What does PB look like

I have rarely had PB/CSR show up in SH (maybe once a year). Now I'm getting 2 or 3 a month. When I look at the graph, they are always about 2 minutes long and I cannot distinguish them from any other breathing pattern during the night...the green highlighted section looks the same as any section not highlighted in green. I never really took the time to understand PB/CSR since I didn't have them. Do you think these are really PB or just SH error? My AHI is very good at <.5

Look at John Fisher's post of definition and flow chart here - viewtopic/t50482/Periodic-Breathing.html


ChicagoGramps

SH error.

No, it is not SleepyHead error. Encore will show the same thing. I guarantee that it will. SleepyHead is only reporting what the machine flags...SleepyHead doesn't make the decision as to whether PB has occurred.

We have to remember that CSR is just a type of periodic breathing (One of many types..not the only type)..read up on the actual definition for PB from Respironics...no where does it say CSR. Flagged PB doesn't have to automatically mean CSR.
I wish Mark hadn't done the CSR thing in the reports. Encore doesn't do it and it scares people needlessly. This was something added by Mark because he saw real CSR in his reports and didn't have these barely meeting the criteria PB that you have shown. He didn't know that most PB wasn't CSR PB.

From Respironics manual:
Periodic Breathing is a Respironics data feature defined as a persistent waning and waxing breathing pattrn which repeats itself between 30 and 100 seconds. The nadir of the breathing pattern is characterized by at least a 40% reduction in airflow from an established baseline flow. The pattern must be present for several minutes before it can be identified as periodic breathing. No therapy adjustments are made in response to periodic breathing.

99% of my flagged PB will look like yours above and Encore shows the exact same green flagged area.
This particular PB is nothing to be alarmed about especially when short lived and random.
There's a huge difference between this PB and CSR PB and even then an occasion CSR PB is nothing to worry about.

I don't think that this is PB or CSR or CSR/PB



My flow waves are similar:




These are respiration waves with some flatness, i.e. Flow Limitation

avi123 wrote:I don't think that this is PB or CSR or CSR/PB

The Respironics machine's algorithm thinks it is PB and it likely meets the definition criteria for PB flag just barely.
It's PB by Respironics definition and that's what that matters. It wouldn't have got the green flag if it didn't. The machine made the decision.

I'm having a bit of an issue with CA events but have only been on CPAP therapy for less than a week. Have 40 events per night, sometimes 80, usually in clusters. I've actually had a good night last night so these are just interesting data points and may not be permanent. Don't know if this actually shows anything but it kinda looks like PB.

See here:


http://www.resmed.com/us/en/commercial- ... g-csr.html





The probability of CSR existing is reported if the sleep study shows:

•At least 3 consecutive cycles of a cyclical crescendo and decrescendo change in breathing amplitude; cycle length is most commonly approximately 60 seconds, although the length may vary.

•One or both of the following:

......... ◦5 or more central sleep apneas or hypopneas per hour of sleep.
......... ◦At least 10 consecutive minutes of the cyclic crescendo and decrescendo change in breathing amplitude.

SleepWrangler wrote:I'm having a bit of an issue with CA events but have only been on CPAP therapy for less than a week. Have 40 events per night, sometimes 80, usually in clusters. I've actually had a good night last night so these are just interesting data points and may not be permanent. Don't know if this actually shows anything but it kinda looks like PB.

Yes, it does look like it. Enough like it that your doctor may need to be made aware of this if you see it often.
What is your AHI when you see this? How much of it is central index?
When is your scheduled follow up with your sleep doctor?
Are you sleeping well or spending a lot of time awake on the machine?

Pugsy wrote:Yes, it does look like it. Enough like it that your doctor may need to be made aware of this if you see it often.

Yes, centrals are a nightly occurrence and when I have them they usually are accompanied by a change in breathing amplitude. I also get periods of a rhythmic change in breathing amplitude without an actual CA being flagged by the CPAP.

Pugsy wrote:What is your AHI when you see this? How much of it is central index?

Even with these mixed results I am now able to get up before noon, no granny naps, so I count that as an improvement. My diagnosed AHI is 34.1 and I was actually feeling not too bad that week, sleepy but alert after noon.

Pugsy wrote:When is your scheduled follow up with your sleep doctor?

Scheduled follow up with the DME next week and doctor at the end of next month.

Pugsy wrote:Are you sleeping well or spending a lot of time awake on the machine?

My tolerance of the machine, tubing, mask, and all that stuff seems to be improving. I generally have one waking period per night that I remember. I get back to sleep without too much fuss or anxiety.

