Forget to breathe while falling asleep; heart rate jacks up

[wakeasisleep]

Here is some extra information according to my ResMed information.

Machine: S9 Autoset
Min Pressure: 6 cm H2O
Max Pressure: 20 cm H2O
EPR: Off

Therapy
Pressure - cmH2O (Median 11.5) (95th percentile: 15.0) (Maximum: 16.5)
Events per hour (AI: 9.0) (HI: 1.2) (AHI: 10.2)
Apnea Index (Central: 4.0) (Obstructive: 4.80 ) (unknown: .2)

I wish I had more but I only have the results from my first sleep study, which I slept really poorly and couldn't get more than like 2 hours of sleep. This stuff really scared me when I first heard it.

Apnea Index: 65.0
Hypopnea Index: 84.0
AHI: 149.0
RDI: 149.0

Number: (Central Apneas : 75) (Obstructive: 5) (Mixed: 0) (Total: 80) (Hypop : 100) (Apn & Hypop :180) (Total All events 180)

It was so aggravating, I saw that I had primarily Central Apneas (75 of them) and was really worried but my doctor still insisted on CPAP.

Anyways, if you guys would like more information I can look through my old sleep study until I get my new one.

Thanks!

(Oh, the lowest my oxygen desaturation level was at was 75%... is this where permanent brain damage occurs? not that I can do anything about it now as far as damage I've already incurred but I'm still curious)

[jnk...]

A big reason for diagnostic studies and titration studies is to get insurance to pay for you to try a machine. Once you have a machine, the important numbers are now your therapy numbers. And it appears that you ARE seeing major improvement in your numbers with therapy.

The numbers you provide show you are having some obstructive apneas AND some central apneas. Getting your pressures at a level that eliminates the obstructive events is generally where to start, once you are used to therapy and your leaks are consistently within good range. With your median of 11.5 and a 95th percentile of 15, some here would advocate that the first major thing to do would be to try using a Min Pressure that is closer to what you need to eliminate obstructive apneas, as long as that didn't make you too uncomfortable and didn't unduly increase the number of central events. Once obstructive apneas are gone, centrals sometimes go away on their own.

With your response to PAP, even with that low minimum pressure, your doc is not off-base to see if your sleep can be fixed without resorting to ASV, in my opinion as a fellow patient.

There are some very knowledgeable people here to help you with software and posting graphs to get more pointers and observations.

May it go well for you!

[Susie Kay]

Apnea Index: 65.0
Hypopnea Index: 84.0
AHI: 149.0
RDI: 149.0

Number: (Central Apneas : 75) (Obstructive: 5) (Mixed: 0) (Total: 80) (Hypop : 100) (Apn & Hypop :180) (Total All events 180)

As you know, you had many centrals during the study as listed above.

Therapy
Pressure - cmH2O (Median 11.5) (95th percentile: 15.0) (Maximum: 16.5)
Events per hour (AI: 9.0) (HI: 1.2) (AHI: 10.2)

Then your CPAP has greatly reduced the number of centrals. I don't understand how CPAP did this. My knowledge and experience are very limited. Maybe Pugsy will see this thread and help.

What you were remembering at work was not enough information, as some have already pointed out. It's good that you supplied this information.

Remain optimistic because these problems can be solved with the right machine, mask and machine settings. BTW, what type mask are you using?

[jnk...]

. . . your CPAP has greatly reduced the number of centrals. I don't understand how CPAP did this.

It often does:

"Aside from [heart-failure] patients, about half of those suffering from CSA can be managed on CPAP alone."--Michael Coppola, M.D., a pulmonary, critical care and sleep disorders physician in Springfield, MA, who is a member of the American Sleep Apnea Association board of directors http://www.sleepapnea.org/learn/sleep-a ... apnea.html

The common belief that everyone with CSA needs to be on ASV is an unfortunate fallacy that is not supported by the treatment data.

That having been said: for those who need it, ASV is amazing technology that can be an absolute godsend.

Mayo puts it well, in my opinion:

"CPAP is usually the first treatment given for central sleep apnea. . . . CPAP may prevent the airway closure that can trigger central sleep apnea. . . . If CPAP hasn't effectively treated your condition, you may be given ASV." http://www.mayoclinic.org/diseases-cond ... n-20030485

So statements such as . . .

What you are describing is a fairly significant central event. The correct machine for that condition is an ASV machine. . . .

. . . are (although commonly made on this board with the very best of intentions) particularly misleading, in my opinion, and can needlessly sow seeds of discontent among the CSA patients being treated very well by their very-comfortable, mainstream, everyday CPAP machines.

[chunkyfrog]

And finally, to the OP, congratulations on correctly spelling the word "breathe"
{{{"breathe" is the verb! folks; breath is a noun}}}
---so relieved to finally get that off my chest!

