At home sleep study, apap, showing centrals and panicked!

[cre8vmynd]

I'll try to condense my story.

A doctor (and endo I was seeing for something else) ordered me an in-home sleep study, apnealink I believe. The study showed mild apnea even tho I slept very little that night and my AHI should probably be much higher. I then was sent to a sleep doc who since I already payed for the home study and it showed I had apnea, wrote a script for an autopap without having me do an official sleep study at the lab. Well, since I didn't have the study done at the lab, my insurance wouldn't cover the machine so I bought a used one from the DME out of pocket.

I've been using the machine every night, all night for just over a week. After looking at my data using sleepyhead, I'm now showing VERY few OA's and multiple CA's, even at very low pressures.

I'm kind of in a panic thinking I just payed for this machine, but may actually need a different form of therapy. Like I said, it's been just over a week and I'm a little overwhelmed. I've gotten more used to the therapy each night, but still sleep fairly light and fitful and am wondering if the centrals are somehow a result of that. I'm 29 and judging by my symptoms, have probably had apnea since childhood. I would really appreciate some insight.

Casey...

[Pugsy]

Could you please post an image of the report you see?
Let's see just how many centrals you are having and when they occur before we get in a panic.
Some are normal. We all have them. I had a truckload show up on my report this morning about an hour before I got up. My cats were wanting out and wouldn't leave me alone.

Here is how I post images.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[cre8vmynd]

Thanks for the interest.
Casey...

[Pugsy]

Is this your best night or worst night or typical night?
I cannot see the numbers clearly (small print and bad eyes) Can we make image larger next time or manually add AHI breakdown and pressure.
Your minimum pressure is 5? Maximum setting? 9 or so?

The 4 AM cluster? Did you happen to wake up then that you know of? Are you sleeping soundly? Or are you having frequent wake ups?

I can see why you might want to panic but this report isn't nearly as scary as you might think. Some centrals occur during sleep transition and even turning over in bed (sleep study would toss those out).

That 4 AM clear airway cluster IF we saw clusters like that all night..then we panic but we don't see them happening all night. There could be a simple explanation for it that is unrelated to these pointing to be true centrals of the type we would be alarmed about.

So these warrant concern but not panic. Let's hope John Fisher comes by tomorrow and offers his thoughts. He has a much greater understanding of centrals because he lives with them every night.

[cre8vmynd]

I'll try to post better images in the future.
My settings were initially 5-18 but I upped them to 7-18. My highest pressure that night was just under 10.

As far as how I slept that night, It was one of my "better" nights on cpap but I still had frequent wakenings. I don't remember in particular waking at 4am but it's very possible. I'm a very light sleeper, and all the more so being new to cpap. So no, not really sleeping soundly.

I've slept poorly for the better part of my life so I understand it may take time with my therapy for my body to calm down and do what it's supposed to regarding sleep. And I also understand that at this point, analyzing (or attempting to) my data this early may cause me undue alarm.

Again, the interest being shown is really appreciated.
Casey...

[Pugsy]

Frequent awakenings will obviously lead to frequent sleep stage transitions. I mention this because it is quite common to experience centrals during sleep transition stages. Either way...going from awake to sleep and coming from sleep to awake or semi awake stage.

Wonder what we can do to help consolidate your sleep so less fragmented sleep and thus less sleep transitions?
Is there anything particular that you can think of which might be happening or do you think this is simply just the way it also was prior to starting cpap therapy?

There is sleep maintenance insomnia where a person gets to sleep in a timely fashion but either awakens often and/or has trouble getting back to sleep.

Pain, meds, bed comfort?

I mention all this because it is entirely possible that the bulk of your clear airway events are sleep transition events and if we can eliminate the frequent awakenings...then you have a much clearer idea as to whether those clear airway events are anything to really be concerned with. We all have them from time to time. I had CA index of 2.3 last night myself. Some nights I don't have any but some nights I have several. Last night I had a few more awakenings during the night than I normally do. So I suspect the bulk of my CA index was sleep transition events.

Your pressure didn't ever go anywhere into the range where we might consider those CA events being related to pressure.

So what can we do to limit the fragmented sleep? Have you ever tried any sleep aids...OTC or RX?
Do you currently take any meds that are known to mess with sleep?

[cre8vmynd]

Pugsy, your questions and comments are definitely helping me to take a calmer approach to my data. I guess I wasn't aware that transitions in sleep stages could cause CA's. And considering how much I've been waking up in the middle of the night, it would make sense that many of the CA events are not to worry about just yet.

