Central ... significant?

How many central apneas does it take for them to be significant?

Do you need to have them every night for them to be a concern?

In testing a 420E it said I had centrals on 4 out of 7 nights. I had 2,6,0,8,3,0,0 apneas on successive nights.
There were also regular apneas as well as hypopneas every night. But some nights had centrals. Slightly over 50% of the time there were centrals.

Being a relatively short test I'm not sure how indicative it is .. if it is something to be concerned with or not.

Lung doctors said I have COPD and Asthma and from some things I've read here there is a possibility I should have a bi-pap, dunno.
The M series with A-flex seems real good, but doesn't detect centrals. The Sandman does but I haven't tested that machine so not too sure about it.

Last time I saw the sleep doc I didn't have any reports that showed centrals, now I do. I was having problems with day time sleepiness even though I had been on cpap for 2 years. Since using some apap machines that has < greatly > improved. Hate to go back to straight cpap now but not sure if I should go for a machine that recognizes centrals or not.

I'm not sure I can answer the "how many is significant" question (but I too will be watching for the answer )

Did they notice that you have a tendency to get central's during your titration? I guess some people are more prone to getting them than others. If they didn't notice any central's, that doesn't necessarily mean that you don't get them.

How's for answering a question with a question

Are you still getting a lot of daytime sleepiness now?

Arizona-Willie wrote:In testing a 420E it said I had centrals on 4 out of 7 nights. I had 2,6,0,8,3,0,0 apneas on successive nights.

I'd consider those insignificant. Even the "8" on one night, especially if you were sleeping at least 5 or 6 hours each night.

Better to look at the Ca index, I'd think, which averages the number of events per hour during the session.

Arizona-Willie wrote:There were also regular apneas as well as hypopneas every night. But some nights had centrals. Slightly over 50% of the time there were centrals.

I get lost in statistics stuff, but I don't think you can say 50% of the time since that sounds like total "sleep time". You had a few centrals show up during slightly more than half the nights (or "sleep sessions", to be exact), yeah. But not half of your total sleep time.

Me... I'd would regard those few centrals as nothing to worry about. I used to see a few scattered ones on some nights on my 420E data, too.

I don't know why, but there's something about the idea of "central apneas" that cause people to get overly concerned about them (not saying you are at all, Willie -- you're just asking.) The idea of the brain occasionally not sending a signal to "breathe now" sounds more alarming than it really is. Yet we are perfectly at ease (well, most of us are...lol ) with the idea that a few obstructive apneas and hypopneas can sneak through while we get overall very successful cpap treatment. The brain is not sending a timely signal to keep the airway well and truly open then. But we're used to hearing about obstructive apneas/hypopneas and with seeing a few obstructives appear on our data, even when the treatment went very well overall for the night.

Here's a link to many discussions about "central apneas" -- I'd pay special attention to the old posts by christinequilts. She actually did have Central Sleep Apnea and was very well informed about "centrals." Extremely intelligent lady.

Links to Central Apnea discussions
viewtopic.php?p=22702

One of my favorite quotes from a post by Christine was:

"having centrals is not really any different then obstructive apneas- they just have a different cause, but they both mean you are not breathing as well as you should be"

Oversimplifying a bit...I'd translate that into:

The cause of one (central) being that the brain did not send a timely signal to "breathe now" even though the airway (throat) is open.

The cause of the other (obstructive) being that the brain was not sending timely signals to the tongue/oropharynx muscles to keep the airway (throat) open for breathing... brain allowed throat to collapse shut.

More from that great post by Christine:
"6 centrals is not a lot- less then 1 per hour, and is perfectly normal. Everyone has central apneas- take 3 or 4 very slow & deep breaths right now, then count how many seconds after the last inhale until you feel the need to inhale again. Was it more then 10 seconds? If it was, you just had a central apnea. Next time you sigh take note how long before you inhale again....yep, another central apnea. Yawn? same thing can happen. Pick up a heavy box or weight- did you remember to breath? if you didn't, then you had another central apnea. Think of what you hear exercise trainers lecture about breathing while exercising- its human nature to not breath when we exert themselves.

Of course all of these are awake apneas- but any time you don't breath for 10 seconds, you technically have an apnea. While sleeping, you can have similar things happen- you can take several deep breaths and not need to breath for several seconds. During transitions between sleep stages, it is common to have central apneas because the acceptable levels of O2/CO2 are different for each stage...sort of like when you're still going 55MPH as you enter the 35MPH zone. When you turn over at night, it is common to not take a breath- just like when you lift something or exercise when awake. In people with OSA, they don't consider centrals a problem until they are well above 5 per hour- central apneas can be a symptom of OSA, just like snoring, arousals, etc. A few centrals are nothing to worry about- most sleep labs don't get concerned about centrals unless there are a lot of them."

