We use cookies and other tools to enhance your experience on our website and to analyze our web traffic.
For more information about these cookies and the data collected, please refer to our Privacy Policy.

frequent CSR

69 posts
Was this reply useful? Learn more...
   
[-]
ittiandro +0 points · about 1 month ago Original Poster

I am 82, on the CPAP machine since 2020. My AHI's are usually low, under 1, except that over the last 7 months , I see more and more CSR's, some of them as high as 8.6, in the average around 3. Generally I sleep well, I exercise regularly . I don't know what to make about them.. The last time I spoke to my sleep doctor he didn't seem to worry too much about it, but the frequency is increasing. Any idea?

Thanks

Ittiandro

131 posts
Was this reply useful? Learn more...
   
[-]
PutSleepApneatoBed +0 points · about 1 month ago Sleep Commentator

I would mention it to your cardiologist. A greater number of CSRs can be associated with increasing severity of CHF in people with OSA. (You can Google the studies on the subject.) Perhaps your cardiologist will want to adjust your cardiac meds.

PS. I’m not a doc, just a OSA patient who has had the condition for a long time and read a lot…..

3,119 posts
bio
Was this reply useful? Learn more...
   
[-]
Sierra +0 points · about 1 month ago Sleep Patron

I also suffer from CA events, which form the large % of my AHI. However my AHI on average is around 0.85, and not that high. I get the occasional flags for CSR, with a long term average duration of 0.1%. See the graph below. The magenta part of the bar graph are CA events. I almost never go over 3.0 however.

I recall we have discussed this issue before, but I can't remember where you are at for machine settings. I have found that using a fixed pressure and keeping pressure as low as possible limits the frequency of my CA events. The only direct way of controlling CA events with a PAP device is to the ASV version. However, it is highly recommended that you get heart function tests before going down that road. The ASV may be just covering up a potential heart issue that needs treatment. It would be worth seeing a heart specialist in any case to see if there are any issues requiring treatment.

CSR can also be caused by altitude and there are medication treatments used for elevation sickness that may work, if you live at a high elevation, or you could use an ASV.

69 posts
Was this reply useful? Learn more...
   
[-]
ittiandro +0 points · about 1 month ago Original Poster

Currently, my EPAP-IPAP settings are 10.2-15.2 but I don’t see a correlation between these settings and the CSR, because in the past the same settings didn’t yield higher CSR’s. Should I lower hese settings? I will speak both to my sleep specialist and possibly a cardiologist.
The former doesn’t seem to pay too much attention to the CSR’s., even though they are a bit high ( up to 7%). Perhaps he should. He just goes by the number of AHI’s and for him that is enough, as long as they keep below 5 and I feel well. As to the cardiologist, I have already seen him a couple of months ago, for a follow up on my atrial fibrillation. Everything is OK. So I don’t think the CSR’s underlie a heart problem or I wouldn’t be able to run, exercise on the elliptical or shovel the of snow around the house, which is sometimes hard work... There might be some causes elsewhere, but it is like finding a needle in a hatstack. Perhaps my medication ( betablocker, and, recently, Ozempic for diabetes, now completely under control. By the way, Ozempic does wonders. I even lost 10 kg, down from 96 kg, a real bonus for the heart...

I also have a hunch that the hypersensitivity of these CPAP machines may be an issue. As helpful as these state-of-the-heart machines are, sometimes I wonder if they don’t amplify the inputs beyond measure and perhaps give false warnings. Who knows?

THanks

Ittiandro

3,119 posts
bio
Was this reply useful? Learn more...
   
[-]
Sierra +0 points · about 1 month ago Sleep Patron

About all you can do is try lower pressures to see if that helps with CA events. The ideal pressure may be when OA and CA event frequencies are about the same. OA events tend to go up when you lower pressure, while CA events tend to go down with lower pressure. The trick is to find the happy median.

Quite some time ago I reduced my beta blocker, bisoprolol, from 5 mg to 2.5 mg as a test, and I think it reduced my CA frequency. My doctor was a bit skeptical, but agreed with it, as my blood pressure remains good. My wife uses Ozempic, but I have stuck with insulin and metformin. I also use a Libre 2 sensor to monitor things. My A1c is usually right about 6.0 or a bit less...

I am not sure it is fair to blame the CPAP. My wife uses the same machine as I do, and her AHI averages about half of what mine is, and she has hardly any CA events. See graph below. My theory is that CA events are caused by a slow response to the need to breath faster or slower to keep blood oxygen and CO2 levels constant, and a little faster heart rage might help. I also take the bisoprolol in the morning so it has more effect during the day, and less at night.

69 posts
Was this reply useful? Learn more...
   
[-]
ittiandro +0 points · about 1 month ago Original Poster

Thanks

I lowered the pressure settongs by small increment ( .02) Ill see ow it goes over the next few days . Today the AHI was .86 which is my normal.. I cxan go weeks without CSR's . I find it odd that I had them for a few days in a row.

Thanks

3,119 posts
bio
Was this reply useful? Learn more...
   
[-]
Sierra +0 points · about 1 month ago Sleep Patron

I don't fully understand it either. I can go days with my AHI under 1.0, and last night it was over 3. I don't know what really triggers the CSR flagging as what I saw last night sure looks like CSR to me, but was not flagged. What I do know is that once a CSR cycle starts it can go on for some time and really run up the frequency of CA event per hour.

69 posts
Was this reply useful? Learn more...
   
[-]
ittiandro +0 points · 29 days ago Original Poster

For some reasons, possibly because of the recent pressure adjustment, I had the best AHI reading ever : ZERO !!! I think I had it once or twice before. The only odd thing is that my flow rate shows ZERO between 23:30 and 0:30 but with a dotted line in the gap. I know I have got off the bed to work on the computer for about an hour.I don't remember the exact time, but why the dotted line ? Usually, if I go off the CPAP for some time, the gap on the graphic is blank, I don't think I stopped breathing !!!.

Ittiandro

3,119 posts
bio
Was this reply useful? Learn more...
   
[-]
Sierra +0 points · 28 days ago Sleep Patron

Seems unusual. If I get up in the night the graphs all go to zero.

3,119 posts
bio
Was this reply useful? Learn more...
   
[-]
Sierra +0 points · 27 days ago Sleep Patron

Are you talking about a red dotted line on the Flow Rate graph? If so I noticed on my wife's OSCAR report this morning that there is a dotted line at the "0" flow rate when the machine is off. She has a nap in the afternoon and with the long break between the nap and the evening sleep it is easy to see this dotted line. I do not nap during the day, and my breaks are short during the night if any. I think that dotted line is there too, but it is harder to see with a short break compared to a longer break. If that is what you see, I think nothing to worry about.

131 posts
Was this reply useful? Learn more...
   
[-]
PutSleepApneatoBed +0 points · 28 days ago Sleep Commentator

Could that have happened because the machine kept running? Mine used to turn off automatically a minute or so after I removed the mask, but now it doesn’t.

69 posts
Was this reply useful? Learn more...
   
[-]
ittiandro +0 points · 27 days ago Original Poster

Sierra yes, it is a red dotted line. Usually when I take off the mask for a break , the machine goes off automatically and all the graphs show a blank gap, except the flow rate in this case. THe break lasted for about an hour during the night session.

TKS

Ittiandro

Please be advised that these posts may contain sensitive material or unsolicited medical advice. MyApnea does not endorse the content of these posts. The information provided on this site is not intended nor recommended as a substitute for advice from a health care professional who has evaluated you.