Central sleep Apnea - is this normal?

Hello,

I've returned to trying CPAP after quitting a few years ago and I have been using it now for four nights. I am actually finding it much easier this time and have been able to wear it throughout the night and managed 10 hours last night. I am still waking up every few hours. I am 44 in October and I think I have had some sort of problem since at least my mid 30s. I am slim, but have to take medication for high blood pressure. I have a slightly receding lower jaw, which I often thought was the cause of my apnea.

Background

I've never had this properly diagnosed in a sleep study. I'm in the UK, using the NHS, which sometimes leads to rationing of services. They did try two sleep studies (wearing equipment at home). The first time the equipment failed to record and the second time I was so wound up I didn't sleep at all. I did get my own private study organised (again wearing equipment at home), which actually showed everything was fine, which is why I stopped treatment a few years ago. This was against the advice of my doctor (Consultant), who was convinced from my symptoms that I had moderate apnea. She thought that I hadn't gone into deep sleep during the private sleep study.

I should also add apnea has been observed by partners. My ex wife commented on it when I was around 37 and having started a new relationship it was spotted this year by my girlfriend who was quite scared to see it. I've also noticed I have been going downhill this year, so I wrote to my doctor and have been put back on CPAP but don't have an appointment with her till October.


Central Apnea

Anyway, to the reason why I am posting. I viewed data from my CPAP machine using the SleepyHead software, as I was wondering if my pressure (8) was correct, and I saw that I had had hardly any OSA events, but I was experiencing CSAs. Now the overall rating wasn't bad..1.75, but I did notice that the CSAs sometimes were clustered, and I thought that must be disturbing me. For example last night the machine recorded over 10 hours sleep, but there were 19 CSAs. That sounds like a lot to me!

I did a bit of Googling and I saw some information suggesting that people can start to develop CSAs this when they start CPAP, but that it will pass. Is this correct? What I couldn't see was what was 'normal'. Is this something everyone has a little bit? when I looked at some of the causes for CSA, it seemed a bit scary, so seeing it appear in my results has troubled me.

I will of course need to discuss this with my doctor, and I will try and speak with the technician at the hospital before this, but it would be great to hear about other peoples experiences.

How I am feeling

I should finish by saying I am still very tired, but not feeling like I am dying, which sadly is how I was feeling just a week or so ago. I know that sounds a bit dramatic, but I really was in quite a bad way.

Thank you for any advice.

Hi becksmycat,

1. Two main points stand out from your post.

The first is: what is the basis now of your treatment? Are you being seen and treated within the NHS? Or are you one of the 11 per cent of the population being treated in the private-medicine sector?

Whichever it is can make a difference in any 'next steps' I might offer you. And btw, I am in the UK, and I am familiar with both systems.

2. The second is: your lack of basic information. So when you say "What I couldn't see was what was 'normal'." I believe you.

The measure that sleep-medicine professionals the whole world over use is called the Apnea-Hypopnea Index or AHI, and the scale falls into four 'sections' or categories.

0 to 5 events per hour is called 'normal'.
5 to 15 events per hour is called 'mild to moderate'.
15 o 30 events per hour is called 'moderate to severe'.
30 and above events per hour is classed as 'severe'.

After the third sleep study you had done – the one that worked – did no one tell you what the results were? And did they not use the above classification?

3a. The NHS treats at 15 and above. So, as I said, with you, which is it?

If you are being treated by the NHS, there are things I can tell you which will help you get the best out of the system.

3b. If the third study showed an AHI of, say, 10 to 14, then you wouldn't qualify for NHS treatment, but there's no doubt that, at that level, you or anyone else would benefit from buying their own machine and treating themselves outside the system.

If you are treating yourself, or are in receipt of private treatment, I can suggest things to help you in that context.

If you could make it clear which it is ...

4. You say you've done some searching on the internet on 'centrals'. What you may not have found is the bit of advice which sez that: you or anybody else should read the reports from Sleepyhead or Oscar with some caution when it comes to centrals.

