Greentree's Therapy

[Greentree]

Have you watched Jason’s videos explaining how to use SleepyHead and zoom in to the flow rate and decide if the flagged event was a real asleep event vs arousal/wake related flag?

Http://FreeCpapadvice.com/SleepyHead-free-software

No, I wasn't aware of the videos, but I will most certainly watch them. Thank you very much, Pugsy.

I watched Jason's videos and then took at look at last night's chart with his instructions in mind. It looks to me as though most of those Centrals might not be real. It appeared to me as though there were some arousals or something before them. It didn't appear as though they were happening while I was in a sleep rhythm. I might be wrong, but that is my best guess after one viewing of Jason's explanation.

That would be encouraging, because it would bring your AHI down - but it means that something is waking you constantly in the night - doesn't really matter if it is the centrals, a full bladder, or a train or airplane passing - it is the awakenings that trash our sleep.

I don't know what to do now. I guess I will try to do the same settings as last night and see if it turns out with the same result. I guess I am confused.

If the centrals aren't real, how do I figure out what is causing them? Could they be cpap caused centrals? If so, how is that treated?

If the centrals ARE real, then what do I do?

[Pugsy]

If the centrals aren't real and more related to arousal or awake breathing then it isn't the cpap causing the centrals.
It would be the poor sleep quality causing them. To reduce them you need to fix the poor sleep and that's always easier said than done because we don't often know the cause of the arousals. We have to look at other potential culprits for causing the poor sleep...insomnia, medication side effects, other health issues and even plain old spontaneous arousals where there simply isn't a known cause.

They hyponeas might also not be real asleep flagged events also.

This is where an in lab sleep study would be your best bet because the sleep tech would have you hooked up to the EEG and can easily see for sure if you are asleep or not when this stuff happens.
We can maybe try different things to see if we can get lucky and figure out what is going on but as it stands right now if this were my report I would be pushing for an in lab titration sleep study using cpap. You are just having too much stuff going on that we can't seem to fix with the usual ordinary fixes. Doesn't mean I wouldn't continue trying but I would also be pushing for an in lab study.

You have a complicated situation that isn't an easy fix. If you do actually need more pressure and those hyponeas are real then more pressure in itself is causing aerophagia issues.

If the centrals aren't real and you really aren't asleep....we have to try to get you to sleeping more soundly. It's hard to ignore them but that's what we have to do if you aren't asleep when they are flagged.
If they are real then either a different machine or maybe more time would see them reduce on their own.

[tyrone747]

Is diagnosing a fake hyponeas the same as fake centrals? ie. a spike in breathing before the hyponea?

[Greentree]

If the centrals aren't real and more related to arousal or awake breathing then it isn't the cpap causing the centrals.
It would be the poor sleep quality causing them. To reduce them you need to fix the poor sleep and that's always easier said than done because we don't often know the cause of the arousals. We have to look at other potential culprits for causing the poor sleep...insomnia, medication side effects, other health issues and even plain old spontaneous arousals where there simply isn't a known cause.

They hyponeas might also not be real asleep flagged events also.

This is where an in lab sleep study would be your best bet because the sleep tech would have you hooked up to the EEG and can easily see for sure if you are asleep or not when this stuff happens.
We can maybe try different things to see if we can get lucky and figure out what is going on but as it stands right now if this were my report I would be pushing for an in lab titration sleep study using cpap. You are just having too much stuff going on that we can't seem to fix with the usual ordinary fixes. Doesn't mean I wouldn't continue trying but I would also be pushing for an in lab study.

You have a complicated situation that isn't an easy fix. If you do actually need more pressure and those hyponeas are real then more pressure in itself is causing aerophagia issues.

If the centrals aren't real and you really aren't asleep....we have to try to get you to sleeping more soundly. It's hard to ignore them but that's what we have to do if you aren't asleep when they are flagged.
If they are real then either a different machine or maybe more time would see them reduce on their own.

