Forget to breathe while falling asleep; heart rate jacks up

[Pugsy]

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.

If pressure was the cause of your centrals then increasing the pressure, or for that matter using apap mode, could be a problem but since you had centrals even without any cpap pressure at all...it's doubtful that increasing the pressure will do anything in terms of causing more centrals.
There is a small percentage of cpap uses who find that cpap pressure causes (or makes worse) centrals.
Since you are reporting that the machine is wanting to go higher (mid teens) with the pressure and your central numbers aren't all that high... I doubt that you are in that small percentage.
Higher pressures don't equal higher central count in the bulk of the cpap user population. It's just something that can happen to a small number of people.

So it is something that we watch but most of the time it's just a "watch and see" thing.
Just an extra cautionary "watching"...just in case.

I would feel comfortable using more minimum pressure (especially since the machine was going to the mid teens anyway for the obstructive stuff) if I were in your shoes but I would still keep an eye on the centrals.....just one eye.

This is part of the reason I mentioned seeing the actual graphs....just to put at rest any thoughts that the pressure increasing was causing any central clustering. From what you are reporting I wouldn't be surprised to see central clustering right after known awake times when maybe you are falling asleep and those would likely be a combination of awake/semi awake centrals and maybe some sleep onset (sleep stage transition) centrals. I could be wrong...but that's why I was curious about the actual graphs.
I don't like making assumptions based on the AHI numbers without seeing the time frame in its entirety when possible.
It's a piece of the puzzle that really makes for a better understanding of the whole puzzle.
That puzzle piece is available using software...figure might as well look at it ...just in case.

I just like covering all possible bases whenever I can.

[jnk...]

Sometimes you have to bend the rules a little to avoid looking ridiculous.

I'll try bending more rules to see if it improves my looks, then.

[wakeasisleep]

Thank you all very much! I know this isn't advice meant to take the place of my sleep doctor but I still find it all very reassuring.

When I get an SD card reader I'll upload some graphs for you all to peek inside my sleep!

Thank you guys all again!

[Susie Kay]

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.

Thank you, Pugsy! You are always the best! (No offense to the others.)

[OkyDoky]

When I get an SD card reader I'll upload some graphs for you all to peek inside my sleep!

Are you sure your computer doesn't have a built in SD card reader. Look it over real good before you buy one, because now days most do have a reader.

[Hang Fire]

Are you sure your computer doesn't have a built in SD card reader. Look it over real good before you buy one, because now days most do have a reader.

Good point. They can be there, and you won't even notice them.

[wakeasisleep]

Hey guys this is just preliminary but I wanted to get your opinion on it before i go further.

My stats last night with pressure increased to 9cm were:
Ahi 9.6
Total ai 8.9
Central ai 6.5

My week long average however with 6 cm is
Ahi 8.2
Total ai 6.7
Central ai 3.9

I know there are many factors that come into play here, but since we were on the subject of increased pressure causing more centrals, do you guys think that increasing my baseline pressure directly increased my central ai by 2 or is this just normal variance of sleep apnea?

Do you guys think continuing at 9 pressure would be dangerous if it increases my central ai like this?

Thanks!

[Pugsy]

Centrals aren't necessarily any more "dangerous" than obstructive apneas. People do seem to freak out more with centrals for some reason though.
I don't know if what you had last night was just a normal variance or related to the pressure. It's one night.
In terms of AHI...not really much change and pretty much swapped Centrals for OAs and no real improvement.

Again....I really would want to see when those centrals occurred and the relationship to any of the clusters (if you had clusters) to the pressure movement to see if there is even a relationship.

Playing around and DIYing when it comes to centrals in these numbers... I just don't like doing it blind.

Even that 95% pressure number on the LCD screen...all it means is you were at OR BELOW that number for 95% of the night. People tend to forget the "or below" part of the definition and I have seen 95% numbers not really give a true picture of what actually happened too many times to put all my eggs in that basket.

[wakeasisleep]

Sorry if this is a noob question but I do know that people wanted to see overviews of my sleep?

I downloaded sleepyhead and imported my information and I have the daily report, which columns do you wish to see?

[Pugsy]

See this thread for examples
viewtopic/t103468/Need-help-with-screen-shots.html

[wakeasisleep]

ok this was from wednesday at 6 pressure.



this was from last night thursday at 9 pressure

[Pugsy]

Looks like primarily the centrals are clustered around known awake times either at the beginning of the night or after I see a break in the therapy where the machine was turned off and then back on.
Do you normally fall right to sleep or do you take some time to fall asleep? If so, about how long before you fall asleep?

