on Resmed S9 autoset and worried about centrals

[1210donna]

would like an opinion on this...
I'm on a Resmed S9 Autoset (dx 2013 Mixed Apnea, largely centrals and hyponeas)
AHI reduced well with this machine
working 95% of the time at max pressure
but still having series of centrals I'm not convinced its touching (also had a 130 sec hypopnea it looked like it didn't touch either).


Clusters of Centrals, pressure during these and percentage of time not breathing (July 2013 only):

6/7/12

6.58.50 to 6.59.07 (17)
6.59.21 to 5.59.43 (22)
6.59.53 to 6.60.09 (16)

total of 55 secs out of 79 secs not breathing (70%)
pressure was at 8.5 throughout this series (highest setting 10)
pressure went up to 10 at 7.38 (half an hour later)


23/7/13

5.45.02 to 4.45.24 (22)
5.47.23 to 5.47.33 (10)
5.50.25 to 5.50.42 (17)
5.50.58 to 5.51.28 (30)
5.51.33 to 5.52.00 (27)
5.52.10 to 5.52.25 (25)
5.52.45 to 5.53.02 (17)
5.53.40 to 5.54.02 (22)
5.54.41 to 5.54.52 (11)

total of 3.1 mins out of 9.8 mins (30% of that time) not breathing
pressure stayed at 7 throughout this series (highest setting 10)
pressure was at 9 at 5.30 but dropped down to 8 by 5.35, then 7 throughout the series only going back over 8 by 5.57, 2 min after the series.

25/7/13

2.51.31 to 2.51.47 (16)
2.52.05 to 2.52.16 (11)
2.52.25 to 2.52.35 (10)

total of 37 secs out of 64 secs (58% of that time) not breathing
pressure was at 10 at 2.50.10 and dropped to 9 from 2.50.20 (a minute before this series) and stayed at 9 throughout this series (highest setting 10)


27/7/13

6.45.48 to 6.46.00 (12)
6.46.41 to 6.46.52 (11)

total of 23 secs out of 56 secs (41% of that time) not breathing
pressure was at 5 throughout this series

6.49.10 to 6.49.22 (12)

pressure was at 7 throughout this series

6.59.59 to 7.00.12 (13)
7.00.38 to 7.00.56 (18)
7.01.21 to 7.01.39 (18)

total of 49 secs out of 1.4 mins (49% of that time) not breathing
pressure was at 7 throughout this series
pressure reached 10 by 7.06am, 5 min after this series

7.28.15 to 7.28.32 (18)
7.29.53 to 7.30.10 (17)

total of 25 secs out of 55 secs (45% of that time) not breathing
pressure was at 9 throughout this series


31/7/13

I'd got up from 4.56-4.57. Ramp up started at 5.15

5.10.00 to 5.10.11 (11)
5.10.19 to 5.10.34 (15)
5.10.37 to 5.10.50(13)
5.11.13 to 5.11.29 (16)
5.12.12 to 5.12.25 (13)
5.12.43 to 5.13.04 (21)
5.13.30 to 5.13.43(13)

total of 1.7mins out of 3.7mins (46% of that time) not breathing
pressure was at 5 (max setting 10)

5.33.05 to 5.33.19 (14)
5.33.29 to 5.33.50 (21)
5.33.45 to 5.33.58 (13)
5.34.18 to 5.34.33(15)
5.34.46 to 5.35.10 (24)
4.35.32 to 5.35.58 (26)
5.36.04 to 5.36.23 (19)
5.36.36 to 5.36.53(17)
5.37.03 to 5.37.16 (13)
5.38.14 to 5.38. 24 (10)

total of 2.8mins out of 5mins (56% of that time) not breathing
pressure reached 9 by 5.30 and remained at 9 through this series (max setting 10)

5.44.09 (16)
5.44.52 (12)
5.45.51 (14)

total of 27secs out of 1.7mins (26% of that time) not breathing
pressure was 8.5 through this series (max setting 10)

[LSAT]

Your S9 will identify, but not treat central apneas no matter what the pressure is set at. The CPAP only stops obstructive apneas. Can you post pictures of 1 or 2 nights from sleepyhead? If most of the centrals come when you are awake or just falling or awakening from sleep, it may not be a serious problem.

[1210donna]

Your S9 will identify, but not treat central apneas no matter what the pressure is set at. The CPAP only stops obstructive apneas. Can you post pictures of 1 or 2 nights from sleepyhead? If most of the centrals come when you are awake or just falling or awakening from sleep, it may not be a serious problem.

thanks for answering

The big clusters of centrals tend to be around 5am which is around an hour before I wake up.
I wouldn't worry about concessional centrals here and there... but when I have 5-15 in succession that's not good.
especially as I'm immune deficient and in remission from breast cancer
cancer cells don't care what your AHI is
they just grow better when you have hypoxia.

[Pugsy]

If the clusters of centrals are primarily close to the time where your wake up time is then it is possible I suppose that they are more along the lines of possible awake/semi awake centrals or sleep onset centrals as your body goes in and out of sleep to wake stage.

I would think that this is something you should talk with your doctor about considering your history if you are seeing this happen night after night. I have seen what you mention (clusters of centrals about an hour before awake time) but mine have been extremely rare.

Do you have an overnight recording pulse oximeter so you can at least evaluate the oxygen levels in your blood during this time frame?
It might or might not be as scarey as the numbers indicate but at least you would know.

Your machine by design is going to ignore those centrals...it can't or won't try to fix them with pressure....no matter what the cause of the centrals and if they are real or awake/semi awake sleep onset type of event.
The auto adjusting pressures only respond to obstructive type of events where the airway tissues collapse.
It doesn't do a thing when the air way is open.

[1210donna]

heard from my specialist. He's helping me arrange a VPAP Adapt machine.

[sawinglogz]

Excellent, that's what you'll need for the centrals.

Note that it will feel very different from the Autoset. It might take a little while to get used when it wants you to breathe.

I hear that the ResMed is a little pickier about keeping you on a fixed breathing rate. With the PR the only trouble I usually have is right after I wake up and try to fall back asleep. My recent rate was rapid before awakening, but now it's slower, but the machine gets a little confused by the sudden drop. I've found two fixes, which might also work with ResMed:

1) Turn the machine off and then back on. That usually resets its notion of your breathing rate.
2) It's really watching the pause between breaths, so rather than exhaling quickly and pausing, slow down your exhale.

You might not need either trick, but in case you do, these might save you some initial frustration.

[SeekSleep]

Even though the two titration studies I went through with the CPAP and BIPAP machines showed I would have a lot of centrals, they made me do a 90 day home trial on BIPAP prior to ordering a VPAP adapt. I just picked it up today so I don't know how I'll do on it. During my third titration night however, which was for an asv machine I found it somewhat difficult to fall asleep as I tend to have a lot of centrals during the transition, and the machine would try and blow me away when that happens which tends to wake you back up. Based on the nights in the sleep lab, I learned that I have a lot of centrals during transitions, which they don't score as part of your numbers evidently. I also evidently have a lot of them when I go into rem sleep, which it appears you're doing as well. Good luck with your new machine when it gets here. It took my DME a little over two weeks to sort out issues with my prescription, and get an S9 vpap adapt on hand to give me.

[1210donna]

doing great on VPAP... first time with 0 apneas... AND the I:E ratio was finally in the right direction... with CPAP the Inspiration time was always LONGER than the Expiration time... almost double... on VPAP it normalised - yay