I figure I am in an adjustment period. Either I will adjust to the prescription or the prescription must be adjusted to me I'd really like to avoid buying a machine not suited to my needs. I have a month trial with the current machine.

SleepWrangler wrote:I figure I am in an adjustment period. Either I will adjust to the prescription or the prescription must be adjusted to me I'd really like to avoid buying a machine not suited to my needs. I have a month trial with the current machine.

Where are you located that you get a one month trial before purchasing a machine?
What are your pressure settings?
You know you did have that one perfectly acceptable AHI of 2.93..so it can happen...we like to see AHI less than 5.0..some of the other nights you were close.

Some things to talk to doctor about when you see him.
Did you have any centrals on the diagnostic sleep study without a machine?
Is this AutoSet trial your titration sleep study? If you you want to talk about the possibility of CompSA going on here. It's hard to say based on this limited data and your rather borderline AHI at times...the other night's not so borderline

There's a lot of possibilities going on here so make sure that your doctor is aware of the centrals and the breathing pattern and doesn't just look at hours of use and overall AHI average. He needs to see the detailed reports for those high central nights.

It's possible that you just need a pressure adjustment if these centrals are related to pressures. Meaning if you can stay below so and so pressure the centrals may also stay away. Using APAP and letting the machine go wild isn't the way to go IF these are pressure related centrals.
Since you say you are sleeping well with minimal wakeups then we can't blame the centrals on being awake/semi awake centrals.

Now I am not saying that you have CompSA but just in case it ends up being that, you might want to watch this video
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

Sometimes even if a person develops CompSA (didn't have any centrals on the diagnostic sleep study) they can get by with a regular machine (and not have the high dollar ASV type of machine) if the centrals abate on their own as a person gets used to cpap therapy and/or if a pressure can be found that adequately prevents any obstructive apnea events and doesn't trigger centrals (if that is what is happening in your case).

Oh...one more question...do you live at a higher altitude? Sometimes that will act as a trigger for centrals.

So lots to discuss with your doctor.
CompSA needs to be ruled out and if it can't then you do have some options on how to try to deal with it.
When you have time can you post a detailed report showing the nightly details..on that nice low AHI night and one of the other nights with AHI in the teens?
Need to see the AHI bar graph on the left and these graphs on the right
Events
Flow rate
Pressure
Leak

You can turn off AHI and mask pressure graphs in SleepyHead Preferences/graphs tab. They are redundant and not needed.

Main thing I am wanting to see if pressure increases coincide with Central clusters. Mainly to satisfy my own curiosity as a learning experience. Since you will be seeing the doctor next week I don't advise any dial a winging stuff. Best leave this to the pros for now.

avi123 wrote:See here:



The probability of CSR existing is reported if the sleep study shows:

•At least 3 consecutive cycles of a cyclical crescendo and decrescendo change in breathing amplitude; cycle length is most commonly approximately 60 seconds, although the length may vary.

•One or both of the following:

......... ◦5 or more central sleep apneas or hypopneas per hour of sleep.
......... ◦At least 10 consecutive minutes of the cyclic crescendo and decrescendo change in breathing amplitude.

This is confusing, as it makes it seem as though someone having 5 or more central apneas or hypopneas an hour has CSR breathing.

icipher wrote:This is confusing, as it makes it seem as though someone having 5 or more central apneas or hypopneas an hour has CSR breathing.

It is confusing but I think it means if the hyponeas were central in nature...they can be either central or obstructive in nature...at least that is what I think it means.

Pugsy wrote:

icipher wrote:This is confusing, as it makes it seem as though someone having 5 or more central apneas or hypopneas an hour has CSR breathing.

It is confusing but I think it means if the hyponeas were central in nature...they can be either central or obstructive in nature...at least that is what I think it means.

If that is the definition, than any of us who have central apnea were all CSR breathing every night before treatment. I don't remember being told I had CSR at my sleep study.

icipher wrote:If that is the definition, than any of us who have central apnea were all CSR breathing every night before treatment. I don't remember being told I had CSR at my sleep study.

Not all centrals (either full or hyponea central in nature) cause the CSR pattern...it can of course cause CSR pattern but doesn't always cause CSR.
There's more involved to making that diagnosis than the one line in the definition makes it appear to be.
CSR is not something that we normally see noted on sleep study reports as far as I have seen on sleep studies even with people who have straight up central sleep apnea on the diagnostic sleep study.