Newbie's AHI higher than at sleep study

I can't really tell much because you have so many graphs showing which makes them too tiny.
Only need these graphs on the right...keep your left side statistics stuff like it is as it is fine.
Events
Flow rate
Leak
Pressure (just one..don't need 2)
and if we need anything else we will

Once you get it so only those 4 graphs show...I want to ask you for something but I don't want you to give me this with all the other graphs making things so small because I need to see the flow rate graph really good.

Go to the events tab...see the categories of events...pick the central category and click on it to open it..then go pick a central flagged somewhere within the Green CSR flagged time frame...pick one that has a couple of other centrals real close in time...pick one...click on it and the graphs on the right will change so that you are zoomed in on the flow rate for that central event so that we can see each breathe...get us a screen shot of that level of zooming showing some centrals within the CSR green time.

At the risk of sounding totally inept and computer illiterate, I tried for a couple hours last night to move and drag the graphs to arrange them, and got nowhere. It may be my laptop, it acts up on a regular basis, or it may be that I am in such a brain fog from no sleep for so long, but I had them compressed into such a mess that I just gave up in frustration and went to bed. I couldn't get to sleep, and when I finally did, woke up 2 hrs later and could not get back to sleep. I lay there with the mask and machine on, for compliance with my insurance co. because they have given me the rented machine for the first 3 months. My ahi was 6 this morning, but am I correct in thinking that it will be lower due to less hours on the machine? I feel pretty tired and disconnected this morning, but will try again on sending the info later if I can. No episodes of CSR and leak was 2. Thanks for bearing with me.

AHI is a per hour average...it may or may not go higher with more hours involved depending on how much actual sleep you get and/or if REM stage sleep is involved.

Create a new user profile in SleepyHead and download to it again...then arrange your graphs...they will be larger and easier to find the bottom of each graph to resize.
Use the Events graph thing on the lower right...turn off unneeded graphs by clicking on that graph and changing it from green to red. You can undo it at anytime.

Pugsy, I'm now going to try and send screenshot of the CA you asked for.

Got it..thank you. Looks like real CSR and real centrals to me.

When is your follow up visit with your doctor scheduled for? Do you have one? If you don't...get one.

While I am not 100% certain based on this limited detail there's a chance we have complex sleep apnea going on here.
It happens in about 10 to 15 % of the cases when someone is put on cpap therapy and they didn't have a problem with centrals but they do now.
The cpap pressure needed to hold the airway open and prevent OSA events is causing central apneas to pop up.

Now sometimes complex sleep apnea (if that is what is going on here) will go away on its own with a bit of time but if it doesn't you may need a different machine.
Your doctor will most likely want to wait and see if it goes away on its own...and that's okay...it might.
You really need to see the doctor directly and discuss these results with him and not necessarily through his nurse who may not understand the mechanics of what is going on here.
More pressure isn't going to fix the centrals because the airway is already open.

I am not even so sure that more pressure would fix the hyponeas...it might but they might also be more central in nature and thus won't respond. Probably wouldn't hurt to try but if more pressure makes the centrals worse you would need to back off.

At any rate...you need more hours of solid sleep for full and more accurate evaluation.
With so many centrals you probably won't sleep well...so caught between a rock and hard place.

Here's a video that might help explain what Complex Sleep Apnea is ...it also talks about the other machine to fix the centrals but don't worry about that right now.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

Normally complex sleep apnea is easily seen during the titration sleep study and that's why I asked about the reports...wonder if it was noted or not or if you had centrals noted on the diagnostic sleep study.

I have a follow up appointment on the 9th of Nov. My doctor, who's a pulmonologist, is not very forthcoming with info. The only thing he told me, after my many questions, was that I had mild to moderate sleep apnea. He spent all of 3 minutes with me then took me to the nurse to set up the orders for the cpap. I only found out yesterday from my DME after asking him to look at my chart, that my study showed AHI of 10, and that a pressure of 10 brought it down to 1 at titration. I called and left a voice mail with my doctor to ask if he will send me a copy. I live in a very small town, no hospital, even, one DME, and my dr is almost 2 hours away.
At the sleep study I could not fall asleep and only slept maybe 2-3 hrs, and the same at titration. Do you think that might not have been sufficient to obtain enough data to determine if I have central sleep apnea? Should I just keep using my machine every night until I get back into seeing the dr? I have what my PCP has diagnosed as asthma, especially exhertional asthma, along with a huge hiatal hernia which has caused an elevated diaphragm. I don't know if any of these conditions would have any affect on my sleep reports. Do you know of anything else that be causing the episode of CSR( only 1 so far reported) and the CA's? This is kinda scary for me.

dorilu wrote: I could not fall asleep and only slept maybe 2-3 hrs, and the same at titration. Do you think that might not have been sufficient to obtain enough data to determine if I have central sleep apnea?

