Newbie's first post-Sleep Onset Central Apneas & Other ?

Hold your breath for 25 seconds...does it cause you any discomfort?
If not then there's nothing to worry about when you see random, isolated events (real or not) of this duration or even a little longer.
They really don't amount to much unless they
1..wake you up
2..you see a truckload of them within a very short time frame...like maybe one each minute for 10 minutes straight type of cluster.

riley525 wrote:

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.

Gee I wish Sludge was still around. I would really like to hear what he would say about this wave flow.

Here's the thing that stands out to me: Those OAs are at 1-2 minute intervals and on this scale they look just like the CAs that are scored at around 2:19:00 and just before 2:30:00 in terms of the breathing both before and after each of the OAs: There are large recovery breaths after each event and then the breathing quickly tapers off and at the nadir of the cycle there's an apnea. Or in many cases, an "almost apnea" that was not scored because it lasted less than 10 seconds. And then there's set of really large recovery breaths. So it does raise the question about whether some of these events are centrals that are being mis-scored as OAs. But answering that question is well above my pay scale and that's why I wish Sludge was still around.

Could you make three more zoomed in screen shots? One showing the part that's actually flagged as periodic breathing---say from 2:18 to 2:23 and another from 2:10 to 2:15? Finally, I'd also like a zoomed in screen shot of the sleep onset CAs---zoom in from 23:30 to 28:35.

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

This stretch looks much more "normal" for a bad stretch of OSA events. The timing of the events is not as regular. The recovery breaths are there, but immediately afterwards the breathing stabilizes into what appears to be more normal sleep breathing for a while before the next event occurs. It might be useful to see two zooms of this area just to compare them to the earlier zooms I requested.

Could you zoom in from 1:30 to 1:35? And then a separate zoom from 1:35 to 1:40?

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.

If they noticed normal sleep transitional CAs, they wouldn't have said anything about it and they wouldn't have scored them as events.

How often do you get clusters like that one between 2:05 and 2:40? Once in a while? Once a week? Twice a week? More than that?

Gee I wish Sludge was still around. I would really like to hear what he would say about this wave flow.

Here's the thing that stands out to me: Those OAs are at 1-2 minute intervals and on this scale they look just like the CAs that are scored at around 2:19:00 and just before 2:30:00 in terms of the breathing both before and after each of the OAs: There are large recovery breaths after each event and then the breathing quickly tapers off and at the nadir of the cycle there's an apnea. Or in many cases, an "almost apnea" that was not scored because it lasted less than 10 seconds. And then there's set of really large recovery breaths. So it does raise the question about whether some of these events are centrals that are being mis-scored as OAs. But answering that question is well above my pay scale and that's why I wish Sludge was still around.

Could you make three more zoomed in screen shots? One showing the part that's actually flagged as periodic breathing---say from 2:18 to 2:23 and another from 2:10 to 2:15? Finally, I'd also like a zoomed in screen shot of the sleep onset CAs---zoom in from 23:30 to 28:35.

This stretch looks much more "normal" for a bad stretch of OSA events. The timing of the events is not as regular. The recovery breaths are there, but immediately afterwards the breathing stabilizes into what appears to be more normal sleep breathing for a while before the next event occurs. It might be useful to see two zooms of this area just to compare them to the earlier zooms I requested.

Could you zoom in from 1:30 to 1:35? And then a separate zoom from 1:35 to 1:40?

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.

If they noticed normal sleep transitional CAs, they wouldn't have said anything about it and they wouldn't have scored them as events.

How often do you get clusters like that one between 2:05 and 2:40? Once in a while? Once a week? Twice a week? More than that?

I looked back and I have been having clusters like this 3 to 4 times a week.

Thanks for your help.

riley525,

Thanks for posting the images. I'll be honest with you: It's going to take me some time to really think about what you've posted here. But the short version is: These things don't look like normal clusters of obstructive apneas.

Gee I wish Sludge would come back reincarnated in some new, but clearly identifiable persona.

