Cheyne-Stokes..only while awake...thoughts

I have been on compliant BiPap since June 9. I have amachine and mask that I like. I have gotten accustomed to the treatment and I am feeling about 80 - 90% better. I still have some good days and bad days. I am not very tired during the day and I rarely feel the need for a nap. I sometimes get a little tired at the end of the day, but not bad (after dinner) and usually don't need/want a nap.

As I have been working on my treatment, I have been monitoring via Encore Pro. I am currently using Bipap w/ biflex at pressures of 8/12.

I have posted a similar question and some recent Encore Pro data on this forum in the past. I am still struggling for answers and whether to be concerned.

The Encore Pro data is picking up OA's events when I am awake only. When I am asleep, the machine is working great and controlling all HI and OA events. But it is the wakeful time that I am concerned about...or wonder whether I need to be concerned. I am wondering if this irregular breathing while awake is Cheyne-Stokes Resp breathing (been doing a little bit of research). Now that I have seen my data, I am a bit more conscious of my breathing when I am settling in trying to fall asleep. This is usually a 30 minute period where my machine is picking up a ton of apneas. I am aware that my breathing becomes shallow and I am also aware of the machine kind of fighting my breathing pattern. Like I will be taking a breath and the machine will stop it's Inhale Mode. This is not a problem with the machine becasue I have had a Bipap Pro 2 and a BiPap Auto and they both record the data the same and have the same kind of reaction to my wakeful breathing patterns.

While trying to fall asleep, on a few occasions I have noticed that I stopped breathing...but do not feel at all out of breath. It is just as I am drifting off and I realize my breathing stopped and I take a breath. This is not scarey at all, and if it weren't for being hyper conscious of my breathing while awake, I might not have even noticed. I don't feel out of breath or gasping in any way which makes me wonder whether this is Central Apnea while awake. Once asleep, my data shows AHI of 0-2.

Does anyone want to weigh in as to whether this is something to be concerned about, or just an anomoly with how the machine records apneas?
Also, has anyone else here experienced anything similar to this?

Thanks in advance everyone for your help and support.

Scott

mesaboog wrote:The Encore Pro data is picking up OA's events when I am awake only. When I am asleep, the machine is working great and controlling all HI and OA events. But it is the wakeful time that I am concerned about...or wonder whether I need to be concerned.

I wouldn't be concerned about the awake time, since you say the machine is handling things great while you sleep.

mesaboog wrote:I am wondering if this irregular breathing while awake is Cheyne-Stokes Resp breathing

Cheyne-Stokes respiration is an unmistakable repeated waxing/waning respiration pattern...it's not just some irregular breaths, or shallow breathing, or occasionally holding one's breath while waiting to fall asleep. If you really have C-S respiration, it surely would have been noted by your regular doctor. But I'm not a doctor -- you could ask your doctor sometime for reassurance that you don't have Cheyne-Stokes respiration.

mesaboog wrote:While trying to fall asleep, on a few occasions I have noticed that I stopped breathing...but do not feel at all out of breath. It is just as I am drifting off and I realize my breathing stopped and I take a breath. This is not scarey at all, and if it weren't for being hyper conscious of my breathing while awake, I might not have even noticed. I don't feel out of breath or gasping in any way which makes me wonder whether this is Central Apnea while awake.

I think what you're probably describing are sleep onset centrals that some people experience as they are drifting off to sleep. From what I've read, having those is quite normal. It's also normal for a BiPAP's timing for inhalation to cut off (going back to exhale pressure before you're through inhaling) IF you take an unusually long inhale. After a long pause with a sleep onset central, it would be normal to draw in a longer inhalation breath than usual. So I can see where such a "cut off" would happen sometimes while you're drifting off.

Your sleeping AHI sounds great. And this is super:

mesaboog wrote:I am feeling about 80 - 90% better. I still have some good days and bad days. I am not very tired during the day and I rarely feel the need for a nap. I sometimes get a little tired at the end of the day, but not bad (after dinner) and usually don't need/want a nap.

Sounds like it's going extremely well for you, Scott. I wouldn't be a bit concerned about what the data says while you're awake, waiting to fall asleep.

Rested Gal-I really value your opinion, so I need to ask you...All of my numbers look really, really good (I don't have the software yet, but I did a week study with my smartcard and DME). I am having a real problem with multiple arousals at night. I sleep for about 3 hours initially, then wake every hour until I give up and get up for the morning. My mask is comfortable, I am comfortable, no pain etc. I know that 70% of my apneas in my sleep study are centrals. What is your opinion? Thanks so much!!!

Gosh, Missy...thanks for your much too kind words.

With your sleep study showing up about 70% of your apneas as centrals, I wouldn't have a clue what to look for. Central sleep apnea is a whole other ballgame.

You may have already done this, but if not, I'd ask sleepydave over at apneasupport.org to look at your sleep study results if I were you. See what he thinks about how it went.

When you get your software and can take a look at your machine's detailed data, perhaps something will jump out more. Something like large mask or mouth air leaks that wake you up but you aren't aware that's what roused you.

Untreated, undertreated, or undiagnosed GERD would be something I'd get checked out, I guess. More and more I'm beginning to believe that nighttime acid reflux people aren't even aware they have (no symptoms to alert them) can really disturb sleep.

Even though you're comfortable with your mask and have no pain, etc., I'd still doublecheck the sleep environment: Got a dog or cat that jumps up on the bed? Room get a bit too warm as the night goes on? Mattress getting a tad old or saggy? Neighborhood dogs barking? Room dark enough?

Mesaboog, are these apneas happening: 1) when you are still awake, 2) just immediately after sleep onset, or 3) not exactly sure?

As an experiment, I would put the mask on and wear it a good thirty minutes before allowing myself to go to sleep. Then I would check the data to see if: 1) your early apneas completely disappear, 2) they simply get pushed further out (approximately thirty-minutes) along the time domain axis on your nightly charts (same density and interval), or 3) they occur throughout that entire thirty minute period each night. I believe the above experiment will shed at least some light regarding what is happening.

Also in your other post a few posters had mentioned bumping your min EPAP setting up to 8 cm on the Auto BiPAP. It sounds as if that didn't work. When you ran a straight BiLevel setting of 12/8 cm on August 8th, a straight 8 cm EPAP still did not manage to keep your apneas away after that short sleep break between the 5 and 6 hour mark. You had also mentioned that August 8th session was very typical of most of your previous straight BiPAP sessions.

So I guess we're not too surprised to hear that moving your Auto BiPAP's min EPAP up to 8 CM yielded similar results as when you used to run a straight EPAP of 8 cm. None the less, it was still a good experiment to try on the Auto BiPAP platform. Then again there is always the continuation of that same min-EPAP-related experiment: bumping your min EPAP up even higher, to 9 cm.

Did you ever get a chance to try any different PS Max settings? I think I had mentioned in your earlier thread the first PS Max I would have personally been interested in trying was a PS Max setting of 3 cm. However, I would have also been interested in experimenting with PS Max settings of 2 cm and 5 cm as well (those settings may or may not yield trends). Unfortunately you may not achieve any improvements whatsoever with PS Max experiments. But there is a chance it just may help.

So those are two additional experiments that you may want to eventually try, if you haven't already. I wouldn't recommend running experiments in tandem, since that makes it hard to attribute resulting changes in outcome. Good luck!