Possibly.

dorilu wrote:Should I just keep using my machine every night until I get back into seeing the dr?

Yes..keep using it.
IF (big if here) you do have complex sleep apnea (and we don't know for sure that is what is going on) there's a chance it will resolve itself once your body gets use to how cpap therapy works.

You've only had one episode of CSR...that could be all you have it was maybe some sort of fluke and may not happen again. I have seen reports where just about the entire night was CSR...so while yours is enough to stand up and take notice...I have seen much worse.

You are having issues sleeping well with the mask and machine and I don't know if those centrals are the cause of the poor sleep or if maybe they are more of a by product of the poor sleep. I would need to be able to see a lot more of the flow rate to maybe have an idea. Maybe a bit later I might have you send me a copy of your SD card so I can look at the data more closely. I would like to have more nights to look at though and hopefully some where you actually slept half way decently. Maybe we can do that if another prolonged period of CSR pops up. I am not the greatest at evaluating flow rate unless it's pretty blatant though...and I don't have the time right now.
Or maybe one of the other forum members has some time...Jay...are you here?

No, I don't think that the hiatal hernia has anything to do with it.

If your doc wants to try a little more pressure...maybe 1 or 2 cm...and see if the hyponeas respond (they don't normally take much more pressure if they are obstructive) it might be worth trying just to see if reducing hyponeas might reduce the centrals if the centrals are a by product of arousals from the hyponeas.
I think that would be worth at least trying.

If you were using EPR I would suggest turning it off but you already have it off so that experiment isn't available.

I have seen centrals go away on their own...even real complex sleep apnea centrals...so I know it's possible.
And if these centrals aren't real..maybe if we get you to sleeping better they will go away.

We know for sure the OSA needs treatment...so we proceed with what is known for sure.

I understand about the small town thing...I am in the same situation and have to drive 20 miles just to have a DME and the doctor is an hour the other direction.

We can maybe try a few things to see if we get lucky and stumble on to something that might help.
As long as you have an appointment with your doctor in the near future I think we can safely do some investigating.

Jay...do you have time to look at her flow rate up close?

I forgot to ask one question?

Do you take any medications of any kind? If so, what?
Looking specifically at anything that might suppress respiration like pain medications, opiates...stuff like that.

The only meds I take is a beta blocker, Atenelol, 50mg in morning and 12mg at night for hypertension. I've taken the 50mg dose for 30 yrs, (I'm turning 60 in few days) but have only added the night dosage bout 2 mo. ago. My resting heart rate is about 50-55. Maybe this med could have an effect?

No. I doubt that we can blame the centrals on your BP meds. Wish it were that simple but I have never heard of it doing that sort of thing.

To update, I spoke with my sleep tech and with the sleep lab nurse and they are baffled. They said there were no centrals on my sleep study, and only 4 at titration. They said this needed to be addressed and they did get hold of my dr who is out of the office today and he said to change to an apap. My DME can not make this change so I am taking my machine in to the sleep lab today for the change. I'm hoping this helps. Has anyone had similar issues and Pugsy, have you corresponded with others who have?

Yes...I have known many many people in the past with similar issues.
It's a hurdle but a hurdle that is fairly easily conquered once some things get sorted. Takes a bit of time to get it all sorted out but it's fairly easily done...just not super fast. There are insurance hurdles and therapy hurdles and doctor hurdles sometimes.

You already have an apap but using fixed cpap mode...did they mean change to apap mode or did they mean change the machine to a bilevel machine which is normally the next thing to try for situations like this?

There's no reason you can't make changes yourself on your machine....no reason to take it in to anyone unless you are just more comfortable taking it in.
In your situation I wouldn't make changes willy nilly but there's no reason you can't make changes your doctor orders.
It's just a matter of getting into the clinical setup menu to make the changes...little secret button pushing.
Explained in the manual...read it..you need to know about your machine even if you don't make any changes yourself...some really good information in it along with some central information stuff and CSR stuff
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Thanks, Pugsy, for the info on my machine. There's a wealth of info there. My DME didn't give me a manual with my machine. I guess that's no surprise from my reading of the forum here. Manufacturers are protecting themselves.
Yes, she just changed my machine to Apap. Its the same machine. She insisted I bring it to the sleep lab to have that done, which is nearly 2 hrs away. She said my DME could not change it, which seems very strange to me. They are about a 15 min drive from me.
I'll see what changes tonight brings.