I'm Almost Afraid To Go To Sleep

[Oddprofessor]

Would you look at this?? It's a 9-minute segment from a last night. During the entire night I had 56 CA events, 4 Hypopnia, and 7 Obstructive Apneas. It looks like my breathing just gets shallower and shallower until it stops, then it starts and does the same thing, over and over. There are similar clusters later in the night. What is going on here?



Here's the entire night. This is mildly alarming. (And this is probably why our sleep doctors would rather that we didn't look at this data without them.)



Vicki

[hyperlexis]

Would you look at this?? It's a 9-minute segment from a last night. During the entire night I had 56 CA events, 4 Hypopnia, and 7 Obstructive Apneas. It looks like my breathing just gets shallower and shallower until it stops, then it starts and does the same thing, over and over. There are similar clusters later in the night. What is going on here?



Here's the entire night. This is mildly alarming. (And this is probably why our sleep doctors would rather that we didn't look at this data without them.)



Vicki

1.) Calm down.
2.) Why are you on CPAP in the first place? Were you diagnosed as having mostly centrals or just apneas/hypopneas? Both? Did your MD tell you that you needed to be specifically concerned about centrals?
3.) I cant say whether these constitute clusters or Cheyenne-Stokes problems (perhaps someone here has more expertise with that).
4.) I have mild apnea and definitely some centrals are detected by the software on my machine every so often. But you will make yourself absolutely crazy by focusing on the strips every day. Long term patterns are more important. If you are concerned, you should be mailing or transmitting your SIM chip data to your DME or MD every month or so often for a formal review. Then if anything really bad is going on, alterations could be made. Some people, with severe central problems (rare) need special machines to deal with them, but your S9 seems to be doing its job responding to yours. If centrals occur, the machine detects it, then responds. That's all you can expect it to do. Because its a brain issue, all the machine can do is just respond to try to jump start another breath.

[jnk]

For some of us, it takes several weeks before the body/brain adjusts to PAP therapy, and some extra "centrals" show up during that process.

Centrals of that sort aren't damaging in the way obstructive events can be, in that your body is not panicking while struggling against blockage of airway.

If centrals persist in series, there are ways to address that. But keep in mind that certain pauses in breathing get ignored in a lab study that show up on home-equipment software--in particular centrals that occur when transitioning between sleep stages. Those MAY be what you are seeing, and if so, they are no big deal. Perfectly natural, for some of us. The brain steps on the clutch while switching gears between ways of monitoring blood gas levels during sleep.

Remember that home-machine data is not supplied to you for diagnosis. It is for trending over time to see if things are improving, worsening, or staying mostly the same as averaged out over many days or weeks.

I enjoy your posts.

[hueyville]

Understand fear of sleep. Took years of changing therapy before I just recently (last night) slept all night without fear or pro lems. See other threads of mine for details.

[Pugsy]

Was there any mention of centrals during either the diagnostic or titration sleep study?

How was your sleep quality during the night? Did you happen to wake up often for any reason? Spend much time awake with the machine on? If you did spend some awake time on the machine did it happen during any of the time you see these clusters?

Are you seeing clusters of centrals like this every night or just a rare night?

What pressure are you using?

Are you taking any medications that might suppress respiration?

[McSleepy]

I had a similar response in the very beginning of my treatment, when I was still on constant CPAP; part of why I was switched to dual-level CPAP. I still have this tendency - to decrease breathing intensity - which was confirmed at my last sleep study (no OA but several CA), and the reason why I use relatively large pressure support (~6cm). Especially in the beginning, it is difficult to fight a high constant pressure when trying to exhale.
Unless you don't have access to good sleep doctors, your best bet is as suggested above: communicate your concerns to your doctor.
McSleepy

[letsride]

Looks like you have the wrong cpap for your type of apnea's.

You should talk to you Doctor about ASV.

[jnk]

If it were me, and I if I were early in treatment, I would likely choose to use the very questions Pugsy just asked in order to help determine whether it was time for me to ask my doc for something different.

[Rick007]

But keep in mind that certain pauses in breathing get ignored in a lab study that show up on home-equipment software--in particular centrals that occur when transitioning between sleep stages. Those MAY be what you are seeing, and if so, they are no big deal. Perfectly natural, for some of us. The brain steps on the clutch while switching gears between ways of monitoring blood gas levels during sleep.

Remember that home-machine data is not supplied to you for diagnosis. It is for trending over time to see if things are improving, worsening, or staying mostly the same as averaged out over many days or weeks.

I had heard this before, but it didn't sink in until I had personal experience recently.

I have been on CPAP for 6 weeks, and monitoring my progress with SleepyHead. I first noticed that I had 3-4 CA's each night when I first got into bed, and another 3-4 in the morning as a was waking up. Of course these numbers repeat each time I wake up during the night to use the bathroom. After seeing this occur on the graphs I started to become consciously aware of these apneas whenever I began to fall asleep. Each time one occurred I panicked and woke myself up. I also got to the point where I was afraid to take a mid-day nap for fear of causing damage to my body. I got to the point that I needed to take a sedative each night so that I would fall asleep quickly and not be aware of my pauses in breathing.

Last Sunday night I went for my titration study. I mentioned to the technician about how concerned I was about all the CA's. She pulled out my original sleep study results and showed me that I had zero CA's. When I woke up Monday morning she told me again that I had zero CA's during the night. So even though SleepyHead continues to show CA's as I fall asleep and wake up, I feel much less anxious about them, and I am now able to once again enjoy mid-day naps.

