OMG - such a bad night with centrals

From one night to the next?

Sunday

Took a sleeping tablet and slept quite well.

And then last night I had trouble sleeping again and so took a half a sleeping tablet. I had felt great yesterday and thought why not since it had helped so much the previous night and I am feeling so much better on more sleep, right?

But that plan sucked as the graph shows. Slept without a mask again ...(not deliberate) I hate to think how bad my OSA must have been last night. Oh well. Lesson learned.

When I woke up at around 2:15 (not sure why the SH clock is an hour off) I put the mask back on, then I tossed and turned but couldn't get back to sleep, much as I tried, sleep would not come.

After an hour of this, I checked the sleep report and saw this nightmare.

Also see that an obstructive was logged during this period. Not sure how this is possible when I was awake?

Just wondering what is going on here ... has anyone seen this number of CAs when awake?

Or was I going to sleep and generating a load of CAs?

Could this disordered breathing be connected to the sleep tab about 5 hours prior? I took a half a zopiclone (prescribed by my DR for one week)

Sad thing is I feel so wonderful when I sleep with APAP but getting sleep is so elusive, and if I am developing CAs as a result of this therapy would it be better for me to stop and wait until I see the Sleep Specialist in Jan. Don't really fancy getting this number of centrals each night.

What do folks think?

Awake breathing irregularities can and will fool the machine and we get "false" positives in both centrals and OA categories. Most often it is central category but it can be any of the other categories as well.

If you were developing centrals as a result of the therapy you would see this sort of central cluster each and every time you slept and the other times were you were asleep (although brief) not much going on and certainly no clusters of Centrals.

I once had 17 centrals in 17 minutes...right near the end of the night similar to yours. Ugly cluster for sure but when I looked at the flow rate up close there appeared to be some increases like we see with awake breathing. Very subtle increases but there...best we could figure out was that maybe I was waking up and going in and out of sleep. I don't have sleep onset centrals or at least only maybe a rare one.

Zoom in on that cluster (go to the events tab and pick a central that is sort of in the middle of a grouping and click on it and the flow rate will zoom in on that event and hopefully pick up a couple of other events on either side) and let's see what the flow rate looks like.
It has to be zoomed in that close...click on the one event..farther out and we can't see the flow rate well and too close we can't see it well that way either.
Let's see what the flow rate is doing during that cluster. You won't be able to get it all...just try to get it with 3 or 4 CAs flagged near each other.

Thanks Pugsy.

I zoom in but can't see a flow rate?

Flow rate...the individual breaths..does the graph showing flow rate not change if you zoom in (click on one single timed event in Events tab/CA category/the list of timed events)?

It should end up looking something like this. BTW this is probably awake/semi awake breathing or what we often call SWJ sleep/wake/junk

When I first used sleepyhead last week the flow rate was there, I see it in my old screen shots that I posted here. But after the first download of data the flow rate disappeared and has not been part of the downloads. I simply can't find that data anymore. I read elsewhere that this is a known glitch.

I must apologise for being so needy here.

I am coping on very little sleep and am sick to the stomach with anxiety. My hope was that I could self treat this until Jan 2016 but the insomnia has become insurmountable and I am not sure if I will get enough data to know if the therapy is working or not. This feeds into more anxiety, and more insomnia and .... well you see the sad results of the lack of sleep night after night, unless I take a sleeping tablet which is of course the worst thing for sleep apnea.

Thanks though for all the support so far. I really have appreciated this compared with the complete lack of interest or compassion I've received from the sleep clinic.

My Nurse Practioner is at her wit's end, knowing that what I need is to get the apnea under control and then the insomnia can be treated safely as needs be with sleep meds and CBT, but she needs to know for sure that the pressures are right. She will not prescribe more sleep meds after these are finished and I completely understand her point of view.

In the meantime I can just use the APAP everynight and hope the number of CAs diminish.

Go down to the bottom right corner in the detailed report where it says "Event Flags"...click on the little arrow and make sure that Flow rate is green and not red. You can change it from green to red by just clicking on either green or red box.
Red means the graph is hidden. Green means the graph is shown.
Let's make sure that Flow Rate is green.

Alternately...create a new user profile and import again and see if Flow Rate shows up on the new profile.
Hurts nothing to have multiple profiles.

Try not to get in a panic over the centrals.
First of all I really suspect they are related to awake/semi awake breathing because of where they are showing up and you report not sleeping well.
Secondly..even if they were the real deal every last one of them there still isn't enough of them to cause alarm.

Work on the insomnia issues as best you can and once you can get more solid blocks of sleep I bet you won't be seeing many centrals at all and if the worst case scenario should happen and the centrals end up being a problem...it's fixable but I REALLY REALLY don't think that you have anything to worry about.

Thanks Pugsy,

Here is a close up.

Here is a screenshot of CA events from the previous night.



To me they look different to the ones from last night, but I could be wrong.

Weird thing is that when the CA events were logged last night I was definitely awake and not asleep. So if they are CA events why am I not breathing for periods of time?

Just lost here.

Arlene1963 wrote:Weird thing is that when the CA events were logged last night I was definitely awake and not asleep. So if they are CA events why am I not breathing for periods of time?

