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Well....ResMed is certainly comfortable calling them central apneas. I would assume that they think they know what they are doing.
https://www.youtube.com/watch?v=fDhGpyeYb0c
There was a paper documenting ResMed auto scoring of centrals vs manual human scoring and the difference in numbers was actually vary small. ResMed proved accuracy. I can't seem to find that documentation at the moment.

The machine can't tell if it's a central apnea, there are more factors needed, including an O2 drop for a diagnosis. The CA after a deep breath or the body waiting for a c02 build up to trigger a breath aren't central apnea.
Philips also call periodic breathing, Cheyne stokes. This also isn't correct and causing unneeded concern.

ajack wrote: ↑

Wed Jan 30, 2019 11:44 pm

The machine can't tell if it's a central apnea, there are more factors needed, including an O2 drop for a diagnosis. The CA after a deep breath or the body waiting for a c02 build up to trigger a breath aren't central apnea.
Philips also call periodic breathing, Cheyne stokes. This also isn't correct and causing unneeded concern.

Blah blah blah... more "I don't understand concepts, but I read a lot of stuff" crap from you.

It's a *central apnea*, by *definition*.

The only question is whether it's a central SLEEP apnea or not, that the machine cannot determine.

You're simply clouding the issue, as you always do.

There's a saying...

KNOWLEDGE is knowing that a tomato is a fruit.

WISDOM is knowing not to put them in your fruit salad.

You have "knowledge", but you have no wisdom.

Go make your fruit salad with your tomatoes and avocados. (also a fruit).

I have a question, or maybe it is just a comment really, related to this topic.

I wonder if there is a way that manufacturers of these machines can identify breathing patterns before and after SWJ apneas (as we do when we eyeball SWJ) and ignore SWJ for reporting purposes?It is pretty clear to see the difference in a lot of cases and surely there could be a way to change the algorithm to be more specific.
"Alexa, was that SWJ or a true central sleep apnea?"

You should really try and watch the videos that are in the link that Pugsy attached to her first reply. The information is quite good and will help you understand what is happening. When I first started with CPAP, I had a lot of Central events too. Under certain circumstances, Central Events can be a big problem, but a large majority of the time, they happen in the stages between wakefulness and being asleep and are quite common to be marked by the machines. To give you an idea, I'll post a personal example:


If you look at the flow rate on the very left side of the image, you will see a bunch of double hump curves. For most people, this indicates how you breathe when you are "asleep". This is followed by some staggered breathing and then some very smooth curves, all of this indicates that I was aroused to be "awake" and probably rolling over. I stop breathing for about 13 seconds, so a "Central Apnea" is flagged by the machine but I am technically still awake, and then finally on the very right edge of the image, the double hump breathing starts again meaning I fell back asleep. On this board, this is referred to as "Sleep Wake Junk", or SWJ for short. For me personally it doesn't take much, I will be sleeping along and then just have a couple of deep breaths from arousal, followed by a central apnea, followed by falling asleep again. The machine flags these, but they are not considered real apneas because I was not actually "asleep" when they happened. Mine tend to happen the most right at the beginning of sleep, and in a bunch towards the end of my sleeping when you are trying to hang onto that last 15 minutes of being in bed and you are just drifting in and out of sleep. The thing that seemed to help the most for me was turning off the EPR pressure relief. I was afraid to do it because I thought it would be so hard to exhale, but it turned out to be nothing, I can hardly even tell a difference, but I have far fewer central events from turning off EPR (or for some people, even just lowering it a bit can help)

Hi Highlander,

Your graphs remind me a lot of my own a while ago. A fair amount of Centrals with occasional OAs and Hs. But also, a lot of see-sawing, up and down with the pressure between your minimum and maximum.

What worked for me was increasing my minimum, this flattened out my pressure line, including reducing the peaks at maximum, a lot of my centrals also disappeared.

I've attache a graph of a typical night before and after raising my minimum.

Arlene1963 wrote: ↑

Thu Jan 31, 2019 6:12 am

I have a question, or maybe it is just a comment really, related to this topic.

I wonder if there is a way that manufacturers of these machines can identify breathing patterns before and after SWJ apneas (as we do when we eyeball SWJ) and ignore SWJ for reporting purposes?It is pretty clear to see the difference in a lot of cases and surely there could be a way to change the algorithm to be more specific.
"Alexa, was that SWJ or a true central sleep apnea?"

Who knows what the next round of software improvements will bring?

Or they might just continue to say 'here's the data, figure it out yourself" .... but I hope the machine's programming gets smarter.

More examples:

viewtopic.php?f=1&t=113409&st=0&sk=t&sd=a#p1094245

That is interesting what were your pressure settings before and after?

I recently woke up around 3:00 am and was never able to fall back asleep but kept the mask on and CPAP on. The time after 3:00 was full of centrals which tells me that they must be happening when I am awake.

I'm not able to tolerate APAP, when I'm in auto mode the machine keeps adjusting pressure upward after sensing CA's and I end up with higher pressures then I actually need. CA's disappear when I'm on a straight CPAP setting. In my case pressure changes cause CA's. Luckily my pressure needs are minimal anyway so I don't feel like I'm missing out by having a straight pressure.

It's very normal to have the machine tag apneas while awake, they really aren't apneas.
Also you will find that new user CA normally settle within 12 weeks

Highlander wrote: ↑

Thu Jan 31, 2019 8:28 pm

That is interesting what were your pressure settings before and after?

I recently woke up around 3:00 am and was never able to fall back asleep but kept the mask on and CPAP on. The time after 3:00 was full of centrals which tells me that they must be happening when I am awake.

Awake breathing is typically very irregular, and since the machine doesn't know whether you're awake or asleep, it tends to flag a bunch of stuff. Hold your breath for 10 seconds...there ya go, a central.

Dorian wrote: ↑

Thu Jan 31, 2019 8:43 pm

I'm not able to tolerate APAP, when I'm in auto mode the machine keeps adjusting pressure upward after sensing CA's

Well, it shouldn't, because the machines are programmed *NOT* to increase pressure after a central.

Dorian wrote: ↑

Thu Jan 31, 2019 8:43 pm

CA's disappear when I'm on a straight CPAP setting.

Quite possibly because your machine doesn't try to detect what kind of apnea you're having in single pressure mode, since there's nothing it can do about them anyway.

Dorian wrote: ↑

Thu Jan 31, 2019 8:43 pm

In my case pressure changes cause CA's.

Highly unlikely.

ajack wrote: ↑

Thu Jan 31, 2019 8:45 pm

It's very normal to have the machine tag apneas while awake, they really aren't apneas.

Please stop misleading people.


ap·ne·a
Dictionary result for apnea
/ˈapnēə/
noun Medicine: apnoea; noun: apnea

temporary cessation of breathing, especially [but not necessarily] during sleep.

Not breathing, is *by definition*, an apnea.

you are again mistaken, it is the machine that is falsely tagging normal breathing events while awake as apneas.