Central apneas

LARS52 wrote:I have tried to get a screen shot and post it here. Hopefully it works; have not done this (or used Imgur) before.

Hopefully this is the link: http://imgur.com/a/2OfzH

close enough. I'd suggest trying a lower setting for EPR, and we don't need the insp/exp graphs. leak is much more important, but yours looks like it's most likely controlled.

Here's a link to a screenshot showing the duration of the central apneas; a number of them are almost 1/2 minute in duration if I am reading it correctly.

Link: http://imgur.com/a/2OfzH

The EPR is at the lowest setting permitted at "3".

The leak data for 7/14/16 is:
Average leak Rate = 0.83
90% Leak Rate = 1.20
% of time above Leak Rate threshold = 0.11%

LARS52 wrote:The EPR is at the lowest setting permitted at "3".

that's the *highest* setting, most pressure difference.

Julie- I know the feeling. I was on a Usenet group for ADHD suppprt in 1995. Same thing vibrant helpful and occasionally surreal and a lot of fun. People got close and we all learned a lot. Then one person showed up and single handedly killed the group over a period of several years by mocking, attacking and manipulating new posters. He actually put in 5-6 years doing it, posting daily. Last time I checked, 2-3 years ago, he was pretty much the only person posting. I still miss it.

Omne wrote:Julie- I know the feeling. I was on a Usenet group for ADHD suppprt in 1995. Same thing vibrant helpful and occasionally surreal and a lot of fun. People got close and we all learned a lot. Then one person showed up and single handedly killed the group over a period of several years by mocking, attacking and manipulating new posters. He actually put in 5-6 years doing it, posting daily. Last time I checked, 2-3 years ago, he was pretty much the only person posting. I still miss it.

Here we go again. Lars needs some health with his health issue, and what are you and Julie doing? You are junking up the thread with crappy chit-chat. Start another thread and isolate your nonsense. Don't interfere with people trying to help Lars.

LARS52 wrote:Here's a link to a screenshot showing the duration of the central apneas; a number of them are almost 1/2 minute in duration if I am reading it correctly.

Link: http://imgur.com/a/2OfzH

Click on the "Events" tab and you will get itemized lists of the events including the length of each one.

ChicagoGranny wrote:

LARS52 wrote:Here's a link to a screenshot showing the duration of the central apneas; a number of them are almost 1/2 minute in duration if I am reading it correctly.

Link: http://imgur.com/a/2OfzH

Click on the "Events" tab and you will get itemized lists of the events including the length of each one.

The second image at the posted link shows the itemized events. I can't get all of the centrals to show because the list is too long. Is there a way to show the entire list of 79 centrals?

There is a very small subset of people who will have centrals pop up as a result of bilevel pressures and your using EPR at 3 is creating a bilevel pressure situation.
So PR's suggestion to reduce or turn off EPR was made as something to try to see if the centrals are reduced in number.
It is something to try that may or may not make any difference but it's an easy thing to try.

Your centrals are too numerous...assuming that were asleep during those time frames.
As to what is causing them...at this point that is unknown and we may not be able to figure out the cause.
For some people it is simply cpap pressure and it doesn't have to necessarily be higher pressures. In your images we see clusters of centrals when the pressure is increased (that would be to deal with the obstructive apnea events) but we also see clusters when the pressure isn't higher.

Do you take any medications? If so what?

Forgive me if these questions have been answered previously but I didn't see it mentioned in this thread.
Your diagnostic sleep study...was it a home study or done in a sleep lab? Do you have a copy of those results? If you do...does it mention any centrals.
Did you have an in lab titration sleep study where there was a tech involved while adjusting the pressures? Do you have a copy of those results. If you do...does it mention any centrals?

When is your follow up schedule with your sleep doctor? If you don't have an appointment...make one.

At this point you need to try to figure out where these centrals are coming from and the starting question would be did you have them during either the diagnostic sleep study or the titration sleep study (if you had one) and go from there.

While trying to sort it out (and waiting to see the doctor) you could try turning EPR off and see if you happen to be one of that very small subset of people who develop centrals in response to bilevel pressures. It's something to try that won't hurt and might (it's a long shot) help.

One thing I would like to see is a zoomed in section of the flow rate showing breath by breath of a time frame that includes 2 or 3 centrals.
So go to the events tab and pick a central that has a couple of centrals right before and right after it and click on that central...the graphs will change to the level of scale that I want to see...get me a screen shot of that flow rate showing maybe 3 or 4 or 5 centrals. I can't see what I want to look for if you have 20 or 30 centrals squished together.....So just click on 1 event in that central list but make sure it has some other centrals in close proximity and that's the level of zooming in that I want.

In addition to the above questions...one more

Do you have any other health issues of importance especially anything related to cardiac/heart issues?

Pugsy wrote:There is a very small subset of people who will have centrals pop up as a result of bilevel pressures and your using EPR at 3 is creating a bilevel pressure situation.
So PR's suggestion to reduce or turn off EPR was made as something to try to see if the centrals are reduced in number.
It is something to try that may or may not make any difference but it's an easy thing to try.

