Sleepyhead Graph Question - are these real events or not?

Hi -

I'm trying to actually understand the nuts and bolts of my condition better, so I'm reading about sleep apnea and looking at my Sleepyhead results more carefully. I understand most of the graphs pretty well, but parts of the flow limitation graph are still giving me difficulty.

So - I have a question about centrals. The first graph has a central, but its from when I was awake, so not really a central, right? But the 2nd graph with two centrals was from when I was definitely asleep. Are those what actual centrals look like? If not, what do they look like?

Thanks,
HK

halokittie wrote: ↑

Tue Feb 05, 2019 12:26 pm

Hi -

I'm trying to actually understand the nuts and bolts of my condition better, so I'm reading about sleep apnea and looking at my Sleepyhead results more carefully. I understand most of the graphs pretty well, but parts of the flow limitation graph are still giving me difficulty.

So - I have a question about centrals. The first graph has a central, but its from when I was awake, so not really a central, right? But the 2nd graph with two centrals was from when I was definitely asleep. Are those what actual centrals look like? If not, what do they look like?

Yes, they're all 'centrals'. (apnea = not breathing, central = not *trying* to breathe) Doesn't matter if you're awake or not. Some people don't get that distinction.

What we're concerned about is whether the centrals are legitimate central sleep apneas, and more technically, whether they'd probably be counted on a sleep test as a 'central' or discounted as 'not meaningful'.

The first one, when you were awake is obvious, it'd be discounted.

The next two, (always best to put the flagged bit close to the right edge so there's more 'before breathing', with just a few breaths after) look, at first glance, like you were moving around, that something else had knocked you out of your normal breathing... so they'd *probably* be discounted too.

Frequently when we are awake doing something like turning over, we hold our breath, if do that for 10 seconds or more and our airway is not restricted the cpap records a Central. This is not a valid central because you were holding your breath and awake. In a true central you are not awake and your CO2 balance is off meaning that you have no reason to breathe so you don't (not the only reason, just one of them). So yes the 2nd graph is central. Another hint is that you don't have a Recovery Breath, one that is generally bigger than normal as you go into a "recovery" mode, that frequently follows an Obstructive event.

in either case you don't need to worry about those centrals right now.

Fred

bonjour wrote: ↑

Tue Feb 05, 2019 3:28 pm

So yes the 2nd graph is central.

You *cannot* legitimately say that the second graph are central sleep apnea events without seeing more of the preceding breaths, those that are visible look ragged, and not sleep breathing shapes.

palerider wrote: ↑

Tue Feb 05, 2019 4:46 pm

bonjour wrote: ↑

Tue Feb 05, 2019 3:28 pm

So yes the 2nd graph is central.

You *cannot* say that the second graph are central sleep apnea events without seeing more of the preceding breaths, those that are visible look ragged, and not sleep breathing shapes.

of course, he can say it. whether he's right or not, i don't know!

zonker wrote: ↑

Tue Feb 05, 2019 8:17 pm

palerider wrote: ↑

Tue Feb 05, 2019 4:46 pm

bonjour wrote: ↑

Tue Feb 05, 2019 3:28 pm

So yes the 2nd graph is central.

You *cannot* say that the second graph are central sleep apnea events without seeing more of the preceding breaths, those that are visible look ragged, and not sleep breathing shapes.

of course, he can say it. whether he's right or not, i don't know!

Good point, let me amend my post...

He cannot legitimately say that.

Thanks, I think I'm getting it.. A couple more examples because I think I'm getting a lot of false CA's, so please bear with me.

Do any of these look like CA's? My breathing is trucking on along, then it seems to go a little off, then the CA, then back to normal. Is that possibly just a position change?

Thanks again for your help.

halokittie wrote: ↑

Wed Feb 06, 2019 9:48 am

Thanks, I think I'm getting it.. A couple more examples because I think I'm getting a lot of false CA's, so please bear with me.

Do any of these look like CA's? My breathing is trucking on along, then it seems to go a little off, then the CA, then back to normal. Is that possibly just a position change?

Thanks again for your help.

I'd say that's something post arousal.

I really appreciate your help. I think most, if not all, of my centrals are false and I can eliminate them from my score, which would bring it down considerably.

Now I'm wondering about the OA's. Would it be better to continue in this thread or start another?

Thanks,
HK

Continue in this thread if you are wondering about other categories of events.
Maybe change the topic to something like "are these events real or not" and not limit it to just centrals.

I have seen OAs and hyponeas flagged that are definitely post arousal or awake breathing false positives in my own data...so it's not limited to centrals.

Thanks Pugsy. I changed the title.

The charts here are from last night. They show two OA's per sleepyhead. Do they look like what you would expect an OA to look like or are they a possibly a false positive?

Thanks so much. This is really helping me figure out my situation.

Those are what I would call "iffy"....look more like post arousal to me. The slightly irregular breathing just preceding the flag and the lack of a recovery breath at the end of the flagged event makes me lean towards arousal related and not real but "iffy" in that not clear cut to me anyway. The breaths just preceding the flag...barely irregular and of really short duration makes it not clear cut in my mind but I lean towards post arousal IMHO. Not easy clear cut unfortunately.

Whenever I see "iffy"....I go ahead and mentally put them in the "real" basket though because I would rather make an error calling something real and it might not be than the other way around and ignore too many "real" events.

Your reports scream poor sleep quality and I assume that is why you are digging so deep under the microscope to try to figure out what is going on.
Have you tried more minimum pressure and more maximum just to see if it helped reduce any of this ugly stuff....just in case the real stuff is maybe causing some of the arousal related stuff?

Pugsy wrote: ↑

Thu Feb 07, 2019 10:48 am

Your reports scream poor sleep quality and I assume that is why you are digging so deep under the microscope to try to figure out what is going on.
Have you tried more minimum pressure and more maximum just to see if it helped reduce any of this ugly stuff....just in case the real stuff is maybe causing some of the arousal related stuff?

I've had poor quality sleep for a long time, but lately its gotten worse. My AHIs have jumped from the mid 7's to the 10-11's. However, most of them appear to be post arousal if I'm reading my flow limitation graphs correctly?

My usual pressure is 16/20, but I lowered it to 12-16 for a few days to see if it would bring the false centrals down. Doesn't seem to have worked.

My sleep doctor had me do an overnight bi-level titration study a few weeks ago. I'll see him for the results in a couple of weeks, but I'm not sure if a bi-level is the answer either.

This is from last night. I'm guessing most of these are false events:

Meds???
On any that might even remotely mess with sleep architecture?

And yes...most of those look post arousal to me also.
Now figuring out what causes the arousals....that's the hard part.

I assume you were once on cpap/apap and still had this problem with sleep and centrals and such?

I'm still on APAP, at least until I see the doctor in late February. I've been on one for about 6 years now. Doctor wanted to evaluate me for a bi-level because I'm still exhausted during the day despite sleeping 11+ hours.

Now that you mention it, meds may be an issue. I'm on night time Topamax for migraine prevention, Reglan for gastroparesis and Crestor for cholesterol. I also take Nuvigil in the morning. Probably a cluster* of sleep architecture altering meds.

Ideas for approaching this with the doctor? He will have the bi-level titration study in his hands. I haven't seen it. Thanks.