An ASV or CPAP for Central Apneas (Cheyne Stokes?)

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Curioussleep
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An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Curioussleep » Tue Aug 02, 2022 8:57 pm

I am currently using an Airsense 10. I was able to do an at home sleep study but I will not be able to do an in Lab study as I'm paying privately. My initial home sleep study showed that I had an AHI of 7.5. The issue was not the amount of events but that I keep waking up with my heart pounding. I a male in my 30s and live an active healthy life style, I weigh 85kg and exercise regularly. I have recorded my self sleep several times prior to the sleep study. I was aware that I would stop breathing due to lack of effort and not obstruction. I suspected it was Central Apnea. I have managed to hire an Airsense 10 as a trial to see if it can address the events and improve my sleep. I'm not sure if an ASV would be better for what I'm experiencing. I seems as if the CPAP only records and notifies me of my CAs. I have attached a copy of my sleepy head report. Any advice would be appreciated.

https://imgur.com/a/dWI5MlH

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zonker
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by zonker » Tue Aug 02, 2022 9:57 pm

Curioussleep wrote:
Tue Aug 02, 2022 8:57 pm
I seems as if the CPAP only records and notifies me of my CAs. I have attached a copy of my sleepy head report. Any advice would be appreciated.

https://imgur.com/a/dWI5MlH
welcome to the zoo.

it doesn't only record ca. in the report you show, it also shows hypop. and the centrals aren't enough for you to worry about.

is there any reason why your pressure range is so tight?
why folks don't like it when asked to clarify their statements?
We can't take this journey for you, but there is a forum full of people here who will gladly take it with you.-jnk

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Pugsy
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Pugsy » Wed Aug 03, 2022 7:31 am

The first cluster of centrals you zoomed in on you weren't asleep when those were flagged. If you aren't asleep they don't count and aren't real and do not warrant any sort of treatment except to try to fix the not sleeping problem.

The second zoomed in section in the middle of the night...not sure you were asleep for that as well but even if you were it's maybe a sleep onset central and not enough of them to be a problem or warrant treatment.

You mention Cheyne Stokes....have you seen that pattern flagged on your reports? If so...get a zoomed in image of that as well.

Nothing shown on the above reports points to needing an ASV machine at all.

Seeing some central apneas is actually normal and doesn't mean there is a problem. The problem comes when people have a large number of them and they are for sure asleep. Yours doesn't qualify even if every single one of those events were real asleep events (which they aren't).
There is no evidence of central apneas being present on the reports you shared to earn that diagnosis.

Where did you get SleepyHead????...it was replaced by OSCAR long ago.

https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
http://www.apneaboard.com/wiki/index.ph ... ganization organize and how to do screen shots.
wiki/index.php/Oscar:organize Wiki

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html
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Curioussleep
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Curioussleep » Fri Aug 05, 2022 3:23 pm

Hi Zonker and Pugsy. Thank you so much for responding.

Sorry I never meant to say that it’s only reporting CAs. What I meant to say is that it’s not treating them, but showing them on the report instead.

I was initially using Sleepyhead but now I’m using Oscar. The trouble for me is not that I’m experiencing few short events, it’s that I wake up gasping with my heart pounding. Initially I suspected it was sleep onset centrals because I’d continuously wake up not breathing as I was falling asleep. I’ve been experiencing this since last year October. I’ve worked with a sleep specialist on some programs for sleep hygiene, sleep restriction and sleep efficiency with no real improvement. My wife has recorded/observed me sleep and says that she can see I stop breathing before waking up. Some nights worse than others and more frequent. I’m really hoping to find something that will help with this. I can’t recall when last I’ve slept the whole night. I do have a few more reports I could share. While using the AirSense 10, the highest AHI I have had was 6. But using the Air Mini I have had close to 20 on some nights.

Regarding Cheyne Stokes, I’ve only seen it mentioned online (where I’ve spent far too many hours in desperation trying to find a solution). Never knew that the software would flag it. I thought the images looked similar. But I’m glad to hear it’s not.

I’ve added an additional 2 images. I’ve tried a fixed pressure of 6 with no min and ramp off, EPR off. That seemed to caused hypopneas and I really struggle to fall asleep. Halfway through the night last night I switched back to auto ramp on, min of 5, max of 6.4, epr 3.

Thanks again for the feedback and advice.

https://imgur.com/a/o5Kzipo

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Pugsy
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Pugsy » Fri Aug 05, 2022 4:07 pm

The stuff you zoomed in on with this last image. You weren't asleep.
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Curioussleep
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Curioussleep » Fri Aug 05, 2022 5:01 pm

Hi Pugsy. Sorry if it’s a dumb question. But how can one tell if someone is awake or asleep? Would you say that all central events are while I’m awake?

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Pugsy
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Pugsy » Fri Aug 05, 2022 5:07 pm

The flow rate/breathing is very regular and rhythmic when you are asleep.
It's irregular when awake.
Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software

Now why you woke up.....million dollar question.

Asleep breathing is circled in red....if it's not circled I was awake or half awake.

Image

Image
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Curioussleep
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Curioussleep » Fri Aug 05, 2022 6:36 pm

Thanks for the link to the videos. Very helpful. I initially thought that that the uniform waves were while I was awake and that the waxing and waning/irregular pattern were an indication of when I was falling asleep because of how much of my night is that waxing and waning pattern. Would you have any recommendations of settings I could implement to figure it out. I see there are a few CAs where there are no arousals prior.

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Pugsy
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Re: An ASV or CPAP for Central Apneas (Cheyne Stokes?)

Post by Pugsy » Fri Aug 05, 2022 8:02 pm

Real asleep centrals can't/won't respond to little tweaks with the pressure settings one way or the other unless they happen to have a line where the pressure above so and so starts triggering centrals.

It is entirely normal to have a few real asleep centrals anyway. Like it's normal to have a sleep onset central apnea or some people call them transitional apneas.
Centrals are only a problem when present in large numbers and causing desats or in the case of sleep onset centrals they keep bouncing a person out of sleep repeatedly again and again and again.

Even if all your centrals were real asleep centrals (which they are not) you aren't having enough of them that a doctor would want to do anything about them.

Since most likely your centrals are awake/arousal related centrals you have to try to fix whatever it is that might be causing the awakening/arousal. Reduce the arousal breathing and you should then reduce the centrals that are arousal related.
Problem being we don't know what is causing the arousals or awakenings so that you can go try to fix it.

You are using a really tight auto range...really tight....and you couldn't handle 6 cm fixed with no EPR.
I don't know why you want such a tight range and no EPR.
Your FL graph is a wee bit active. It's not horrible though as I have seen much worse but compare your FL graph to one of mine and you will see what I mean.
Image

I don't know if your FLs are impacting your sleep quality or not but they might unless you are experiencing nasal congestion which could show up on the FL graph as increased activity and we blame the FLs on nasal congestion.

So....I can't really offer advice on settings because I don't know what your sleep quality problem is caused by.
But the centrals you have shared....are a symptom of the poor sleep and not the cause of the poor sleep.

We can't fix centrals with more (or less pressure) except in some very special circumstances where the pressure was causing a LOT of real asleep centrals.

Have you ever tried adding in EPR?
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