If you were me ... ?

I don't have a lot to add to this excellent discussion about centrals, except one thing: Patience and time (well two things, I guess). When I started CPAP a moderate amount of centrals started showing up and I was quite worried. Then I got a nasty chest cold and they went up some more. I got better and they dropped a bit. Then a month later, I had a bad leg injury and they went up as high as they ever had. I nearly panicked but finally decided to just hang tight and stick with what I always found to be my best pressure. Sure enough day by day my centrals started disappearing and now I'm always AHI < 2, that is, unless I have a really bad night cuz of stress, pain or whatever. My point is that sometimes it takes awhile for the brain to figure out what it needs to do to get better. It's not a machine (a truck? semi?) where you fix the problem and it's instantly better. It's a bio-organism and very good at what it does, however it's rarely instantaneous.

sylvie wrote:Pugsy,
I hope you don't mind me interjecting and asking a question about your graph--but in that hour on your graph where we see a lot of centrals and OAs, I did not know that the machine would also score OAs while you were awake. I understand why it would score centrals. So now I'm thinking that I may at least excuse some OAs in my report? (If I happen to have a particularly bad night?)

Yes, the machine can make a mistake when it is trying to evaluate awake breathing. Our awake breathing pattern is really erratic compare to sleep breathing and the machine can be fooled. When I have a bad night (like lots of pain and lots of tossing and turning) I have a lot more of both central and obstructive events. I rarely have Hyponeas though. It has always been that way with me. If you know you had a restless night for some reason and know you had times where you had some wakeups and your AHI is higher just remember that sometimes what we see on paper doesn't mean we need to panic.

I think you can see from my report that except for the bad hour...I had a good night. If I saw a lot of hours like this one and had no reason that might explain why it was so ugly then I would worry about it but most of the time what I see is pretty boring so I just shrug my shoulders and laugh when I see something like that one ugly hour.

I wonder if there is a gender trend with respect to pressure requirement.
That would make an interesting study.
Hubby's high is my LOW.

Pugsy wrote: Yes, the machine can make a mistake when it is trying to evaluate awake breathing. Our awake breathing pattern is really erratic compare to sleep breathing and the machine can be fooled.

Thanks for that. I really appreciate you posting your graphs when you're explaining something--I find that immensely helpful. Thanks again.

Sloop wrote:
As I've already explained, I have NO problem scrapping my suggestion of 12 and going with the pressure setting of 6, and yes, on rexamining his first post, I see where the Lab also had him at 6. The ONLY reason I provided any input at all, is because no one had yet suggested he simply try the CPAP mode. And I doubt now, because of this side-show, that he will even consider it. Such is life.

Don't go getting your panties all in a wad. You gave potentially dangerous advice. I tried to offer a nice polite explanation why what you offered was not a good idea...not just for you but for any new person who might be reading this thread.
If you don't want to take it in the way I offered it...then so be it.

Did you ever get a full data machine yet? Right now you are showing the Plus in your profile. You have no idea if you are having centrals or not unless you have a full data machine now and just haven't changed your profile.

BTW...when using APAP mode the minimum and maximum pressures can be set the same so effectively making it cpap mode with a fixed pressure without losing the flow limitation data reporting. Flow limitations are kinda important...that's why they are flagged and that's why we like to see them.

GumbyCT wrote:

123.Shawn T.W. wrote:Only water, very little sugar ...

I worded my original question rwong - I should have asked about caffeine products? NOT coffee <smiles again>

No caffine in any form

Pugsy, maybe you misunderstood about the four hours, it was sometime after 4am this morning that I could not sleep, so I got up.

But rarely do I ever sleep for more than four hours in a row, then I get up and pee, then head back to bed for more sleep

chunkyfrog wrote:I wonder if there is a gender trend with respect to pressure requirement.
That would make an interesting study.
Hubby's high is my LOW.

There might be, though my husband and I run counter to that hypothesis. His OSA is MUCH more severe than mine, but his pressure needs are much lower (7-9cm) in comparison to mine (10-14cm). Just one of those weird things.

But I will say, there is definitely a perception among the medical community that men need higher pressures than women. Our doctors all assume I require less pressure than he does. I try to remind them that pressure needs are pressure needs, and they are unrelated to body size, severity of OSA, or astrological sign.

Be sure to go look at the duration and depth of those centrals on the airflow waveforms and the events tab on SH.

If your centrals are 12 seconds long, it's not nearly as bad as 120 second long centrals.

If you only partially stop breathing, it can be a lot less of a problem than completely stopping breathing.

The same applies to all apneas and hypopneas, but the AHI number counts them the same.

Don't be afraid of the word "central." It's the lack of air that kills you, not whether it's obstructive or central. Centrals are harder to eliminate, not necessarily more harmful.

123.Shawn T.W. wrote:

GumbyCT wrote:

123.Shawn T.W. wrote:Only water, very little sugar ...

I worded my original question rwong - I should have asked about caffeine products? NOT coffee <smiles again>

No caffine in any form

Certainly you are aware that caffeine comes in many other food products - even Anacin + Excedrin lists caffeine as a "pain reliever enhancer".
I had NO Idea, that caffeine did that.

But just keeping you honest

I'm not aware of any foods I eat that have caffeine in them, but no I did not know that those had caffeine, even though I don't take them ...

