Help with sleep onset centrals?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
wired1
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Help with sleep onset centrals?

Post by wired1 » Mon Aug 01, 2022 6:01 pm

I could really use the wisdom of the board.

I am a newbie, 10 days into treatment. I have had anxiety and difficulty tolerating the mask, but I have made some progress. My current problem: I have only successfully fallen asleep with the mask on once. Whenever I am close, I snap awake. It feels like it may happen over and over again, although I can't say for certain whether my sense of time is off.

I finally got an SD card and Oscar, and it looks like there are quite a few Clear Airway indicators. I have included a screenshot from two nights ago with 16 in 20 minutes. I have many questions:
- Are these sleep onset centrals?
- If so, is this volume normal?
- Some seem quite long: one is 32 seconds and another 33 seconds. Is that how long I was not breathing for, and if so is that dangerous?
- What can I do to address this?

Thank you for your help!
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Pugsy
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Re: Help with sleep onset centrals?

Post by Pugsy » Mon Aug 01, 2022 6:11 pm

If you aren't able to fall asleep with the mask and machine on then I would lean towards those centrals as being a product of awake breathing.
Can't really tell from this level of zooming in but I think most likely that the centrals are awake breathing irregularities or pauses in breathing getting flagged by mistake.
These machines can't tell if we are asleep or not. They only measure air flow and that means awake breathing air flow as well. Our awake breathing is very irregular when compared to asleep breathing but the machine only knows it's irregular so we get some sort of apnea flag.

Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software

To fix the problem you have to be able to fall asleep first and then see if you still have a problem.
What is bothering you that you can't sleep? Anything specific or just general anxiety and brain won't shut down?
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wired1
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Re: Help with sleep onset centrals?

Post by wired1 » Mon Aug 01, 2022 7:04 pm

The first few days I could not fall asleep from anxiety. But the last few days it has felt like something was waking me up. I wasn't sure why, e.g. changing CPAP pressure? But last night I was more certain it felt like pauses in breathing, and I was jerking awake (repeatedly) gasping.

Is that something that is typical - repeated pauses in breathing while falling asleep? And should I be concerned if they are that long (e.g. 33 seconds)?

I have included a zoomed in view of the first few events in case it's helpful. Thank you again!

Image

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Pugsy
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Re: Help with sleep onset centrals?

Post by Pugsy » Mon Aug 01, 2022 7:22 pm

You weren't asleep when those zoomed in on centrals were flagged.
It is normal for you to pause your own breathing and not realize you are doing it. Happens all the time.

Example below.....See the nice smooth rhythmic breaths??? Then see the green line? Right after the green line the awake/arousal breathing started and the false positive flags happened. Commonly called SWJ or sleep/wake/junk around here.
I see no real evidence in your zoomed in segment that you were ever asleep.

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ozij
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Re: Help with sleep onset centrals?

Post by ozij » Mon Aug 01, 2022 8:29 pm

You are spending your "fall asleep" time at the non-therapeautic pressure of 4.
Any special reason your machine is instructed to start at a pressure of 4?
When I had a home sleep test the doctor said: "and if your breathing disturbances hadn't woken you up so frequently your AHI would have been much higher". I wonder if that's what's happening to you: your starting pressure is so low that you're waking up before the machine even identifies the need to raise the pressure.
Is your machine setup to use "autoramp? "
According to Resmed: "AutoRamp™ with sleep onset detection delivers a low pressure to help patients fall asleep with ease. Once the patient is asleep, it comfortably ramps up the pressure to the prescribed level."
If so, turn it off.

Do you know what they found in your sleep study?

Were you ever titrated for the correct therapeutic pressure, or were you given this machine in the hope it will find the best pressure for you?
If you were titrated, what pressure was discovered as necessary for you to sleep?
If you were not titrated (i.e.) were not given a sleep test with mask and machine, then the first step I'd suggest is making your minimum pressure higher.
Since anxiety was an issue, make the changes gradually - and use EPR to make sure your exhale feels easy.
Once you've found a pressure you can fall asleep at, we'll be able know which breathing disturbances happen while you sleep. Then we can start thinking about how to help you breathe better while you sleep.
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

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wired1
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Re: Help with sleep onset centrals?