Another good, educational read...her posts and those of StillAnotherGuest throughout this rather long thread:
Not Such a GoodKnight:
viewtopic.php?t=20405

Actually I am < somewhat > concerned over centrals. Having the brain fail to tell my body to breathe seems distinctly ungood.

Last year I was at Mayo Clinic getting an abdominal MRI and the people running the machine came and asked me to breathe faster. They said I was only breathing 7 times a minute and they needed me to breathe at least 11 times a minute. The machine takes a shot every time your chest gets to a certain location and it takes quite a few slices to do the job so it was taking too long.

I've had enough MRI's and cat scans etc. that they don't bother me with the noise and / or confinement and I was so relaxed I was right on the edge of being asleep.
So I know I have a slow breath rate when relaxed / asleep and my pulse oximeter confirms that I sometimes spend more than 10% of the night below 90%. The APAP seems to help that some.

Unfortunately, I don't think any of the machines actually deal with centrals ... a couple of them spot them though. Not sure if it is good to know or not.

I don't know how any machine could deal with centrals... unless they wirred up some electrodes to zap the old grey matter somehow to wake it up.



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rested gal wrote:

Arizona-Willie wrote:In testing a 420E it said I had centrals on 4 out of 7 nights. I had 2,6,0,8,3,0,0 apneas on successive nights.

I'd consider those insignificant. Even the "8" on one night, especially if you were sleeping at least 5 or 6 hours each night.

Better to look at the Ca index, I'd think, which averages the number of events per hour during the session.

Arizona-Willie wrote:There were also regular apneas as well as hypopneas every night. But some nights had centrals. Slightly over 50% of the time there were centrals.

I get lost in statistics stuff, but I don't think you can say 50% of the time since that sounds like total "sleep time". You had a few centrals show up during slightly more than half the nights (or "sleep sessions", to be exact), yeah. But not half of your total sleep time.

Me... I'd would regard those few centrals as nothing to worry about. I used to see a few scattered ones on some nights on my 420E data, too.

I don't know why, but there's something about the idea of "central apneas" that cause people to get overly concerned about them (not saying you are at all, Willie -- you're just asking.) The idea of the brain occasionally not sending a signal to "breathe now" sounds more alarming than it really is. Yet we are perfectly at ease (well, most of us are...lol ) with the idea that a few obstructive apneas and hypopneas can sneak through while we get overall very successful cpap treatment. The brain is not sending a timely signal to keep the airway well and truly open then. But we're used to hearing about obstructive apneas/hypopneas and with seeing a few obstructives appear on our data, even when the treatment went very well overall for the night.

Professor Ian Wilcox wrote:It’s not unusual for normal individuals who don’t have obstructive apnea to have a few central apneas, particularly changing between sleep stages, and so you may also see a few central events or a central element to what is otherwise predominantly
OSA in patients without heart failure. You can also get occasional central apneas in untreated OSA and during PAP treatment possibly due to stimulation of upper airway afferents as there’s a protective reflex that stops you from continuing to inhale when there is something in your upper airway. In general, therefore, we don’t usually worry about the occasional apnea, central or obstructive, during PAP treatment. In the absence of heart failure you would not normally expect a change in the central component of OSA over time.

Professor Wilcox is in practice as a Cardiologist, including appointments as Consultant in Cardiology at Royal Prince Alfred Hospital and Clinical Associate Professor at the Department of Medicine (Central Clinical School), Sydney University where he supervises a Research Program on Sleep and Cardiovascular Disease. He is also Head of the Department of Medicine at Strathfield Private
Hospital, Sydney.

Source: Resmedica. http://www.resmed.com/en-au/assets/docu ... 0933r1.pdf

Arizone-Willie wrote:I was so relaxed I was right on the edge of being asleep.

Sounds like "Sleep Onset Centrals"....

On the page of links to Centrals discussions:

"Sleep onset centrals" are normal:

viewtopic.php?t=18117
page 2, from a post by StillAnotherGuest:

Assuming that the obstructive events are properly managed, then the likelihood of these being sleep-onset centrals is fairly high (you'd need PSG to be 100%) and those things are pretty much a normal event.