Pugsy, I really appreciate the time and attention you have paid to my complicated sleep issues. I completely agree with you that I need a second sleep study. One was requested for me in January, but the Medicare approval wheels are grinding very slowly. I don't really have any idea when or even if it will be approved. In the meantime I am grateful for my apap which has gotten control of the OA issue. Now I guess it is a waiting game. I will be hopeful that perhaps more time might help reduce the Hypopneas and the Centrals and the other little gremlins.
Again, bless you for all the help you are so generously giving to us all.

[Greentree]

Hello friends, I have posted two screenshots, one is my data chart from last night and the other is a close up of one grouping of the CA episodes. My pressure is set at 10/20.

I continue to get nightly reports like this. I am hoping that someone might be able to take a look at them and perhaps interpret whether the Centrals are real or not. I am not going to be able to get a second titration study done until the end of the summer. I am being seen at a University Sleep Disorders Clinic at that time. That was the first appointment they had available to me.

At the time of my compliance meeting the first of this year, my apnea was about half obstructive and half central. Now the OA's seem to be almost under control but the CA's have taken over as well as the hypopneas.

I don't have any options except wait until the end of summer for further information, but I am a bit frightened to go that long if these centrals are real. Hope you can help me interpret them.

[Pugsy]

zoom in closer on the flow rate at around 01:00 but only get a 5 minute segment/
Pick 5 minutes that has 2 or 3 centrals flagged and put them to the right of the graph so that we can see the flow rate preceding the centrals as well as 2 or 3 centrals.

[Greentree]

zoom in closer on the flow rate at around 01:00 but only get a 5 minute segment/
Pick 5 minutes that has 2 or 3 centrals flagged and put them to the right of the graph so that we can see the flow rate preceding the centrals as well as 2 or 3 centrals.

Thank you, Pugsy. I will work on this tonight and see if I can do as you asked.

I have another question for you. Somewhere on the forum I saw a nifty P10 hack that you did combining the straps of another mask with the P10. Now, however, I can't find it. Can you direct me to it? Thank you!

[Pugsy]

P10 nasal pillows and hose married to the Swift FX silicone headgear.

viewtopic/t173987/I-married-the-Swift-F ... it=married

[Greentree]

zoom in closer on the flow rate at around 01:00 but only get a 5 minute segment/
Pick 5 minutes that has 2 or 3 centrals flagged and put them to the right of the graph so that we can see the flow rate preceding the centrals as well as 2 or 3 centrals.

Thank you, Pugsy. I will work on this tonight and see if I can do as you asked.

I have another question for you. Somewhere on the forum I saw a nifty P10 hack that you did combining the straps of another mask with the P10. Now, however, I can't find it. Can you direct me to it? Thank you!

I hope I did this new screenshot correctly. Let me know if I missed the mark and I will try again. And thank you for the info on the P10/Swift Marriage. I am going to try it!

[Pugsy]

How about a couple more 5 minute segments a little bit later in that first grouping of flagged centrals?

Are you remembering being awake at this time by chance?

[Greentree]

How about a couple more 5 minute segments a little bit later in that first grouping of flagged centrals?

Are you remembering being awake at this time by chance?

I do not believe I was awake during this time period.

[Pugsy]

Well it's Periodic Breathing but not classic Cheyne Stokes Respiration IMHO.
There are maybe a couple that look Cheyne Stokes ish....to me but the bulk of the flow rate doesn't look like CSR.
Some are definitely preceded by some sort of arousal breath....but some aren't. So a mixture of asleep breathing and while not fully awake maybe...still looks like some arousals are happening.

You really need to have a doctor evaluate all this and of course you will be having that done but later this summer.
Too bad that you have to wait so long.
I will be honest...I don't know what is going on with you. It's ugly breathing for sure and ugly sleep...but not classic for sure asleep centrals with classic CSR (at least on what I see here). Periodic Breathing is the waxing and waning of the air flow that lasts at least 2 minutes.
Cheyne Stokes Respiration is one type of Periodic Breathing but it isn't the only type of PB. It is the type that makes people stand up and take notice though because it often goes hand in hand with heart issues. Not always....but often enough that people should have the heart evaluated if they haven't recently.