Post by wired1 » Tue Aug 02, 2022 6:33 am

A few responses below and a few questions because I only partly understand:

I was diagnosed with mild OSA through at home sleep test. I was not titrated. On my machine AutoRamp is enabled. My doctor seems to have control of some settings, including my minimum pressure.

I understand that the OSCAR charts reflect a period when I was not asleep. And that the CA indicators may not be accurate. But does the flow data itself show repeated pauses in breathing (when falling asleep)? If I zoom in, in some places it seems to show the flow going to zero for extended periods. And if my breathing is pausing, would raising the minimum and turning off AutoRamp help if it's not an obstruction causing the issue?

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Pugsy
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Re: Help with sleep onset centrals?

Post by Pugsy » Tue Aug 02, 2022 6:47 am

wired1 wrote:
Tue Aug 02, 2022 6:33 am
And if my breathing is pausing, would raising the minimum and turning off AutoRamp help if it's not an obstruction causing the issue?
The idea is that the increase in the minimum and eliminating ramp might offer a more comfortable exchange of air...moving the air with our breathing and that increase in comfort might help someone fall asleep more easily.
We have to be comfortable first before we can fall asleep.
You have to fall asleep to not be having all that awake/arousal related breathing stuff.
The problem isn't so much the airway itself as it is the not being able to fall asleep.

Without sleep the rest of this stuff doesn't matter much. Gotta get to sleep first.
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Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

lynninnj
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Re: Help with sleep onset centrals?

Post by lynninnj » Tue Aug 02, 2022 8:18 am

Pugsy wrote:
Tue Aug 02, 2022 6:47 am
wired1 wrote:
Tue Aug 02, 2022 6:33 am
And if my breathing is pausing, would raising the minimum and turning off AutoRamp help if it's not an obstruction causing the issue?
The idea is that the increase in the minimum and eliminating ramp might offer a more comfortable exchange of air...moving the air with our breathing and that increase in comfort might help someone fall asleep more easily.
We have to be comfortable first before we can fall asleep.
You have to fall asleep to not be having all that awake/arousal related breathing stuff.
The problem isn't so much the airway itself as it is the not being able to fall asleep.

Without sleep the rest of this stuff doesn't matter much. Gotta get to sleep first.
I think this was my problem. They set the pressure at four for 15 minutes or something like that. Then it was supposed to go up to a higher level 8 to 16 or somesuch I can’t recall. I felt like I was gasping for air at four. I turned it down to five minutes which basically gives me time to kind of settle in a little bit but not so much that I feel like I’m struggling to breathe.

The first couple of weeks were great and the mask help me get terrific sleep.

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Pugsy
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Re: Help with sleep onset centrals?

Post by Pugsy » Tue Aug 02, 2022 8:36 am

lynninnj wrote:
Tue Aug 02, 2022 8:18 am
I think this was my problem. They set the pressure at four for 15 minutes or something like that. Then it was supposed to go up to a higher level 8 to 16 or somesuch I can’t recall. I felt like I was gasping for air at four. I turned it down to five minutes which basically gives me time to kind of settle in a little bit but not so much that I feel like I’m struggling to breathe.
This "gasping for air" is a common complaint from newbies. They just can't move enough air to get past the feeling like they are air starved or suffocating. We won't suffocate at 4 cm but it sure feels like it. Also the pressure at 4 cm doesn't allow for any exhale relief to help us feel like we are exhaling comfortably so people think they CAN'T exhale against the pressure.
We can't sense any drop in pressure utilizing exhale relief (where the pressure drops) because the machine simply can't drop anywhere when the minimum is 4 cm. 4 cm is as low as the machine will go so it doesn't matter if exhale relief is enabled or not...it's not working because it can't work.

While not everyone will have those problems with 4 cm....most people do. A better choice for a newbie would be say a minimum of 6 or 7 and utilize exhale relief of 2 or 3 and the moving of air with breathing is MUCH more natural feeling and comfortable and with comfort comes ability to fall asleep easier.
It's the difference in pressure between inhale and exhale that offers the comfort. The greater the difference the more comfortable it is ....for most people. Again there are a few who don't like the change but most people do.
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wired1
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Re: Help with sleep onset centrals?