I was always a pretty light sleeper. I would take forever to fall asleep, and would wake many times thru the night. I'm not on any meds right now and I don't drink or smoke. I have had a problem with taking in large amounts of caffeine everyday for many years, due in part to my apnea induced fatigue. Plus my sleep hygiene could be better. I also have noticed that when my pap pressure has woken me up from going higher, I was on my back. And when I wake in the mornings, I'm on my side and the pressure lower and comfortable enough I can't tell its on. So I'll try harder to sleep on my side, which I avoided at first because of mask leaks.

The only sleep aids I've tried, are melatonin in different dosing. Smaller doses help me to go to sleep but don't keep me asleep, and higher doses knock me out but leave me feeling hungover the next day.

I'm kind of wondering (thanks to your questioning) if my fragmented sleep is an issue that is a composite of multiple things that I can thru time, alleviate.

You've really got my wheels turning, thanks!
Casey...

[archangle]

Check to see how long the centrals are. There's a number on the events if you look on the events tab.

More importantly, look at the waveforms. When you look at the waveforms, the centrals may not be so scary. You may be partially breathing during the time in which the machine is recording an event.

I think people and doctors get panicked far too easily by something the machine calls a "central apnea."

First off, your O2 concentration may not drop at all during a short central apnea. You may simply not be breathing for a while because you have enough O2 in your blood. You may not even have stopped breathing, you may be breathing lightly. Most importantly, an 11 second apnea is not nearly as bad as a 120 second apnea.

That doesn't mean that centrals can't be bad. They can be just as bad as any other apnea. It's just that you need to look at all the data, not just the count.

[Pugsy]

It's just that you need to look at all the data, not just the count.

This is true. The reason I haven't gone into this discussion is that OP is newbie and I can almost guarantee that he will have no idea what he is looking at in the wave forum data. I didn't want to add any more stressors than were already present.

My main concern right now was to alleviate the panic that the machine was going to kill him with centrals since his knee jerk reaction was the wrong machine.

And now that we know that there is a very real probability that frequent sleep transition is affecting the data I thought it best to try to address that problem (since it needs to be addressed anyway) first and then if we need to put the waveform from the machine scored centrals under the microscope... once we give him some clues on what to look for.

To OP...Melatonin..it helps some people and some people it doesn't.
Caffeine....do you tend to drink it in any form after 6 PM?
If you have a life long habit of sleep fragmentation it is going to take some work to try to fix it.
Even without the possible central issue you want to limit sleep fragmentation because it messes with sleep cycles which will end up limiting restorative sleep and makes it harder to feel better even if no sleep apnea.

So how many times do you think you wake up during the night?
How long do you think you stay awake when this happens?
Since this problem predates cpap we know it isn't all related to the cpap and mask but is there any possibility that mask discomfort, leaks or anything cpap related is adding to the problem?
Do you have trouble getting back to sleep?

[avi123]

I'll try to condense my story.

A doctor (and endo I was seeing for something else) ordered me an in-home sleep study, apnealink I believe. The study showed mild apnea even tho I slept very little that night and my AHI should probably be much higher. I then was sent to a sleep doc who since I already payed for the home study and it showed I had apnea, wrote a script for an autopap without having me do an official sleep study at the lab. Well, since I didn't have the study done at the lab, my insurance wouldn't cover the machine so I bought a used one from the DME out of pocket.

I've been using the machine every night, all night for just over a week. After looking at my data using sleepyhead, I'm now showing VERY few OA's and multiple CA's, even at very low pressures.

I'm kind of in a panic thinking I just payed for this machine, but may actually need a different form of therapy. Like I said, it's been just over a week and I'm a little overwhelmed. I've gotten more used to the therapy each night, but still sleep fairly light and fitful and am wondering if the centrals are somehow a result of that. I'm 29 and judging by my symptoms, have probably had apnea since childhood. I would really appreciate some insight.

Casey...

Reply:

Hi Casey,

I took the liberty to some what enlarge your graphs.




In my opinion you like many other posters on this board have extra more central and hypopneas events. Usually, this indicates some kind of underlying medical condition. In my opinion, at this point you should NOT focus on money and costs but try to find out your medical condition that lead to those events. When you write ENDO, in my jargon it could apply to a more than a dozen specialties.

The At- Home Sleep Study which uses Resmed's ApneaLink or ApneaLink Plus (Instant Diagnostic Systems, Inc [IDS] uses it), is often more reliable , imo, than full PSG clinic sleep study, because the results are analysed by first class sleep doctors (without questionable respiration technicians ). And it costs less than $300. So you could repeat it at any time your doctor asks for it (any doctor).