If you haven't tried without any EPR...you might give that a try but I have my doubts as to if all this ugly is related to simply EPR being used. Wouldn't be totally impossible but I think unlikely.
Especially since you had about half your diagnostic AHI being centrals....you weren't using cpap then and you still had a sizable number of centrals.

[Greentree]

Well it's Periodic Breathing but not classic Cheyne Stokes Respiration IMHO.
There are maybe a couple that look Cheyne Stokes ish....to me but the bulk of the flow rate doesn't look like CSR.
Some are definitely preceded by some sort of arousal breath....but some aren't. So a mixture of asleep breathing and while not fully awake maybe...still looks like some arousals are happening.

You really need to have a doctor evaluate all this and of course you will be having that done but later this summer.
Too bad that you have to wait so long.
I will be honest...I don't know what is going on with you. It's ugly breathing for sure and ugly sleep...but not classic for sure asleep centrals with classic CSR (at least on what I see here). Periodic Breathing is the waxing and waning of the air flow that lasts at least 2 minutes.
Cheyne Stokes Respiration is one type of Periodic Breathing but it isn't the only type of PB. It is the type that makes people stand up and take notice though because it often goes hand in hand with heart issues. Not always....but often enough that people should have the heart evaluated if they haven't recently.

If you haven't tried without any EPR...you might give that a try but I have my doubts as to if all this ugly is related to simply EPR being used. Wouldn't be totally impossible but I think unlikely.
Especially since you had about half your diagnostic AHI being centrals....you weren't using cpap then and you still had a sizable number of centrals.

Thank you, Pugsy for another very thoughtful analysis of my ugly sleep patterns. I am so grateful for the time you have spent trying to help me. I have asked to be placed on a cancellation list at the university, so there is a chance I might be able to get in to be seen sooner. In the meantime I will keep experimenting with masks to try and find the best options for me.

I will definitely be back on the forum once I have been seen and evaluated further at the University.

[Greentree]

Hello forum friends,

I am back on the forum after waiting 5 months to be seen for a second titration study at a nearby University Sleep Disorders Clinic. That was completed recently and I have some questions I am hoping you can help me with. I am still, at this moment, using my Air Sense 10 For Her.

1) I have been using the F20 memory foam mask for several months. It is comfortable and I have very few leaks and can deal with the redness it causes. However, in the last few days it has begun to break down the skin a bit on the bridge of my nose. I have put a tiny bit of Neosporin on it and I think I will wear one of my non-full face masks for a few days to help it clear up. Going forward I thought I'd try a bit of moleskin or a small piece of well-worn t-shirt under that upper portion of the mask that touches the bridge of my nose. But, is it pressure that causes the skin to breakdown? Or is it movement of the mask that does it? Any other ideas of how to deal with this soreness? It feels very sore and bruised.

2) My second question is the biggie. I began CPAP in December of 2018 due to OA. At my compliance meeting I had half OA and half CA and was advised that I needed a second titration. After waiting two or three months and no answer as to when it was to be scheduled, I took matters in my own hands and made an appointment at the University. That titration was the one that was completed recently. It showed I had developed Treatment Emergent Central Apnea and the recommendation was for an Air Curve ST. I had been hoping they would suggest an ASV, but the synopsis of my Sleep Report said that if the ST didn't help, that I should return for a titration on the ASV. The prescription for the ST has been sent to my DME but I have not heard anything from them. I really don't want to waste time on the ST. I found it very hard to deal with during the titration. Each prompted breath caused my mask to inflate with a huge "thwaaaap" noise and then deflated some only to repeat over and over and over. I don't like the idea of the fixed pressure of the ST. In the meantime, I have written a My Chart note to the NP at the University to see if they might reconsider prescribing an ASV, but I am doubtful it will work. I have not yet heard from her. In that note I asked if I self-paid for an ASV if she would be willing to continue handling my care. Of course it would be preferable if Medicare and my supplemental insurance would pay for the ASV. So, I guess my question is: Is the ST as bad as I think it is? And do you think I should be a "good patient" and follow the guidelines and spend several more months trying to get rid of my CA?

It is good to be back in the group and hopefully moving forward with my treatment. Any advice you might have for me would be greatly appreciated.

Greentree

[palerider]

Yes, it is that bad.