Cheynes-Stokes and Centrals.

[rozr1111]

Hi all,

I was diagnosed with severe sleep apnea (65AHI) many years ago. I use the Resmed AutoSense Apap machine and Dreamwear nasal mask. I am concerned about the Cheynes-Stokes and central apneas I have seen on Oscar. I use Kaiser and have not had any useful input from sleep tech/sleep doctor. I would appreciate any input from you all (especially Pugsy). I have set up an appointment with my primary care physician and sleep tech.

I know I have a lot of leaks but don't necessarily see that connected to the centrals or Cheynes-Stokes events. I've attached charts from last night(no Cheynes-Stokes) and a couple of Cheynes-Stokes nights. Thank you again for any input you have to offer me.

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[Pugsy]

How's your sleep quality overall?
Wake often during the night or sleep soundly for the most part?
What meds do you take?
Go here and watch the videos and learn how to zoom in on the flow rate so we can evaluate if the CSR/PB flagged stuff is really CSR or just PB.
There are many forms of Periodic Breathing which is just a waxing and waning of the flow rate and doesn't mean much.
CSR is one of many forms of PB so not all PB is CSR.

http://freecpapadvice.com/sleepyhead-free-software

Then zoom in on a couple of the green flagged times with and without events in them in about 3 minute segments and post for review.

[rozr1111]

Pugsy, thanks for your quick response. My sleep quality is not great. Have trouble falling asleep, some times get out of bed after an hour because not sleeping, usually wake up in middle of night to pee, and am many days fatigued. I do take a lot of medications for rheumatoid arthritis, hyperthyroidism, high cholesterol/blood pressure, and a pill to help me go to sleep. The daytime fatigue can indeed be affected by the conditions and medications. Because most of my immediate family eventually had heart problems, I am concerned about the Chenes-Stokes breathing. Here is a chart with more detail. Thanks.

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[Pugsy]

Pain meds can affect respiration and tend to suppress respiration which in turn can set off some central apneas.

You probably should be having a chat with your doctor about your concerns. It's not classic CSR but real close. Close enough to get the doctor in the loop.

[zonker]

Pain meds can affect respiration and tend to suppress respiration which in turn can set off some central apneas.

You probably should be having a chat with your doctor about your concerns. It's not classic CSR but real close. Close enough to get the doctor in the loop.

could you elaborate on that? i'm so used to seeing newbies come in, afraid of csr, but folks here saying it's not.

this may be the first time i've heard anyone here confirm that it may be "real close".

[Pugsy]

Pain meds can affect respiration and tend to suppress respiration which in turn can set off some central apneas.

You probably should be having a chat with your doctor about your concerns. It's not classic CSR but real close. Close enough to get the doctor in the loop.

could you elaborate on that? i'm so used to seeing newbies come in, afraid of csr, but folks here saying it's not.

this may be the first time i've heard anyone here confirm that it may be "real close".

Which part did you want me to elaborate on....the pain meds or the fact that the flagged CSR/PB looks "real close" to being real CSR?
I am going so assume the "real close" part because I think we all understand what pain meds can do to respiration.
Now the OP didn't share an image zoomed in of flagged PB time without any events like I asked him to do.
The one image he shared showed some sort of CSR looking stuff. Sometimes it is obvious that despite the flagging it isn't CSR but sometimes it's not so easy to tell. When in doubt.....I always will say "talk to your doctor" especially when on a bunch of meds and I don't have any real history to go on. To my eye what he shared wasn't classic CSR but it does look a bit weird and if he was asleep when that happened then the prudent thing would be to alert his doctor since this is a new thing and has happened on more than one night....and he does obviously have some significant health issues to be on the meds (whatever they are) for the conditions he listed.

Better to play it safe and defer to the doctors. He isn't using exhale relief so I can't do my usual "turn off EPR/Flex" and see what happens and that's really the only thing I have in my bag of tricks for people that have a lot of central apneas.

The one image I saw....it's iffy (to my eye) as to whether it's real CSR or not and in this situation I always figure if things are "iffy" then best to err on the side of caution if I am going to err. Either way...he's concerned and that also means he needs to talk to his doctor about it.

Now there are some situations where people just up and get centrals and CSR breathing out of the blue and only for part of the night and it just happens and no one knows why and they don't know how to fix it because they don't know why but I feel that is what the doctors get paid the big bucks to figure out.

Classic CSR looks like this


or here from a patient

[zonker]

I am going so assume the "real close" part because I think we all understand what pain meds can do to respiration.

yes, this.

To my eye what he shared wasn't classic CSR but it does look a bit weird and if he was asleep when that happened then the prudent thing would be to alert his doctor since this is a new thing and has happened on more than one night....and he does obviously have some significant health issues to be on the meds (whatever they are) for the conditions he listed.

so to make sure(because you said much more), was it the possibility of his being asleep that alerted you?

along with the health issues.

[Pugsy]

so to make sure(because you said much more), was it the possibility of his being asleep that alerted you?

along with the health issues.

Yep, that's pretty much it. I couldn't explain them away....I couldn't advise "turn off EPR"...it's happened on more than one night...and they were "iffy". Now the times with no events that are flagged green...probably not real but we don't know what might have changed to cause this new thing. It's new and different and he's been on cpap a long time and something like this up and happens....that's odd.
So really a combination of things.

One lone random short segment of even real CSR probably doesn't mean much but when I can't find a reason to poo poo something off....I always defer to the doctors. It wouldn't be impossible for something in his health to have changed. Now if he was brand new to cpap therapy and having the usual problems sleeping soundly might be a different story but something changed to cause this to happen now.
It might not be anything bad but I have no way of knowing that and we already know about other health issues.

This is one of the times I just say....alert your doctor to what is going on and go from there.
It's more of a gut feeling....something changed and we don't know what. Now it might be a fluke but the pattern is iffy and I don't know how much room "iffy" is and when I don't know or I am unsure....I don't want to delay or screw around when I can't blame it on anything that I can maybe offer a solution for...like turning EPR off.

The rheumatoid arthritis thing....it can be scary if you really dig into what it is and can be a lot more than just a joint thing.
My own uncle died at the age of 42 from complications of RA. I think it was damage to his lungs but I was in my teens when that happened and I can't remember for sure (there was some mention of pulmonary edema if I remember right) but the RA did more damage to his organs than it did to his joints.

So it was a combination of things that led me to say what I said. I am not comfortable experimenting and delaying in this situation.
There's that old saying I am sure you have heard......First do no harm.

[zonker]

so to make sure(because you said much more), was it the possibility of his being asleep that alerted you?

along with the health issues.

Yep, that's pretty much it. I couldn't explain them away....I couldn't advise "turn off EPR"...it's happened on more than one night...and they were "iffy". Now the times with no events that are flagged green...probably not real but we don't know what might have changed to cause this new thing. It's new and different and he's been on cpap a long time and something like this up and happens....that's odd.
So really a combination of things.

good to know.