Robysue

riley525,

Can you make a whole series of zoomed in shots on the cluster that lasts from about 2:10 to 2:35?

I'd like a series of zooms each of which is 5 minutes long starting at 2:00AM and ending around 2:45. I want the zooms to start before the cluster gets started and end after it's clear that normal sleep breathing has resumed.

Thanks

robysue wrote:riley525,

Thanks for posting the images. I'll be honest with you: It's going to take me some time to really think about what you've posted here. But the short version is: These things don't look like normal clusters of obstructive apneas.

Gee I wish Sludge would come back reincarnated in some new, but clearly identifiable persona.

unless we presume that the machine's detection is just completely broken, we have to believe that, at least at the time of the pressure pulse, the airway is obstructed.

that said, my feeling is that they are central apneas, based on recovery from them, (no recovery breath in most cases) more of a crescendo more typical of co2 depletion perhaps.

it wouldn't be the first time that we've seen airway collapse during a centrally motivated event.

robysue wrote:riley525,

Can you make a whole series of zoomed in shots on the cluster that lasts from about 2:10 to 2:35?

I'd like a series of zooms each of which is 5 minutes long starting at 2:00AM and ending around 2:45. I want the zooms to start before the cluster gets started and end after it's clear that normal sleep breathing has resumed.

might it be easier for him to put a copy of the data up on dropbox?

palerider wrote:

robysue wrote:riley525,

Can you make a whole series of zoomed in shots on the cluster that lasts from about 2:10 to 2:35?

I'd like a series of zooms each of which is 5 minutes long starting at 2:00AM and ending around 2:45. I want the zooms to start before the cluster gets started and end after it's clear that normal sleep breathing has resumed.

might it be easier for him to put a copy of the data up on dropbox?

Perhaps.

But I don't have time to set up a place in my personal (and almost full) dropbox and then post instructions on how to drop it in the drop box this evening. I'm still grading midterms. And making green tomato pickle relish.

robysue wrote:

palerider wrote:might it be easier for him to put a copy of the data up on dropbox?

Perhaps.

But I don't have time to set up a place in my personal (and almost full) dropbox and then post instructions on how to drop it in the drop box this evening. I'm still grading midterms. And making green tomato pickle relish.

well, Riley can upload a zip of the *entire* sd card to here: https://www.dropbox.com/request/0LalWvEsijRIgX8sdM7H

and I can share it with you at your convenience.

I am swamped right now too...I have a couple of people I am doing the entire card thing...plus to be honest I admit to not being so great at the subtleties in wave form...if it's so big a blind man can see it I am pretty good but if it isn't I struggle with breath by breath stuff. It's not what I am particularly good at.

I still think that it wouldn't be impossible for the ugly seen here to be perhaps related to sub optimal cpap therapy during that time frame...maybe REM or supine related.
Why not first try easy and simple attempt to fix what appears to be a known problem with sub optimal pressures and see what happens after a small pressure change upwards to better hold the airway open in the first place.
If it doesn't help or clear up then start doing the dig deeper micro analysis.

These machines are good but they aren't without their limitations and sometimes they do miss name something...my big problem is I don't know enough about the air flow patterns to recognize a machine naming error myself.
This is an area where Sludge would be a great help but we ran him off so now we have to try and do the best we can without him.

Finally OP here has a doctor who is aware of the problem and actively trying to address the situation and maybe asking the doctor some of these questions might be in order..that's what he gets the big bucks for.
There's so much about this level of analysis that I don't want my word to be taken as gospel because I recognize my limitations..
I have my thoughts and ideas based on reasonable logic and experience but I could be all wet...talk to your doctor about your concerns and see what he says.

Fix or attempt to fix the known problem with a known common solution and if that doesn't resolve the issue then we start digging deeper. Never know...1 cm more pressure might just answer all our questions here.

Edit..I see PR offered to start the upload stuff...I was just going to ask him if he had time to tackle it and to be honest I think he's better at this level of analysis than I am.