"Events" of any kind do not count while you are awake!! Period! When you are awake, your breathing is very irregular. When you are awake, it is not uncommon to hold your breath for 15 or 20 seconds, like when you move, rollover, reach for something, etc. If you happen to be wearing your gear and gathering data while you are awake, your machine will usually report these "events" as CA because the machine doesn't know you are awake. Likewise, when you are just drifting in and out of sleep, like when awakening in the morning, you are likely to see these kinds of events, typically called sleep-wake-junk, but again, they are not serious and should not be counted.

Sleep disordered breathing, i.e., Obstructive Apneas, Hypopneas, Central Apneas, by definition only occurs when you are asleep. The events you are seeing would not be counted in a sleep lab and even though the machine reports them as CA, they are not.

So, you need to stop making yourself anxious by worrying about events that occur while you awake. That can only make your insomnia worse. Review Pugsy's remarks above and try to stop worrying. Concentrate instead on just trying to get a good night's sleep. Checking your numbers in the middle of the night is not likely to be helpful. It looks to me as if your therapy would work just fine if you give it a chance.

Thanks Jay, I really am going to try to take the advice offered here by you and Pugsy and just chill and relax about this.

Anxiety is truly my worst enemy.

I am going to have a lovely warm bubble bath , a glass of hot milk and read and relax on the sofa this evening and not be quite so obsessive about the numbers. I don't believe I will die from lack of sleep between now and seeing the sleep specialist!! Crazy how things can seem so bleak in the middle of the night.

Many thanks for your kind words.

Arlene: The tyranny of too much information... well actually an accurate amount in a big initial dose!. Yes, most CPAPtalk members have succumbed a few times, including me! No harm, no foul.

Arlene1963 wrote:Thanks Jay, I really am going to try to take the advice offered here by you and Pugsy and just chill and relax about this.

Anxiety is truly my worst enemy.

I am going to have a lovely warm bubble bath , a glass of hot milk and read and relax on the sofa this evening and not be quite so obsessive about the numbers. I don't believe I will die from lack of sleep between now and seeing the sleep specialist!! Crazy how things can seem so bleak in the middle of the night.

Many thanks for your kind words.

Now you're talkin'
Remember that any therapy you are receiving now is better than none and that after you see your specialist and get used to your machine you can work on optimizing the treatment. And I agree, you're not likely to die from lack of sleep before that happens

Both of those zoomed in reports look like SWJ Sleep/Wake/Junk to me. Especially the second image.
If you are awake....they simply don't count in the evaluation and you have to mentally remove anything that gets flagged while you are awake. Pretend it isn't there. I know it's hard when we are stressed out and anxious but awake breathing has to be ignored.

Pauses in breathing are very common while awake and it only takes as little as a 10 second pause to get flagged. We do it and don't even realize we are doing it. The machine doesn't know if you are awake or not though...it really only measures air flow and when we are awake the air flow is very irregular and we do stuff like hold our breath and don't even realize we are doing it and it means nothing bad at all.

Right now your number one priority...work on the insomnia situation.
RobySue has a lot of useful information in her blog about insomnia. You might find some of it useful.
http://adventures-in-hosehead-land.blog ... er_19.html
While she has called in "cpap induced insomnia" if you read it she was battling insomnia in some form long before she ever started cpap...cpap brought it back with a fury.
I think she recommends a couple of good books in her blog.

Your worst enemy is stress and worry....so work hard on not trying to micro analyze these reports especially when you know you were awake because awake breathing has to be set aside. It doesn't mean anything when it comes to sleep apnea.
Easier said than done I know only too well when anxiety breeds insomnia and insomnia breeds anxiety.

While I don't have problems with sleep onset insomnia (where you have trouble falling asleep) I do know what it is like to have sleep maintenance insomnia (where you wake up a gazillion times a night) and it's a battle I fight every night. In my case there is a known medical cause for mine that I deal with as best I can but it's something I will always have to battle. Sometimes I win and sometimes it wins but I don't stress out over win I lose.

Welllll, I took all the advice here and tried to chill about this. Many thanks for the wise advice and kind words.

So last night my husband was snoring (ugh) and so I slept in the basement for part of the night ... but got some zzzzzsss.

So the graph is fragmented but UGH.

The dramatic increase in the space of mere days in the number of centrals is noteworthy ... something has changed. Maybe I am adapting to treatment and this will pass, but I don't like to take chances.



I want to ask folks here for some advice:

I am self treating until my apt in Jan ... do you think I should just stop the APAP, and concentrate on treating the insomnia and anxiety until I see the sleep specialist and see what she has to recommend in the circumstances?

I have family visiting from overseas for the whole of December into Jan and I want it to be a period of joy, not this kind of stuff every morning and night.

Also I gather that since my Sleep Specialist apt was not rushed or urgent, and not a single word has been mentioned about needing CPAP ASAP, I guess the sleep doctor who looked at my sleep study didn't think a delay in treatment of a few months would be critical.

I'm thinking maybe I'm developing centrals from treatment and this might be simply a matter of waiting for it to resolve, but would it be better to have this monitored under Dr supervision rather than going solo?

It might be easier on me psychologically as well to have the support of a local doctor (or resp therapist) to view results and monitor progress.