.

1) Listen to Pugsy.

2) put 'ajack' on your foe list. (click on his name, then 'add foe'. He'll mislead you almost every time. Not *every* time, but trying to figure out what to listen to and what to ignore just isn't worth the trouble.

[deepsleep66]

Thanks All
My internist recommends increasing electrolytes while exercising while waiting for physical in 2 wks when we will look into things with more info and in depth.

My nutritionist wife and DPT daughter both agree with this.

[Pugsy]

Sounds like a reasonable plan.
I concur...FWIW

[idlewire]

I don't mean to be an alarmist, but I know of one case (posted on a different CPAP forum) of a man who had had a heart attack (non-fatal), and when he later looked back at his charts, it showed the new appearance of Cheyne-Stokes 18 days prior to the heart attack. It looks like you've had this for at least 3 months but there has been an uptick in the last few weeks.

If it were me, I would not delay. Not sure where you are located but many doctor's offices can do an EKG on the spot and an Echo the same day. Make sure you get an Echo at some point. I would also push for an exercise stress test.

Going to the ER is also an option, just tell them you had chest pain. Again, I've no interest in being an alarmist, odds are you'll be fine waiting the two weeks, but do at least take it easy in terms of physical exertion.

[deepsleep66]

Update - Had my physical and EKG this AM. EKG detected A-Fib - with absent P waves. Seeing a very reputable cardiologist tomorrow.