[jnk...]

Dang. Are we being graded for spelling here? Nobody told me!

[chunkyfrog]

Oh, heck no!
But good spelling is like a soft hug for those of us who spent way too much time doing spelling drills in school!

[wakeasisleep]

Thank you everyone for your words.

I am happy that the CPAP has reduced my numbers overall (which it has), that being said I feel like there is still another major component to my sleep that is still left unaddressed, namely the fact that my sleep onset is plagued by these (what I believe are central) apneas that cause me to panic.

In general they occur at the onset of sleep and when I wake up I know I have had one since I am sweating, need to take a huge breath, and my heart is racing like its going to explode. Usually I check my resumed s9 and it will say "time used" or something similar ".2 hours" or ".5 hours" or something in that similar time range and my AHI will be anywhere from 30-60. In general this happens 2-3 times and then I fall asleep for real and when I wake up my AHI will be around 8-12?

If anyone has any advice for overcoming this initial hurdle to sleeping I'd be most appreciative since it is quite worrying; I fear this sort of event will lead to heart damage of some sort.

My doctor has prescribed sleeping pills which seem to help (sometimes) although I can rapidly feel my tolerance increasing.

I will, however, heed your advice and raise my minimum pressure. There is no reason to set the upper pressure though right? Simply raising my minimum pressure to ~9 (-2 of the average) should be sufficient and allowing the upper bound to go high will allow me extra air if I need it?

Thank you all!

[Pugsy]

Then your CPAP has greatly reduced the number of centrals. I don't understand how CPAP did this.

Just because it sometimes helps. I think a lot of it depends on why the person is having the centrals in the first place...like are they sleep onset centrals that reduce once we actually get to sleep or are they arousal centrals that reduce because the OAs causing the arousals are reduced or if they are indeed sleep onset centrals then a byproduct of less OA arousals would mean less chance of sleep stage transition.

It hurts nothing to try "simple cpap/apap" first and save the big guns ASV for later (if needed) because sometimes it works. Sometimes it doesn't and sometimes it makes centrals worse but we don't know what will happen until we try something.

I will, however, heed your advice and raise my minimum pressure. There is no reason to set the upper pressure though right? Simply raising my minimum pressure to ~9 (-2 of the average) should be sufficient and allowing the upper bound to go high will allow me extra air if I need it?

Then machine won't go to that upper limit unless it thinks it needs to...it won't go there for centrals at all...it only responds with more pressure to the usual obstructive (airway collapse) warning signs...OAs, hyponeas, flow limitations and snores.

It doesn't act like a ventilator...it can't do that.

I would be really interested to see the software graphs of your events to see exactly when those centrals are occurring along with the pressure graph.

The increase in minimum pressure should reduce the OAs though.
If the centrals increase in number with the reduction in OAs might need to re-evaluate things.

[jnk...]

I would be really interested to see the software graphs of your events to see exactly when those centrals are occurring along with the pressure graph.

If Pugsy wants to see, it will be well worth your while to find a way to let her.

[wakeasisleep]

I'll get a sleep report as soon as I can from my machine but in the meantime I increased my CPAP machine pressure to 9 last night.

That being said, all this talk about increasing centrals and my own preliminary googling is talking about how it can be dangerous to increase pressure if they increase centrals is worrying.

I know you guys aren't medical professionals and I won't hold you liable (even if I could) if you give me advice but, will increasing my minimum cpap pressure from 6 -> 9 be dangerous?

[jnk...]

According to the numbers you supplied, your auto is already going up to 16.5 with a median of 11.5. So technically speaking, you are not choosing to raise pressure; your machine is doing that for you on its own. You are merely choosing to change the starting pressure. And no one is twisting your arm. People on the Internet don't have arms.

But if centrals increase, you can always choose to find what starting pressure works best for you.

Some docs consider starting pressure on an APAP basically to be a comfort feature. When I was starting out, my doc and I had a verbal agreement on what he didn't mind me fiddling with. So your question about dangers is one only your doc can answer.

At the bottom of every page on cpaptalk.com are the words, "The information provided on this site is not intended nor recommended as a substitute for professional medical advice." Not just a disclaimer. Words to live by.

[wakeasisleep]

Oh yeah absolutely. I understand nobody is holding a gun to my head forcing me to do so and that all of my decisions will be 100% of my own volition, I just figure it couldn't hurt to ask you guys first

[jnk...]

I won't hand anybody an aspirin. But I'll tell them where the bottle is.



(Apologies to chunkyfrog for my mixing singular and plural pronouns)

[chunkyfrog]

No problem.
Sometimes you have to bend the rules a little to avoid looking ridiculous.