Centrals and CSR help me talk to my doc – Sleepyhead data

I've increasingly been waking up in the early parts of the night with the sensation that I've forgotten to breathe. Only for a few seconds, but it's disruptive and disconcerting and happens repetitively during the first hour. Only seems to disturb me when I'm first falling asleep at night, not later on, though I do also see clear airways later in the night when I look at CPAP data.

I've tried to talk with my sleep doctor about it via the phone, but haven't been able to get him to take it seriously. He's only able to see monthly and nightly averages on the uploaded data, which don't look that bad. I've argued that those nightly averages conceal short periods with many more apneas and disruptions, but with no success.

I've included one recent bad night below. Would you take a look and see what you think, and perhaps offer a suggestion or two about how to talk to the doctor about it? This was a particularly bad night, but I'm happy to include others if that would be helpful. Thank you!

I looked at the SleepyHead report and noticed that you have a string of central events. If you drill done in the report, you may be able to see the durations of them and that may be of interest to your doctor. When you get the data enlarged, then take another screen capture to bring to your doctor.

A second thing to discuss is the relatively high rate of CA's that are shown. The rate shown is almost 5 per hour and that is quite a few. Sometimes we get those during the transition between wake and sleep and, if it occurs then, it generally is ignorable. That doesn't seem to be the case here. Encore is a better reporting tool for this particular type of occurrence and the report of interest is the waveform report. It shows all breaths, breath-by-breath, for the entire night and will help the doctor distinguish between "ordinary" periodic breathing and "CSA" periodic breathing,

SleepyHead reports as CSA events, what are actually just periodic breathing. Don't use the term CSA when speaking to your doctor as it implies a diagnosis for which there is no data in the SleepyHead report.

This is not a recommendation to abandon SleepyHead but to supplement it with Encore. I use both and find each has important ways of presenting the data in a useful manner. Encore has an important limitation that SleepyHead does not. I.e., Encore will only load in the wave form data from the most recent night so that means loading every day if that is thee report you need to look at. SleepyHead will load all data whenever it is run so running every day to get all the data is not needed.

Thanks for the input, I'll give Encore a try-- I'm a data geek in my professional life and enjoy different ways of looking at things.

Do other folks have thoughts on whether the number of centrals I'm seeing are numerous enough to cause concern or not? My doctor's nurse has taken the don't-worry-about-it approach when I've raised them in the past.

How often do you see nights where the centrals are present in numbers like this recent report you just showed? Is it a common occurrence or a rare occurrence to see the centrals in this number?
And are you for sure that you were asleep when they happened?

I agree with JDS. You need to download Encore and make copies of your bad nights as he suggested. My data looked like yours and I took about 7 nights' worth of Sleepyhead and Encore reports in for discussion. Be sure to ask about specific things (clusters of events, length of events, etc.) if the doctor tries to sweep it under the carpet. I think they initially try to do that until they see that you are serious about improving your therapy.

I bought a pulse oximeter that records overnight. After seeing that I had problems with low blood oxygen, I printed off a reasonable number of reports and took those in to the office as well. I am currently on ASV and 2L of oxygen and my nights are now 100% better.

Sometimes you just have to insist that the doctor pay attention to your homework! Good luck.

Pugsy wrote:How often do you see nights where the centrals are present in numbers like this recent report you just showed? Is it a common occurrence or a rare occurrence to see the centrals in this number?
And are you for sure that you were asleep when they happened?

That was a particularly bad night, but it's roughly representative--see another two below, but most of my nights look something like this. I do have an occasional night (1 in 7?) where I have very few clear airways, though.

I was asleep in the sense that I wasn't reading-- sometimes I partially wake with the sensation that I've forgotten to breathe, sometimes I have that sensation when I'm just drifting off, but the bulk of them happen when I'm asleep and unaware of them.

I have a pulse ox and sometimes see a short spike down to 93 or 94, and once 90, but it's largely in the 96-98 range for most of the night, even when these centrals are popping up. The above dips down are just momentary and i have some question about whether they might not be measurement error.

If the good nights are relatively rare and the not so good nights are what you see most often then I would be wanting to improve things.
On this last night the CAs and OAs were about half and half which makes me wonder if the minimum (to deal with OAs) is optimal.
The Centrals don't seem to correlate to the pressure.
Makes me wonder if the centrals are maybe related to arousals or sleep stage.

Have you used any other pressure settings? Particularly a little higher minimum?

I don't know how to get a doctor to pay attention other than being extremely blunt and in their face. I have had to do that on occasion.
These findings concern you and they don't concern the doc's nurse but have you got right in the doc's face and ask him?

Thanks folks!