If you hold your breath voluntarily, even if only for a few seconds, the machine may well score it as a central. If you wake up in the night and there are pauses in your breathing as you adjust, the machine will score those as centrals.

If you do any of the slow/ deep breathing patterns that are all the rage these days (and with the mask on, and the machine running) the machine will score them as centrals.

People on this forum have an expression – 'sleep-wake junk'. That may be what's happening in your case. There's a way to tell from Sleepyhead charts, but we would need to see some 'zoomed-in' details.

4, Lastly, for this first reply to you – and again it doesn't seem that your doctor has told you – but very, very few people on sleep apnea treatment find all their symptoms go away right away. And patients shouldn't expect overnight or 'miracle' results.

The way I like to put it is: at the start of treatment, it's the equivalent of "Good. We've managed to stop the bleeding. Now we can ... " The first benefit of treatment is that it stops the OSA from doing you any more harm.

And it can easily take three months of making up for poor sleep before the average patient begins to 'feel better'.

As to your pressure, and why it has been set to a fixed level – even though you have an auto-adjusting machine – again, whether you are being treated as an NHS patient or as a privare patient has a bearing on what I or others can say about that.

Thanks Rick, I'm being treated by the NHS, my Consultant took the view that she treated the patient not the test, and she was quite dismissive of the private home sleep study, which showed a normal AHI (I don't remember the exact number, but definitely under 5). Her view was that when I was wired up to all the monitoring equipment I wasn't sleeping properly, I wasn't going into deep sleep. That could be true as i didn't sleep that well when I was hooked up.

It did undermine my belief that I had a problem though, so despite her advice I stopped treatment for a few years.

I would very much like a definitive sleep study to know exactly what was going but, but I suspect when I am wired up, I will end up with some level of insomnia again.

Thank you for the advice on CSA, that sounds more reassuring.

The Elite isn't an auto adjustable pressure capable machine....it's fixed pressure only.
The report image above shows the Elite is being used.

About the "centrals"....how is your sleep quality in general? Wake up often or if you do wake up do you spend much time awake with mask and machine on?

You might want to take some time to try to learn to distinguish awake flagged events from real asleep events.
http://freecpapadvice.com/sleepyhead-free-software
If you aren't asleep they don't count other than we wonder why you might have been awake so much which of course is unwanted.

My bad. The report says 'Elite' but the 'machine' tag-line in the OP says 'Autoset'. I'll double-check next time.

rick blaine wrote: ↑

Sat Aug 31, 2019 10:38 am

My bad. The report says 'Elite' but the 'machine' tag-line in the OP says 'Autoset'. I'll double-check next time.

I try to always check both if I can but always look at reports first because they never lie unless one of the really weird high end machines where things are iffy....or someone might be using fixed mode in an auto capable machine.
Plus looking at the reports is easier. I didn't even look at the profile choice in this instance.


To OP....you have the wrong machine chosen in your equipment profile. When you have time you might edit it to reflect correct model machine to avoid potential confusion later.

Oh I am so sorry, it is an Elite. I've changed it in my signature. I hadn't realised there were so many variations!

I'm waking up every few hours, but I have only been back on CPAP for four days.

This is another rookie question.

My girlfriend slept over for the first time with me on CPAP and she noticed at one point during the night my machine started pumping air more loudly and then I shook, before going back to sleep.

Does anyone have an idea what happened here? I thought my device was set to give continuous pressure? Unfortunately she didn't note the time.

Many thanks

The pressure is fixed but the air flow needed to maintain that set pressure can vary at times....usually it's working harder because of a big leak.
Air flow and pressure are not the same things though people often think they are.

So it might have been a leak?

Thank you

I am betting on it being leak related. It's really the only logical explanation for someone hearing the machine motor ramp up a bit and be louder sounding.

Now if it becomes a habit...then we dig deeper.

becksmycat wrote: ↑

Sun Sep 15, 2019 8:25 am

So it might have been a leak?

Thank you

How about pulling the SD card and posting a screenshot of that night.

It really does sound like a leak, though, and it bothered you, you moved a bit, and the mask sealed back up.