My nightly AHI is always under 2. Since 75% of my total AHI is caused by CA's, my real AHI is always under .5. So as jnk says. use your machine to watch for changes in your numbers (trends) , but don't worry excessively about the actual numbers if the sleep studies and doctors have not indicated a concern.

[DoriC]

Since I'm in a position to observe my husband's sleep patterns, I can tell you that when he's having a restless night with semi arousals or is having excessive leaks, he holds his breath as he's turning from side to side. I make note of the times if I'm awake and they are scored as CAs on the reports. This also can occur as newbies when you're still adjusting to therapy.

[BlackSpinner]

I have been on CPAP for 6 weeks, and monitoring my progress with SleepyHead. I first noticed that I had 3-4 CA's each night when I first got into bed, and another 3-4 in the morning as a was waking up. Of course these numbers repeat each time I wake up during the night to use the bathroom. After seeing this occur on the graphs I started to become consciously aware of these apneas whenever I began to fall asleep. Each time one occurred I panicked and woke myself up. I also got to the point where I was afraid to take a mid-day nap for fear of causing damage to my body. I got to the point that I needed to take a sedative each night so that I would fall asleep quickly and not be aware of my pauses in breathing.

They are normal, everyone has them, they are called sleep transition CA's. They are only a problem when your SPO2 drops to far. For me it was a relief to learn about them, they were not anxiety attacks and I was not going crazy.

[Oddprofessor]

Hmm. I've had two sleep studies done, one that showed an enormous number of apneas happening all night, far exceeding the limit for a clinical diagnosis, but my doctor didn't say which kind of apnea they were. The second study was with a cpap machine, and my doc said that I had only two or three apneas during the night.

If I look at my OA numbers over the last week (yeah, I said I was a noob! ), they are far less; the CA events are much more numerous, sometimes 4 or 5 times the OA numbers.

No, I'm not panicking; the subject line is a bit of hyperbole. In general, I figure if I have lived this long without diagnosis or treatment, chances are good that I'm not going to just stop breathing and never start again, especially with a friendly machine monitoring me all night.

I just am kinda gobsmacked by the numbers.

Thanks for your responses!

Vicki

[Pugsy]

If those centrals are the real deal, and at this point we don't know if they are or not, you would be better off being concerned because if you have developed complex sleep apnea then it isn't something to pooh pooh off. It's serious stuff.
About 15 % of the people put on cpap therapy develop CompSA. You might want to watch this video.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

[Oddprofessor]

Was there any mention of centrals during either the diagnostic or titration sleep study?

How was your sleep quality during the night? Did you happen to wake up often for any reason? Spend much time awake with the machine on? If you did spend some awake time on the machine did it happen during any of the time you see these clusters?

Are you seeing clusters of centrals like this every night or just a rare night?

What pressure are you using?

Are you taking any medications that might suppress respiration?

No mention of centrals. In fact, I'd never heard of them until I read this forum.

My sleep quality is neither better nor worse than before. I fall asleep fairly quickly, stay asleep for a couple of hours, wake up between 2 and 3, then have very frequent periods of wakefulness, alternating with short sleeps, for about an hour and a half or so, then manage to sleep fairly soundly until between 5 and 7, usually closer to 6. I am almost always dreaming when I wake for the day. The pattern with the machine is very similar, although the mask sometimes keeps me awake.

More often than not, I have >40 CA events a night. One night it was 10. I don't know what was different about that night.

I started at 4, ramping to 6 over 20 minutes. Now I'm at 6 ramping to 9 over 5 minutes. The pressure at 9 feels comfortable, and I don't feel as though it's an effort to breathe, as I did sometimes at 6.

I do not believe any of my very few meds suppress respiration. Simvastatin? Prilosec? That's about it.

Vicki

[Pugsy]

See if you can correlate the awake times in the wee hours of the morning with the central clusters you are seeing.
Our awake breathing is more irregular than asleep breathing and the machine doesn't know if you are awake or not so sometimes it mistakes awake breathing irregularities for some sort of apnea event and most commonly it will flag it as a central.

Also people who have CompSA most often will see centrals all night long...every night. So since you are reporting considerable awake time during the night and I assume with the mask and machine on...and you also have nights where not many centrals are happening along with periods of the night with not much exciting going on..then there's a good chance what we are seeing is awake/semi awake breathing getting flagged by mistake.
Should these centrals persist in these numbers and you can't explain them away with awake/semi awake breathing irregularities then you need to discuss this with your medical care team.

Normally CompSA is seen on the titration sleep study if it is the pressure triggering them..if they were the real deal.

Once your sleeping becomes more normal and not so many wake ups the centrals should reduce if they are awake/semi awake breathing getting flagged by mistake. If they persist once you can sleep all night long with only maybe a handful of short lived wake ups..then for sure talk to your doctor about them.

I have seen ugly reports like yours and the person tell me that they went to bed...lights out...slept right through until morning with no wake ups...those people usually end up on a different machine because we couldn't blame awake breathing for the ugliness.

Just keep an eye on things and see if you can correlate the ugly clusters with awake times without adding to the stress of not being able to go back to sleep.

If you continue to have long periods in the night where you wake up and can't go back to sleep then talk to your doctor about the situation. Sometimes other meds we are on will mess with the sleep architecture and cause varying levels of insomnia.