Thank you palerider, pugsy, and robysue for your input and offers to help read my sleepyhead reports. I am trying to educate myself more about this new part of my life, I watched a video from the TheLankyLeft27", "How to Review and Evaluate your own Home CPAP BiPAP Bilevel Therapy Data with SleepyHead." It had some good examples, too. I am also searching and reading some of the older posts which are full of information. With what you all have shared with me, I think I will wait until I can get my pressures adjusted/new machine, since I am sure based on my track record I will have lots of questions then, too. It does look like many of the CAs that occurred in the middle of my OAs and snorefest should be scored as OAs instead of CAs. So that would leave me mainly with my sleep onset CAs which are normal for me and I may have to live with.

How long do you wait to get a call back from the sleep doctor or his nurse???

The time that you CPAP ANGELS put in to help us newbies out is so amazing and appreciated! And you have been doing this for years! Your support means a lot. I felt so lost until I found this board. Thank you so very much.

riley525 wrote:I think I will wait until I can get my pressures adjusted/new machine, since I am sure based on my track record I will have lots of questions then, too.

I think that's fine. We know that you need some sort of adjustment and the bulk of the questions might be eliminated with the changes...and if they don't then we can dig deeper.

The sleep onset centrals...you are likely stuck with them. It's just who you are but you aren't having enough of them to really be worrisome. It's doubtful that you have enough to cause serious desats and you are progressing into normal sleep and not continually bouncing out of sleep only to have to start the process all over again.

I am a thorn in a doctor's nurse's side at least once a day until I get a call back. If it goes past 3 days...I am a thorn 2 or 3 times a day.

Received my new APAP Bilevel Dreamstaion today, upgrading from the DS Bilevel. I have a horrible cold right now and developed a dry cough towards the end of the night so usage time was not good. My question on the above chart is-shouldn't the APAP kicked in to a higher pressure when a Obstructive apnea lasts that long? I see three 14 second pressure pluses. I have had some side effects, ear and sinus pain, swallowing of air, acide reflux... So I requested the max on the APAP be set at 15 initially so I can get used to the higher pressures. Thanks for your help.

Auto adjusting pressures don't work that way. They don't say "OMG there's an OA I need to increase the pressure and stop it". No auto adjusting pressure (apap or bilevel) work that way. They all wait until the OA/hyponea resolves and then they do whatever it is they do to sense the patency of the airway and then decide if a pressure increase is needed to better prevent the OA/hyponea from happening again.
None of the machines will respond by trying to "blow the airway open" with a pressure increase...and even if they did they can't increase the pressure fast enough to accomplish that feat.
It's all about preventing the airway collapses in the first place and not blowing open a collapsed airway while it is collapsing.

riley525 wrote: Received my new APAP Bilevel Dreamstaion today, upgrading from the DS Bilevel. I have a horrible cold right now and developed a dry cough towards the end of the night so usage time was not good. My question on the above chart is-shouldn't the APAP kicked in to a higher pressure when a Obstructive apnea lasts that long?

No. APAPs (all APAPs) wait for the event to clear itself and then increase the pressure---if the event is not isolated. An isolated event---i.e. an event that is at least 2 minutes away from any other event and is not associated with FL or snoring is typically ignored, particularly by the PR Auto algorithm. This mimics the AASM manual titration guidelines for when to increase the pressure during a titration sleep study.

I see three 14 second pressure pluses.

They are there because the machine is trying to determine whether your airway is obstructed or clear. The PR machines also use PP to determine whether it is still able to detect a live human being at the other end of the hose. In other words, you sometimes see a series of PP when the machine is having difficulty detecting your breathing, often (but not always) due to a large leak.

I have had some side effects, ear and sinus pain, swallowing of air, acide reflux... So I requested the max on the APAP be set at 15 initially so I can get used to the higher pressures. Thanks for your help.

What is your titrated pressure?