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CSR showing up all of a sudden

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wthankachan +0 points · 7 months ago Original Poster

I have been have good results with my apnea treatment using a Resmed autoset. I had not been checking my report on sleepyhead as my total events were under control (less than 2). How ever when I looked recently I saw that on one particular day and only on one day, CSR was reported. No CSR before and since. Should I be worried?

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wthankachan +0 points · 7 months ago Original Poster

By the way I have been using the CPAP for 6 months now.

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Sierra +0 points · 7 months ago Sleep Innovater

I suffer from occasional CSR as well. It is a particular type of central apnea. I used to get it fairly consistently about once every month or two. The last time I had it was November. I have made a couple of changes that I think reduced the incidence of CSR. One was that I asked my doctor if I could cut the dose of my beta blocker (bisoprolol) blood pressure med in half. I used to take it twice a day, and I now take it in the morning only. It reduces the heart rate and as a result I think it reduces blood flow and can make the CVS more sensitive to central apnea. Just my own theory, but it seems to have helped. The other change I have made is to change to a fixed pressure CPAP mode instead of the auto mode. Again just my theory, but I think my AutoSet was chasing hypopnea events that were central in nature with more pressure, and the higher pressure was actually causing more central events and sometimes the full CSR cycle. If you zoom in on that event area, you are likely to see a waxing and waning of the breathing effort and typically CA events at the minimum effort points. See an example of mine below.

You may want to follow when these events are occurring for pressure, and also when you are having CA events to see if there is any pattern of it happening when the machine has increased pressure.

I am not a medical professional, but I don't think the occasional CSR flag is anything too serious. If it becomes a regular occurance you should discuss it with your GP or heart specialist. It can be an indicator of reduced function of the cardiovascular system. It also can happen more frequently if you are living at a significant elevation above sea level.

If you post your full Daily Detail page for that day, I may be able to make some more comments...

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bonjour +0 points · 7 months ago Sleep Commentator

I'll also add that CPAP machines are very good at capturing "Periodic Breathing", but unless you look at the wave form (Sierra has a very good example of CSR) It could easily be another form of periodic breathing. I also understand that your CSR series needs to be 15 continuous minutes before it is considered medically significant. CSR is associated with CHF, do you have CHF?

As a rule one-off events may be ignored, if they happen frequently they need to be looked at.

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jeffez +0 points · 7 months ago

My head is spinning from all the acronyms y'all use (being a newbie and all). Is there a glossary somewhere I can print out?

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bonjour +0 points · 7 months ago Sleep Commentator

go to [http://www.apneaboard.com/wiki/index.php?title=Wiki_Home] The 3rd item down on the left is a list

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Sierra +0 points · 7 months ago Sleep Innovater

I find the following link a good one for understanding the ResMed vocabulary.

ResMed Innovation and Technology

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wthankachan +0 points · 7 months ago Original Poster

I did have a heart ultrasound taken last year and the cardiologist did not mention CHF. I have high blood pressure and borderline LVH which I believe was caused by untreated apnea. I don't think I have CHF, not sure if it is developing now. I do go to the gym and I would think inability to exercise is a CHF symptom. Screen shots are attached. I think the pressure range is too wide how ever the CSR did not happen at very high pressure. I was probably close to waking time when this happened.

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Sierra +0 points · 7 months ago Sleep Innovater

Sorry, but I didn't see this post until today. What would be helpful is to zoom in on that area to see what the CSR events look like. You can do that by left clicking on the events in that time frame, and using the up and down arrows and the left right arrows. It seems to me that the CA events started to happen when the pressure went up to the 14 cm range. If find once they start to happen they self perpetuate. And while the pressure was reducing, the events continued. It would also be helpful to move up the Minute Ventilation graph show it displays along with the flow and pressure. Ideally the Minute Ventilation should remain stable, and not cycle up and down. I also see you are using EPR. That can contribute, in my opinion, to CSR and CA events. If it were me I would turn EPR off. It will help to limit pressure. And at some point you may want to talk to your sleep doctor or technician about limiting pressure to some degree. But again a zoomed in capture of the CSA would be helpful to determine if it is real CSR or not...

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wthankachan +0 points · 7 months ago Original Poster

Does this help?

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Sierra +0 points · 7 months ago Sleep Innovater

That is zoomed in a little too much. You want to back out some to see several CSR CA events, similar to the time window that I posted for my CSR. The only other relevant variables are the Minute Ventilation and pressure. No need to post those other graphs. What you are looking for is a smooth repetitive sequence of the waxing and waning. If that is what you see, it is most likely legit CSR.

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wthankachan +0 points · 7 months ago Original Poster

Got it. Yes that is what I see. A smooth pattern of waxing and waning.

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Sierra +0 points · 7 months ago Sleep Innovater

Yes, but I think this is no reason to panic. I think you have two opportunities for improvement. One is to stop the EPR, and the second is to limit the maximum pressure. Your machine is currently wide open, allowing pressure to increase right up to 20 cm. This is something to discuss with your sleep doctor. My view is that central apnea events are just as harmful as obstructive apnea events, and if there is an opportunity to reduce them, it should be explored.

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Sierra +0 points · 6 months ago Sleep Innovater

If you look at the Minute Ventilation graph it shows that your breathing system is unstable. It is like the speed setpoint when we are using cruise control a car. Instead of maintaining a steady speed of 60 mph, the speed is going up too high, and back down too low. This can be caused by the autonomic breathing control system acting too slowly or by the blood circulation being too low. There is a good article in the blog section of this website about the issue at the link below. The control system uses CO2 in the blood as a means to determine if breathing is too much or too little. If it can't get CO2 stable then breathing is unstable as well.

Complex Sleep Apnea

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bonjour +0 points · 6 months ago Sleep Commentator

I don't believe that is CSR. Periodic breathing yes. See how on many of those episodes the initial breath is large, CSR starts very small and builds the wans down to nothing and the cycle restarts. BUT it is something to discuss with your doctor.

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