My usual evening dinner consists of a green salad with some type of meat in it (I prefer the ready made SouthWest Chicken!) and some potato salad, sometimes a few Pringles ... No night snack (or before bed food)

Pugsy wrote:
I tried to offer a nice polite explanation why what you offered was not a good idea .......... so be it

Well touché -- I accepted your critique and tried to offer a nice polite explanation too, but you continue to Lord it over me. Yes, .......... so be it.

Pugsy wrote:
........... but for any new person who might be reading this thread

That is easy enough to rectify via edit

Pugsy wrote:
Did you ever get a full data machine yet? Right now you are showing the Plus in your profile. You have no idea if you are having centrals or not unless you have a full data machine now and just haven't changed your profile.

Thanks for discovering my error -- it's been wrong ever since I set up my profile.

Pugsy wrote: I would back up and start all over... 6cm minimum and reduce max to 8 cm. Flex setting at whatever feels good to you. Heck even try it with Flex off.
Let's see if the centrals reduce with the pressures limited. Per your sleep study there was no mention of centrals at the RX pressure.
I know this is a tight range and unless we know for sure that those centrals can be explained away as sleep onset, awake or semi awake events then we need to back up and see if reducing the pressure makes any impact on the centrals.

I agree 100% with Pugsy's original recommendations.

I would also say to use whatever settings you finally decide on for at least 3-4days (a week is better) before changing them. The machine numbers are best understood as trending data and it is impossible to have a trend based on one data point.

123.Shawn T.W. wrote:....The breaks are when I turn off the machine to go pee ...

There may be light at the end of the tunnel, w.r.t., pee breaks. My prostrate is slightly enlarged (yea, I know it is a prostate, but I like the way Sgt. Andy Sipowicz, on the old tv show NYPD Blue, pronounced it). Since I've settled into my CPAP therapy, my 2-4 times per night pee breaks have stopped. If I drink a lot of water in the late evening, I may need a break. Good luck, Earl

123.Shawn T.W. wrote:Pugsy, maybe you misunderstood about the four hours, it was sometime after 4am this morning that I could not sleep, so I got up.

But rarely do I ever sleep for more than four hours in a row, then I get up and pee, then head back to bed for more sleep

I understand about the 4 hours. My husband is the same way. I think part of that is habit from the forced fragmented sleep. You know the weird delivery times and having to deal with the electronic logs along with sleep in truck stops or whatever.

If the waking up was because of full bladder itself then we wonder a bit about the apneas being a factor in the stress hormone that tells the kidneys to work harder. If the wake up is just a "don't know why" wake up and the pee break is just done because might as well do it and not from a stretched out bladder then it likely is not related. On the road he rarely gets more than 4 hours of sleep at one time and at home he is lucky to get 5 or 6 hours. He just is so used to the fragmented sleep that he can't get a nice long stretch of sleep even when he has the opportunity. Like you he also gets up to pee but he tells me the bladder isn't always full and the wake up doesn't seem to be from bladder discomfort. He is also 63 years old and it is likely that his prostrate is impacting things a bit.

Nocturia is a very common side effect of sleep apnea. The apnea events put stress on the heart and the heart produces a stress hormone with a long name that I always forget and the stress hormone goes to the kidneys and the kidneys react by going into overdrive producing copious amounts of urine and thus full bladders waking us up. Before I started therapy I pretty much had to get up hourly to pee and always with a full bladder to the point it was extremely uncomfortable.
Now I never get up to pee and often when I wake up in the morning I don't even make the bathroom the first stop.
Hence my questions about the pee breaks. Trying to get an idea if the events that you are showing are possibly behind the pee breaks.

So trying to figure out if all that stuff we see flagged as events on your reports are real events or the machine being fooled by awake events or sleep stage transition events or tossing and turning. Since we can't tell from these reports if you are awake or not or what stage of sleep you are in or whatever...if you use the machine off/on thing it gives us little markers to go by and maybe have an idea if those events warrant concern or not.

Finally...just wearing the mask is an adjustment. It is going to disrupt sleep and the sleep stages itself. The brain isn't used to having the alien stuck on its face. If your sleep already isn't "normal" because of your work schedule or whatever then the reports are likely going to be ugly and with time they could settle down as the body gets more adjusted to things.
If you told me that you put the mask on...went to sleep and never woke up for 6 or 8 hours and I saw reports like your last nights report...then we start being concerned. But you obviously have wakeups and some reported time awake with machine on, then we don't have any way to know if what we are seeing is really ugly and warrants concern or if they are simply artifacts from the machine mistaking erratic awake breathing for sleep breathing apnea events.

Until we have a better idea what is going on we back up and start from scratch conservatively and try to implement things that allows us to evaluate what we are seeing. I have seen reports much worse than yours where all the clusters totally disappeared when the person who had them simply stopped laying in bed awake with machine on. I wish I still had the one that comes to mind but I accidentally removed it from my computer and I forget the name.

Step back, take a deep breath and quit trying to hit a home run on the first swing of the bat.
Try to educate yourself on what you are seeing and why you are seeing it and then think about how to fix what you see that you don't like.

Quit worrying about caffeine. Doesn't sound like we can blame caffeine for anything. Would have been simpler if we could.