Next time you post your reports from imgur can you follow these steps..
click on "large thumbnail" first and then copy the last line in the box of addresses and paste that address in the body of your text
If you do it this way the image won't be so huge and if we need to see it larger we will have a clickable link.
It makes for easier viewing.
No need to redo these images...at least for me at this point.

I see no reason to not continue with the 9 cm minimum pressure setting. It's hard to evaluate the pressure line with such fragmented sleep and I doubt it's the pressure causing the fragmenting...I think it is likely the centrals bouncing you out of sleep.
Once you finally got to sleep around 12:40 the centrals didn't seem to increase with the pressure increase.

At some point a trial with fixed cpap (or an extremely tight apap range) might be something to consider trying though. Too soon to have any idea at what pressure though. Can't really come up with a good idea with such short hours of sleep and highly fragmented short hours at that from just last night's report.

Do you take any medications of any kind for any reason? If so, what?

[wakeasisleep]

My schedule is usually I start getting ready for bed around 9.

My old schedule used to be I would pop a melatonin around 9:45, and get into bed by 10:00 p.m., lights out and I would struggle to fall asleep. Usually around 10:30 p.m. I would have a choking event where I wake up with a high heart rate, need to breathe deeply, and usually sweating. This adrenaline rush will keep me up struggling for another hour until the same thing happens at 11:15-11:30 p.m.. Again I will have an event and usually around 1 a.m. I finally fall asleep until I wake up again around 3-4 a.m. for some odd reason. At that point I usually fall asleep within 10 minutes and then I wake up at 6 a.m. for work.

Nowadays, my doctor recently prescribed me a short trial period of ambien and then lunesta. Its the same schedule. It used to be that the ambien would knock me out but when I took it on wednesday it didn't seem to help at all, I still had the choking adrenaline heart rushing events. Must be because I ate a little extra food that day and it wouldn't settle. On Thursday night I took the lunesta and was in bed by 10. Fell asleep probably around 10:30 but I woke up a bunch of times I think at 12:30 and then again at 2.

Sometimes I wake up having taken off the mask in my sleep (or I just don't remember doing it awake)

If you have any questions please feel free to ask, I hope I didn't ramble too incoherently.

[Pugsy]

When is your follow up appointment with your sleep doc?

Sleep onset centrals (assuming that is the primary source of your centrals) aren't normally an issue unless present in large numbers or cause significant desats or keep bouncing a person out of much needed sleep.
You are borderline in terms of the numbers department and definitely meet the "bouncing out of sleep" department.

I don't know how much we can expect them to go away with time (if they even will go away) or how much time to give them.
It's not the same thing as pressure triggered centrals where the body finally adjusts to cpap and the centrals fade away with time. Two different causes for the centrals involved.

Once your body is totally worn out it finally gets past the sleep onset stuff and you finally get some sleep but if the meds aren't enough to help...you are really caught between a rock and a hard place.
4 or 5 hours of sleep isn't near enough and even then your 4 to 5 hours is highly fragmented...not to mention the stress your body is undergoing with all the adrenaline rushes.

I personally don't know how your doctor thinks that the centrals will go away enough on their own when you had them in large numbers even without ever starting cpap therapy. Unless he was thinking that maybe if the OSA was addressed that you would in turn be able to sleep deeply and not thinking these were sleep onset centrals and thinking maybe post arousal centrals instead and hoping if the OSA related arousals were reduced that any centrals related to the arousals would also be reduced.
I am sure he has his reasons and if it were me I would be having a face to face and ask him to explain his reasoning behind what he is hoping/expecting/wanting to happen and what time frame is involved and what Plan B might be should things not work out as hoped.

At this point all I know to offer is treat what is shown to need to be treated with what we have at hand to treat with...and that's just the Obstructive stuff. We can't do anything with the centrals with this machine except cross our fingers and hope we get lucky and by reducing the obstructive apnea related stuff that the centrals will in turn reduce.
And keep one eye on the centrals while trying to reduce the OA stuff.

Trying a fixed cpap pressure (or very tight range apap) would be on the agenda to try...just to see what might happen...once you get some sort of idea what is needed to hold the airway open and prevent the tissue collapse.

[wakeasisleep]

I'll be getting a bipap soon and I guess a trial with that will be in order before we figure out the next step.

I think his mentality was (much to my chagrin) we would go through CPAP->Bipap->Asv...

You don't think these sleep onset centrals can be fixed? LOL thats like my greatest fear that this is going to be my life now until the end. I know life could be a lot worse but having poor sleep still does affect my life..

OH well.

Thanks for helping though! Maybe this increased pressure will help out a bit. We will see.

If you have any other advice it'd be much appreciated