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This is what the CAs looked like at the end of my ramp up. I increased my ramping pressure from 4 to 6.5 last night and still had the Centrals occuring at the end of ramp phase. Thanks for your thoughts on this.

This was from last night. Still had a pretty bad section here. Should I request a pressure increase to bring these down? The sleep dr. mentioned me getting a autobipap machine instead of just a bipap. Thanks for your input!

Generally pressure changes do not affect CAs...They are "clear airway" events. There was no blockage when you stopped breathing for short periods...(easy to do when you are a little restless).

Don't use the ramp and see what happens with the central cluster at the end of ramp.
Starting at 6.5 going to 7.0 EPAP isn't much of a change.
These Centrals/CAs do look more like real centrals though...I am thinking maybe sleep onset centrals. You may just have to be prepared to ignore them...there's not enough of them to be a real problem and it's not keeping you from finally going to sleep and staying asleep.

Your other image from last night and the cluster of obstructive stuff..yes, you need more pressure at least during that time frame.
Usual culprits for when we see reports like this where not much happens for a long time and all of the sudden it get ugly and it's obvious the pressure used isn't doing a good job of holding the airway open are
1...supine sleeping
2...REM stage sleep
3...combination of numbers 1 and 2

And yes auto bipap would be a good choice...so that you can use a higher pressure just for that time frame where you need more.
Otherwise with fixed bipap you have to use higher pressures all night to cover that time frame.

Now we don't know how much more is needed...might be as little as 0.5 cm would do the job or you might be like me and need 6 to 8 cm more (my culprit is REM stage sleep) and I sure wouldn't want to use 16 to 18 cm all night when 10 cm would do the job.
I have used a fixed bipap...needed pressures of 15 EPAP and 19 IPAP to get me the same results as the auto bipap set at 10 EPAP with 4 cm PS and max IPAP of 20 would give me.
Using 10/14 starting out the night was whole lot better than using 15/19 starting out the night.

Thanks, I will try to turn off ramp...It just seems harder to get my mask to seal when it starts at higher pressures. But things are getting a little easier each day...
Also, when are Centrals a problem? Most are just in big batches when I am falling asleep. I also had a bunch when I was trying out a nasal dreamweaver mask-it caused my nostrils? to swell up so I had to switch to full mask.
Thanks!

First of all you need to understand that not every "central" you see flagged is a real central and if it isn't a real central it doesn't mean anything and isn't a problem.
These machines don't know if we are awake or asleep..they just measure air flow and often they will flag awake/semi awake breathing irregularities as some sort of apnea event (often central) and they aren't "real". Our awake/semi awake breathing is much more irregular than our asleep breathing.

Hold your breath for 10 seconds...that's pretty much a 10 second central...the airway is open but no air flow because you are holding your breath. When we are awake or semi awake we often pause our breathing and don't realize it and it's not uncommon for us to pause the breathing long enough to earn a central flag. Yeah, no air was moving but it was because we held our breath and not because the brain didn't tell you to breath.

Some centrals are normal...real centrals....like sleep stage transition centrals. They aren't a problem unless they are so numerous they keep us from ever really transitioning to sleep or if they are so numerous they cause serious desats.
You aren't having enough of them (that's assuming these are sleep onset or sleep stage transition) to really present a major desat and they don't appear to keep you from falling asleep.
In a sleep lab they would be mentioned but essentially otherwise ignored in terms of pressure needs assessments.

How many is too many? Assuming they are all the real deal and not awake/semi awake breathing irregularities flagged by mistake...if there's a consistent high central index...like 4 or 5 centrals per hour...every night all night then we stand up and take notice.
At this point from what you've shared so far...even if every single one of the flagged centrals were the real deal you aren't having enough of them to cause alarm.

