looks like i have cheyne stokes..

[traillrunn3r]

new to OSCAR. looks like I have CSR....
freaking out sorta. looks like i get this 2 - 3 times a month. so its not consistent.

not sure if anyone has CSR but I'm wondering what this all means, and what I can do.

thanks for any experiences or suggestions.

chart2.jpg (441.89 KiB) Viewed 803 times

[zonker]

new to OSCAR. looks like I have CSR....
freaking out sorta. looks like i get this 2 - 3 times a month. so its not consistent.

not sure if anyone has CSR but I'm wondering what this all means, and what I can do.

thanks for any experiences or suggestions.

chart2.jpg

welcome to the zoo!

it's unlikely that you have csr.

do you know if you were awake at those times?

[traillrunn3r]

Hi zonker,

thanks for the reply, why do you think its not CSR, it looks like the pattern. I most likely was asleep during that time...

[Pugsy]

If you weren't asleep during this time....it means nothing.

If you were for sure asleep...we dig deeper because it does look like CSR but it is odd that it is rare and random.

Do you take any medications of any kind especially anything that might suppress respiration.

Try turning EPR off and see if that reduces the number of central apneas. If you can't do without EPR to fall asleep you can set your machine for EPR to be on only during ramp and then you utilize the ramp feature.

[zonker]

Hi zonker,

thanks for the reply, why do you think its not CSR, it looks like the pattern. I most likely was asleep during that time...

because it's rare that anyone has it.

now that pugsy has weighed in, i'll turn it over to her. she'll be the one to get it sorted.

good luck!

[traillrunn3r]

thanks zonker,

Hi Pugsy, i'm on a low dose of beta blockers, but thats it. i'm pretty sure i was asleep..

if it is truely CSR would it be more frequesnt? I've seen this pattern 3 times this month. for about the same time frame 20mins. Also i've seen it in oct and dec 1 or 2 times.

thanks!

[Pugsy]

It's probably real CSR but as to why we don't know.
I know that there are some people that just get random unstable breathing that amounts to CSR and it means nothing and doctors and sleep techs scratch their heads and wonder why.

You probably should bring this to the attention of your doctor and see if 20 minutes with this sort of breathing pattern and central apneas is worth worrying about or not. I don't know your history like your doctor does. It doesn't always mean some sort of heart problem but sometimes it does mean that a little more detective work needs to be done. I don't know where that line is.

Now if it looked like this every night (see image below) we would be worrying but random episodes might not mean much and might be idiopathic which means no known cause. So it's not so much that you had CSR but also how much you have seen it happen. 20 minutes 2 or 3 times a month might not be a big deal. I just don't know for sure and I can't tell you not to worry because I just don't know your history or where CSR amounts to a problem.

If you were taking medications that might suppress respiration be might blame it on meds but you aren't so can't blame that.
But it is very odd that this sort of breathing happens on such a short lived and random and rare time line.

[traillrunn3r]

Thanks Pugsy,

thankfully so far this isn't happening every night.. I msged my Dr. about it, they said the only way to be sure is to do an in-house study. I don't exhibit heart failure symptoms thou. so thats the good news.

I will tweek the EPR setting to 1 as suggested by someone and see if helps...

Pugsy, do you know any other ppl that have had CSR and their outcomes or things that might of helped reduce it? You seem to know alot.

thanks for all your responses.

[Pugsy]

There are some things to try to reduce the centrals...some are easy and fairly common like reducing (or turning off EPR) and some are a bit more....let me say innovative and I am hesitant to go there with you because you aren't having a lot of centrals.
It's not so much that it has the CSR pattern as the fact that you are having truckloads of centrals back to back.
There's an imbalance in the air/gas exchanges causing you to blow off too much carbon dioxide so your carbon dioxide levels don't ever get high enough for the brain to step in and send the "breathe" signals. People think it is oxygen levels that trigger the breathe response and it isn't...it's the carbon dioxide levels.

We don't know why the bilevel situation that using exhale relief seems to cause this imbalance in some people...it's a very small subset of people who see this happen but it's an easy experiment to see if it makes a difference or not. I have seen the centrals essentially go away with reducing or turning off exhale relief.
I have a good friend who gets a truckload of centrals with PS of 4 on her bilevel machine....PS of 4 would be sort of like your machine if it could do EPR of 4. But with PS of 3 essentially all her centrals go away. Sometimes there is a very fine line where the bilevel situation triggers centrals and it doesn't.

Bear in mind that even if you had an in lab sleep study you might not catch it during the sleep study because you aren't having this happen every night.

Even if EPR is a factor it may take you many nights of going without it to see if it helps or not. Might need a months worth of nights.

Finally I have chatted with a couple of sleep techs about why some people get sporadic clusters of centrals at various times during the night and not other times and they simply say that they don't know why....it just happens sometimes. Idiopathic centrals...no known reason.
Usually unless we see a lot of centrals (with or without the CSR pattern) throughout the night and every night....docs don't do much.
If you had an overnight recording pulse oximeter you could check to see what your oxygen levels might have gone to with so many centrals and not breathing but again....you might have to use the pulse ox for weeks to catch a bad night.
It's a lot more difficult when the bad nights are so rare and random.

[traillrunn3r]

pugsy, thanks for all the info, i really appreciate it.

what i'm wondering is since CSR is present, does that automatically mean I have heart failure? because based on the articles i've been reading it seems that a present of CSR may indicate heart failure. granted, i don't have HF symptoms, but I wonder if this is an early warning. or does this mean i need to focus on central apneas. do i have the right machine for central apneas? sorry for my mind dump.

[Pugsy]

No....CSR doesn't automatically mean the heart is in trouble.
It is a marker though that will make doctors stand up and take notice when seen in consistent patterns though because it CAN also be associated with heart issues and we never want to poo poo off potential heart issues without at least checking with our doctor.

I had a similar thing happen to me some years back but mine only happened once. Never did know what the trigger was and back then the machines didn't automatically flag CSR but it sure looked ugly. I had about 20 minutes as well...I think it was 17 centrals in 17 minutes and I was pretty darn sure that I was asleep. Since it only happened the one time I didn't do anything about it.
If I had been seeing it every night I would likely have investigated further.

If it bugs you too much you can get an echocardiogram to measure the ejection rate of the heart and easily test for heart failure.
It's done on an out patient basis. Tell your doc that you would sleep better if you had that test done.

[traillrunn3r]

Thanks again for that info, I did have an echo cardiogram last Nov and it was normal.

Also thanks for sharing your story and info, it def has put me at ease, today was the first time I tried out OSCAR and was shocked to see what it showed.

but at least i know and now my sleep dr and cardiologist know as well.

thanks again, i'll let you guys know if changing the EPR has helped...

[Pugsy]

Ah....if you had an echo last Nov and all was fine then you don't have anything to worry about.

There is this thing called idiopathic central apneas and we just don't know what the cause is and since you aren't having them all night long or even on a regular basis then I wouldn't worry about it especially if your cardiologist knows about them.

[traillrunn3r]

Thanks again Pugsy

[DurtGurl]

I've been researching similar sessions with my own CPAP therapy and *think* I might have treatment-emergent central sleep apnea which is when centrals form as a reaction to CO2 imbalance caused by CPAP therapy. Mine usually occur at the max pressure setting as if the pressure wants to go higher to correct but cannot; yours were below the set max of 13. I'd be interested in seeing the whole night's data.
https://journals.lww.com/cmj/Fulltext/2 ... ue.12.aspx