Centrals Falling Asleep

This keeps happening:


As I'm falling asleep, or having just fallen asleep, I always get these centrals. They are real as evidenced by the SpO2 crash. Occasionally, I wake up and take a breath and I wonder how long I went without breathing.

Any ideas how to mitigate? Or are these no big deal at all?

Note: The unit shot my pressure way high at first but brought it down to about 10 so I can't be too far off with my minimum pressure of 9....


I'm struggling to get my AHI below 4 so I'm open to most anything

I guess I'm disturbed by the fact that I stop breathing for extended periods of time each time I fall asleep, as evidenced by my tanking SpO2. Am I overconcerned about a one-time drop to the low 80's each night?

ETA: I am now battling hypertension for the first time in my life and obviously there's a link between 02 starvation and hypertension....

Are you wearing a pulse oximeter at night to see how low your Sp02 goes?

You need to be asking your doctor if that one relatively short segment with the drop in oxygen is worth worrying about or not.

Sleep onset centrals or sleep stage transitional centrals are normal to have happen and they are real and not necessarily SWJ awake flagged events. Your drop in oxygen levels appear to be real but relatively brief and they don't seem to re-occur later.

It is normal to have a 3 to 4 % drop in O2 once we are asleep. Obviously yours is much more than that for a short period of time when you are having the sleep onset centrals. Your doctor knows ALL your medical history and he is the one in the best position to tell you if this is a significant problem or not. If it was happening often during the night...obviously a problem but I just don't know if the doctor is going to worry about this relatively short period of time or not.

There is nothing you can do in terms of tweaks with the machine to deal with sleep onset centrals or even any SWJ centrals.

icipher wrote: ↑

Tue Jul 21, 2020 8:36 am

Are you wearing a pulse oximeter at night to see how low your Sp02 goes?

Yes, that's the SPO2 graph OP shows

LSAT wrote: ↑

Tue Jul 21, 2020 8:57 am

grounded wrote: ↑

Tue Jul 21, 2020 8:32 am

I guess I'm disturbed by the fact that I stop breathing for extended periods of time each time I fall asleep, as evidenced by my tanking SpO2. Am I overconcerned about a one-time drop to the low 80's each night?

ETA: I am now battling hypertension for the first time in my life and obviously there's a link between 02 starvation and hypertension....

You have the wrong machine listed in your profile...you have the autoset, not the CPAP model. If you look at your Oscar data you will be able to see the length of each CA event.

OP: The Autoset is mysteriously available under 'R' for Resmed. All the other airsense machines are under 'A'. This problem happens alot.

khauser wrote: ↑

Tue Jul 21, 2020 9:04 am

OP: The Autoset is mysteriously available under 'R' for Resmed. All the other airsense machines are under 'A'. This problem happens alot.

Yep and it won't be fixed. I already asked and was told it was too much trouble or work.

Somehow or other when the inventory choices (remember all the choices are tied to current inventory at cpap.com) for the ResMed AirSense/AirCurve machines was entered into the system...the AutoSet was entered with ResMed as the first word...so since the menu choices are all alphabetical...it went to the R section.
The others were entered withOUT the first word being ResMed and that's why they are all up in the A section.

Simple inconsistency of how the various models were entered into the system. I asked to get it fixed...got the run around and was told it was too much trouble. We are on our own with this.

icipher wrote: ↑

Tue Jul 21, 2020 8:36 am

Are you wearing a pulse oximeter at night to see how low your Sp02 goes?

Yes. You can see the SpO2 graphs above.

LSAT wrote: ↑

Tue Jul 21, 2020 8:57 am

You have the wrong machine listed in your profile...you have the autoset, not the CPAP model. If you look at your Oscar data you will be able to see the length of each CA event.

Sorry about that. Fixed.

Pugsy wrote: ↑

Tue Jul 21, 2020 8:55 am

There is nothing you can do in terms of tweaks with the machine to deal with sleep onset centrals or even any SWJ centrals.

Copy that

My clinic thinks any AHI < 5 is awesome. Seems like low expectations to me. Should I be happy with that or aim for better?

grounded wrote: ↑

Tue Jul 21, 2020 2:06 pm

My clinic thinks any AHI < 5 is awesome. Seems like low expectations to me. Should I be happy with that or aim for better?

You never mentioned how you feel in the morning (or I missed it). Are you feeling refreshed?

Focusing on the number for the sake of the number is a bad idea. As you already have read that number may be misleading anyway.

The 'test' part of CPAP is seeking treatment. You already passed! No need to focus on the grade.

grounded wrote: ↑

Tue Jul 21, 2020 2:06 pm

My clinic thinks any AHI < 5 is awesome. Seems like low expectations to me. Should I be happy with that or aim for better?

Well....that's the line in the sand for both diagnostic criteria and acceptable treatment.
If you removed your central index from you AHI...it's quite low..a little less than 2.0 for the obstructive stuff. So that part of it is actually very good.
It's your central index screwing up the numbers and this machine can't do anything about centrals.
You have already turned EPR off except for ramp in an effort to reduce the centrals just in case EPR was making them worse but you still have those sleep onset centrals. Those are just a normal fact of life. I suspect some of the other clusters of centrals later in the night are again sleep onset (because remember if you wake up and go back to sleep you again likely will have a few sleep onset) centrals and maybe a few false positive while for sure awake central flags just from pausing your breathing while awake or turning over in bed.

You aren't having enough sleep onset centrals to warrant an ASV machine unless your doctor is concerned about that initial O2 drop.
They won't usually advise ASV for sleep onset centrals only unless those centrals are disturbing sleep so you never really can move on into the sleep stages or there are significant problematic desats with them. In all honesty I don't know what level of desat and for how long constitutes being problematic which is why I suggested having a chat with your doctor about it.

I suspect the doctor will also be asking how are you sleeping and feeling....that good old clinical correlation stuff.

Your OSA side of things.....very well controlled but the centrals (and for the most part they are actually a normal thing that is getting flagged) are making the AHI elevated and looking not as good as people might want but it is what it is in this situation. Maybe you could start subtracting the central index to get your obstructive index only (OAs plus hyponeas) and it will be lower and make you feel better about your numbers. That's what I would do if I were in your shoes ....assuming the doctor isn't concerned with the one rather remarkable but short lived drop in O2 at the beginning of the night.