Your centrals are too numerous...assuming that were asleep during those time frames.
As to what is causing them...at this point that is unknown and we may not be able to figure out the cause.
For some people it is simply cpap pressure and it doesn't have to necessarily be higher pressures. In your images we see clusters of centrals when the pressure is increased (that would be to deal with the obstructive apnea events) but we also see clusters when the pressure isn't higher.

Do you take any medications? If so what?

Forgive me if these questions have been answered previously but I didn't see it mentioned in this thread.
Your diagnostic sleep study...was it a home study or done in a sleep lab? Do you have a copy of those results? If you do...does it mention any centrals.
Did you have an in lab titration sleep study where there was a tech involved while adjusting the pressures? Do you have a copy of those results. If you do...does it mention any centrals?

When is your follow up schedule with your sleep doctor? If you don't have an appointment...make one.

At this point you need to try to figure out where these centrals are coming from and the starting question would be did you have them during either the diagnostic sleep study or the titration sleep study (if you had one) and go from there.

While trying to sort it out (and waiting to see the doctor) you could try turning EPR off and see if you happen to be one of that very small subset of people who develop centrals in response to bilevel pressures. It's something to try that won't hurt and might (it's a long shot) help.

One thing I would like to see is a zoomed in section of the flow rate showing breath by breath of a time frame that includes 2 or 3 centrals.
So go to the events tab and pick a central that has a couple of centrals right before and right after it and click on that central...the graphs will change to the level of scale that I want to see...get me a screen shot of that flow rate showing maybe 3 or 4 or 5 centrals. I can't see what I want to look for if you have 20 or 30 centrals squished together.....So just click on 1 event in that central list but make sure it has some other centrals in close proximity and that's the level of zooming in that I want.

Pugsy, As stated earlier my initial sleep test was a home study. The results of that test were: OA = about 2; CA = about 3; Hypopnea = about 10 The home test was then followed up with an overnight titration study at the clinic. Based on those results my pressure has been set at a minimum of 8 and a maximum of 20. I will have to check the results of the titration study to see if there is any mention of centrals, I can't recall right now. The titration study was very difficult as I had a terrible time trying to get to sleep and only obtained 2 or 3 hours of sleep. I will try to post an image tonight showing 3 or 4 centrals graphed out for flow rate. Also, I will see about changing the EPR. I had set it at 3 to reduce initial problems with swallowing air.
I take two medications; a statin and venlafaxine (Effexor generic). I have had A-fib in the past but surgery last year has eliminated that issue. So the only health issue now is the apnea which is really wearing me out. I am scheduled to see the doctor again in about 4 weeks.

LARS52 wrote: home study. The results of that test were: OA = about 2; CA = about 3; Hypopnea = about 10

Were these per hour averages or totals over the entire sleep period ?

If turning off EPR causes gastric discomfort...reduce your starting pressure a little or maybe try EPR of 1.
Turning off EPR effectively increases the overall pressures and you may not need as much for the OA/hyponea control.

If you had an in lab sleep titration study I would think that if the centrals were caused by the cpap pressure itself that it would have been noticed and at least mentioned. So see if you can find that titration study to see what it says about centrals.
Sometimes even if someone does have centrals simply from cpap therapy (at whatever pressure) it will go away with some time so sometimes docs will go ahead and begin cpap therapy and have a wait and see philosophy about the centrals. From what I have read it can take months for centrals to go away on their own...and that's IF (big if) they even will go away on their own.

Now if there weren't any centrals during the titration...we have to wonder why now but maybe with the abbreviated sleep the conditions were just right.

So...you have an appointment for follow up in a month...plan on keeping the appointment.

In the meantime there are some experiments that you can do to see if you can get the centrals reduced.
The first one is turning EPR off.
The second one would be perhaps trying a fixed pressure or an extremely tight range in apap mode.
If those centrals are indeed related to the pressure itself then having the machine in apap mode might not be the best thing to do.

I will await the zoomed in graph later tonight. I really want to see the breathing pattern up close during those centrals.

Pugsy wrote:

LARS52 wrote: home study. The results of that test were: OA = about 2; CA = about 3; Hypopnea = about 10

Were these per hour averages or totals over the entire sleep period ?

These values were per hour averages, thus my AHI for the home study was approximately 15. So I did have more centrals than obstructives during the home study, which was a time that no air pressure was being applied by a CPAP.

It's possible that Cpap alone would have stopped the a-fib, so you may no longer need the Effexor and I'd talk to your doctor about that... it could be affecting your sleep in unwanted ways.

ChicagoGranny wrote:

LARS52 wrote:Here's a link to a screenshot showing the duration of the central apneas; a number of them are almost 1/2 minute in duration if I am reading it correctly.

Link: http://imgur.com/a/2OfzH

Click on the "Events" tab and you will get itemized lists of the events including the length of each one.

you might notice, had you looked a little closer, that he already did that. just scroll down.