And one final point....the centrals sometimes seen in the middle of the night could perhaps be what we call a post arousal central. Maybe an obstructive type of event causes an arousal (we might or might not remember) and we end up sort of holding our breath during the arousal and it gets a flag but it isn't a "real" central...it's really just a breathing irregularity flag and if the cause of the arousal is better addressed then it may not happen.
Meaning...do a better job preventing the airway collapses from maybe causing arousals and the irregularity never happens with the breathing and thus no central flag.
Make sense?
When this happens yes...we increase the pressure and the centrals reduce but we aren't increasing the pressure because of the centrals...we are increasing the pressure because of the airway collapsing. The reduction in centrals is merely a by product of a more optimally treated OSA.

riley525 wrote:This is what the CAs looked like at the end of my ramp up. I increased my ramping pressure from 4 to 6.5 last night and still had the Centrals occuring at the end of ramp phase. Thanks for your thoughts on this.

those look like centrals to me.

you might try lowering the flex setting, it *might* help... or you can just ignore them since it's not happening all that much during the night.

riley525 wrote:Thanks, I will try to turn off ramp...It just seems harder to get my mask to seal when it starts at higher pressures.

you should always adjust your mask seal at the higher pressures.

So, I turned off the ramp last night and still had my group of Centrals probably just after falling asleep.





I had one of my rare nights of sleeping 6 hours straight with the bipap. (yeah!) I did see this group of Centrals, a few over 10 seconds long and a long hypopnea, 57 seconds, in the middle of my sleeep. Would this be a concern?



Also, any products you can recommend to relieve nasal dryness? Whenever I am able to go over 6 hours on this puppy, my nose is really dry and my ears feel a little full...
I appreciate the time that you are taking sharing your knowledge and experience, so much!!!!! I hope I am not wearing out my welcome.

For nasal dryness...something like Simply Saline...use it often.
I don't know what humidifier setting you are using...but maybe a little more humidity???

Most likely that clustering of centrals when you first fall asleep are likely sleep onset centrals. I know it may look a bit ugly but believe me...there's been a lot worse out there. Since they don't seem to prevent you from falling into sleep I don't think they are worth worrying about. Not much you can do about them anyway and there's no real need to do anything with them.
Talk it over with your doctor if it bugs you too much.

You are going to have some "events" during the middle of the night and really as long as they are random we don't really worry about those either.
The one long hyponea...I have had those as well but a hyponea is a reduction in air flow that doesn't meet criteria for an obstructive apnea...
OA...needs to be at least 80% reduction in air flow that last 10 seconds or more
Hyponea...I think 50% (some brands use 40%) reduction up to the 80% that would earn it an OA flag...that lasts at least 10 seconds.
You could probably hold your breath that long and not have any oxygen level drops..they would only potentially be problematic in terms of oxygen levels if you start having a bunch of them back to back for several minutes.
Now they might cause an arousal (that you may or may not remember) but random rare hyponeas I don't worry about at all.

You aren't wearing out your welcome...you are learning and you never know but someone else might be lurking and learning from this discussion.
The more comfortable you are with your therapy in terms of understanding what you see the better it is.

If it were me...I would ignore the central cluster at the beginning of the night as something that you just have and can't do anything about. It's really not a bad cluster in the grand scheme of things and it isn't preventing sleep stage progression. I doubt if it is bad enough to cause an oxygen level drop but even if it did it wouldn't last very long and it doesn't happen again.

Rare isolated prolonged apnea events...no matter what the category...I don't worry about.

Now if you start seeing consistent clusters of apneas that are obstructive in nature (OAs, hyponeas) then we think maybe a little more pressure to better prevent them might be in order.

Remember centrals....we can't fix them with more pressure using your machine and you aren't having enough of them to need fixing anyway.

Since not using the ramp isn't going to stop the centrals...if you like the ramp then use it but you need to do your mask fitting at your higher pressure and not ramp pressures...because you won't be using the ramp all night.

Thank you for all the info!

My report shows this 25 second Central Apnea in the middle of the night. Does this look like a real CA?


The rest of the report looks pretty bad too. I am waiting on the doc to get me a new prescription for an auto bipap and increasing my pressures a tad.

riley525 wrote:Thank you for all the info!

My report shows this 25 second Central Apnea in the middle of the night. Does this look like a real CA?

This does look like it might be a random real CA. Or it could be that you had a arousal just before this CA happened and it represents a sleep transition CA. You should note that there is high quality sleep breathing before 4:52:50, then there's an "almost apnea/hyponea" that is NOT scored, most likely because it did not last for 10 seconds followed by a few larger inhalations and then the CA. And normal high quality sleep breathing resumes after 2 or 3 breaths after the CA. It's possible that this represents nothing more than momentarily waking up just enough to shift your sleeping position before settling back down into a nice deep sleep.