Post by wired1 » Tue Aug 02, 2022 7:52 pm

I appreciate the responses. I figured out how to enter clinical mode on the machine so that I can change the settings myself and will give a higher starting pressure a try.

It's still not clear to me whether my breathing was pausing and if so, why. But fingers crossed this will address the issue.

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ozij
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Re: Help with sleep onset centrals?

Post by ozij » Tue Aug 02, 2022 7:55 pm

Did you also stop the Autoramp?
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

wired1
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Re: Help with sleep onset centrals?

Post by wired1 » Wed Aug 03, 2022 9:56 am

I tried setting the minimum pressure to 6 and turning off AutoRamp. No problem tolerating the pressure when awake. But I had the same issue falling asleep - long pauses in breathing as I was falling asleep. The pauses were perhaps not as long as the other nights, but I didn't let the CPAP session go on as long because the feeling of repeatedly waking up gasping for air is so unpleasant.

Image

One other data point: this may be tied to closing my mouth. In the past (pre-CPAP), I typically fell asleep without incident. But occasionally I experienced these pauses in breathing when falling asleep. Looking back, I think they may have occurred when I went to sleep with my mouth closed (I typically sleep with it open). Now, while using CPAP, my mouth has also been closed. Yesterday I ordered a full face mask, which would let me CPAP with mouth open to see if it helps. But I am fairly concerned that I won't be able to tolerate the mask, as my attempts to use a nasal mask have failed - it feels stifling to me.

I have been poking around in the board archives and found a few have reported similar issues. I expect some (many?) of these posters could be experiencing different issues that just present the same way. This one felt similar, in that the poster reported the issue was not as bad without CPAP due to the option of mouth breathing. viewtopic.php?t=18117. There didn't seem to be a posted resolution. I'm still searching through other posts.

Unfortunately, I can't get an appointment with a sleep physician for several months, so if the full face mask doesn't work I may have to stop treatment.

Again, I greatly appreciate your thoughts. Thank you.

lynninnj
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Re: Help with sleep onset centrals?

Post by lynninnj » Wed Aug 03, 2022 10:54 am

wired1 wrote:
Wed Aug 03, 2022 9:56 am
I tried setting the minimum pressure to 6 and turning off AutoRamp. No problem tolerating the pressure when awake. But I had the same issue falling asleep - long pauses in breathing as I was falling asleep. The pauses were perhaps not as long as the other nights, but I didn't let the CPAP session go on as long because the feeling of repeatedly waking up gasping for air is so unpleasant.

Image

One other data point: this may be tied to closing my mouth. In the past (pre-CPAP), I typically fell asleep without incident. But occasionally I experienced these pauses in breathing when falling asleep. Looking back, I think they may have occurred when I went to sleep with my mouth closed (I typically sleep with it open). Now, while using CPAP, my mouth has also been closed. Yesterday I ordered a full face mask, which would let me CPAP with mouth open to see if it helps. But I am fairly concerned that I won't be able to tolerate the mask, as my attempts to use a nasal mask have failed - it feels stifling to me.

I have been poking around in the board archives and found a few have reported similar issues. I expect some (many?) of these posters could be experiencing different issues that just present the same way. This one felt similar, in that the poster reported the issue was not as bad without CPAP due to the option of mouth breathing. viewtopic.php?t=18117. There didn't seem to be a posted resolution. I'm still searching through other posts.

Unfortunately, I can't get an appointment with a sleep physician for several months, so if the full face mask doesn't work I may have to stop treatment.

Again, I greatly appreciate your thoughts. Thank you.
I dont know about anyone else but I use a nasal cushion and if I try to talk or open my mouth with pressure on it is actually somewhat painful to me. Not sure how else to describe it. I cant imagine mouth breathing for any length of time while trying to sleep. ymmv

I apologize for not being able to adequately comment on the reading of the chart but sharing my experience.

Also it would seem like going from 13 down to 8 is a good improvement. If it continues to improve that well you could be in good shape shortly. I can see how it would be hard to fall asleep without the proper fit of the mask. I know I have laid awake a few nights for that very reason.

_________________
Machine: AirSense 11 Autoset
Mask: ResMed AirFit N30 Nasal CPAP Mask with Headgear
Additional Comments: Newbie who loves her machine!