Overall, I don't see anything very wrong (compared to others that I have seen on this board)) in your graphs. But my question is if an APAP machine is appropriate?

P.S. if your At Home testing was done by IDS, you should then be able to get their reports of your results like these:


http://www.instantdiagnostic.com/ids/do ... 0-2010.pdf


http://www.instantdiagnostic.com/ids/ma ... report.pdf

Best of luck.

[cre8vmynd]

@archangle
As Pugsy mentioned, I am new to this, especially interpreting data and was a bit confused as to what I was seeing. That being said, I did actually zoom in on several different central events, and all that I saw showed continued breathing, although very shallow, and the events lasted around ten seconds.

@Pugsy
You did exactly what I needed. I was having a knee jerk reaction and not fully understanding my data didn't help. Thanks for bringing some calm logic into the picture for me

I try not to drink caffiene in the evening, but probably have enough thruout the day to cause some problems.
I realize it will take effort and time to fix my sleep issues, but I'm willing to work at it.
My sleep report did show that I was NOT having severe drops in O2. So maybe my apnea related problems have been more a result of years of sleep fragmentation and less of a lack of oxygen issue?

I probably am aware of waking 3 to 4 times a night. Before cpap i would fall back asleep fairly quickly but not always. I've noticed since cpap that when I wake up after a couple of hours, I almost feel wired, so it takes a bit longer to go back to sleep (this is getting better tho). My set up is fairly comfortable. Just the fact of having something on my face has woken me more than usual. But it's only been about ten days since I've started. Its becoming more natural every night.

[Pugsy]

Did your home study happen to mention any centrals?
I don't know if home studies score them. Don't know how they could reliably because one really needs a tech to monitor EEG stages. They toss out any that are in sleep transition stages. That is the same reason that we can't tell with these machines.

Is there any medical reason why you couldn't try some Benadryl at bedtime to see if we can get less awakenings?

Would you also be willing to narrow your APAP range... on the off chance the pressure variations are acting as a disturbance. Like 8 min and 10 max?

[cnew]

I'm new to this, but I use the same equipment and the same software, and I believe the CA's reported are "clear airway apneas" not "central apneas". I get CA's every night, but I had 0 centrals on my sleep study. My doctor says I am not having centrals.

[Pugsy]

and I believe the CA's reported are "clear airway apneas" not "central apneas". I get CA's every night, but I had 0 centrals on my sleep study. My doctor says I am not having centrals.

Respironics chose not to call there score centrals as centrals. They chose to call them clear airway events.
Same thing. A central is a cessation of breathing with the airway open.
The machine doesn't know if the cessation of breathing with the airway open is a "true" central or a cessation of breathing while turning over in bed. If you hold your breath for 15 seconds...that is a central or clear airway event.

Since it is normal to have even true centrals during sleep onset or other sleep transition, we all will have a few from time to time. The CA in the report is a central within the limitations of the machine. We don't worry about a few here and there. We worry when we have them in sizable numbers...every hour...every night.

OP here has a few more than we would like to see but not horribly so and really in this report, only at the 4 AM mark.
Since he doesn't sleep well..these could be sleep transition centrals.

Now that aside.. the machine has its limitations.. a true central needs to be scored using EEG and thoracic bands along with the machine's scoring. To know for sure a sleep tech doing a sleep study is needed. We didn't get one in the home study.

So we don't know for sure if these clear airway scored events would even be scored as centrals in a tech monitored sleep study. We are just doing the best we can to limit any possible outside factors causing whatever these CA scored events really are. See if we can bring them down so OP isn't alarmed. If we can, then that tells us that most of these are sleep transition events and we don't worry about it any more.

[archangle]

I think another reason they call them "clear airway" apneas is that some central apneas do not have a clear airway. Your brain and lungs aren't trying to breathe, and your airway closes off.

Your machine will score these kinds of apneas as obstructive, when a PSG would call them central apenas. I read something that suggested that something like half of all real central apneas actually have a closed airway.

If it says "clear airway", it's probably a central apnea rather than an obstructive apnea.
If it says "obstructive," it could still be a central apnea.

In this case, I think it's a case of the manufacturer being responsible and not overstating what their equipment can actually detect.

In a sense, they're being properly over cautious. They can't rule out some events being apneas, so they flag them as apneas. You also need to understand that it will not necessarily label all centrals as clear airway apneas.

In a sense, you don't care whether apneas are obstructive or central. A central apnea does no more harm to your body than an obstructive apnea. Duration, frequency and severity are what hurts your body. Central vs. obstructive only matters because you may have to do different things to minimize them.