At any rate, this CA is also well isolated in time from all the other events during the night, and so I'd say it is probably one of the least important of all the events scored during the night.

The rest of the report looks pretty bad too. I am waiting on the doc to get me a new prescription for an auto bipap and increasing my pressures a tad.

The worst of your night is from about 2:05 to 2:35. A zoomed in picture of that data would be much more useful than the picture of the random CA you happened to zoom in on.

The period from 1:25 to 1:50 is also pretty ragged looking. Zooming in on that time frame would also be useful.

Now the real questions are: Why are there so many events between 1:25 and 2:35? Would a bit more pressure have prevented some of these events?

There is also a cluster of CAs at around 12:30 that might be worth zooming in on. Given that you turned the machine on at 22:15, that cluster is a bit late for "sleep transition" UNLESS you were very restless during the first hour you were in bed. But in order to properly evaluate the significance of this cluster, we also need to know whether either your diagnostic sleep study or your titration sleep study scored any CAs and what, if anything, was said about those CAs in the doctor's interpretation of the sleep study.

Questions that would help us help you include:

How long do you think it took you to get to sleep at the beginning of the night?

How many wakes do you remember during the night?

How many times do you remember being restless during the night?

We need the answers to these questions to figure out what might be going on in your data.

That one seems a bit iffy to me..see the little blips near the flag line...those are air movement blips..some air was moving..not much of course but some and centrals are pretty much nothing moving....you usually don't have any air movement at all with a central because a central is when you make no effort to breath.
I would expect a totally flat respiration line with a true central along with normal looking asleep respiration pattern before and after it.

Maybe it was a combo event...starts out as one thing but ends up as another and confuses the machine. It can happen.

At any rate...I agree with RobySue...it's random, isolated and it really doesn't matter in the grand scheme of things.

IMHO it doesn't really matter if it was real or not. I would shrug my shoulders and move on with that one.

The worst of your night is from about 2:05 to 2:35. A zoomed in picture of that data would be much more useful than the picture of the random CA you happened to zoom in on.

The period from 1:25 to 1:50 is also pretty ragged looking. Zooming in on that time frame would also be useful.

There is also a cluster of CAs at around 12:30 that might be worth zooming in on. Given that you turned the machine on at 22:15, that cluster is a bit late for "sleep transition" UNLESS you were very restless during the first hour you were in bed. But in order to properly evaluate the significance of this cluster, we also need to know whether either your diagnostic sleep study or your titration sleep study scored any CAs and what, if anything, was said about those CAs in the doctor's interpretation of the sleep study.

Questions that would help us help you include:

How long do you think it took you to get to sleep at the beginning of the night?

How many wakes do you remember during the night?

How many times do you remember being restless during the night?

We need the answers to these questions to figure out what might be going on in your data.

I could not go to sleep last night, I had restarted the machine at 23:22 so that group of CAs is my "normal...."sleep onset CAs. Once I fell asleep after 23:22 then I don't remember waking up but I never remembered being woke up or restless during the night before CPAP. I previously only noticed waking up during that rare weekend nap. I had asked about my CAs the first week of treatment. They acted like they hadn't noticed the CAs during my study...Thanks for your help.

Pugsy wrote:That one seems a bit iffy to me..see the little blips near the flag line...those are air movement blips..some air was moving..not much of course but some and centrals are pretty much nothing moving....you usually don't have any air movement at all with a central because a central is when you make no effort to breath.
I would expect a totally flat respiration line with a true central along with normal looking asleep respiration pattern before and after it.

Maybe it was a combo event...starts out as one thing but ends up as another and confuses the machine. It can happen.

At any rate...I agree with RobySue...it's random, isolated and it really doesn't matter in the grand scheme of things.

IMHO it doesn't really matter if it was real or not. I would shrug my shoulders and move on with that one.

Thanks! I was concerned about the length of time, 25 seconds. I had some long OAs and HAs last night, too. I think some were scored wrong though. Hopefully I can get my pressures increased soon. I did a lot yesterday, so I was really tired last night.