CyrusManz

I have just stumbled across your post after four years since it was published. Highly interested to know the long term outcome, so I hope this post finds you.

Wow ! I have just stumbled across your post after four years since it was published. Highly interested to know the long term outcome, so I hope this post finds you.

That's the way to go. "Forgetting to breath" while awake, is really not a thing . There are however a lot of other (scientific) causes for your low Blood Oxygen saturation .

Good luck and let's hope it is not serious .

OK, so now we are talking:-) So your SpO2 drops during the day and you think that it is because you stop breathing (according to what I can gather from your last post).

There is however a wide area of science that can explain why your SpO2 drops, other than forgetting to breath enough during the day.

Impairment in gas exchange or ventilation/perfusion mismatches are the most common causes of low SpO 2 in daily routine in pulmonary medicine.

Low Spo2 without other symptoms could signal the onset of COPD, for example.

You need to see a specialist who will start you off with . Arterial blood gas analysis (yes not only Oxygen but also your CO2 should be tested) and then depending on what they find, you can be referred to a more focused specialist.

".....So i was curious to know if anyone ever stops breathing during the day (while awake)? ......."

Without a doubt this has been the most curious question I have ever come across (unless one suffers from apnea and sleeps during the day). Respiratory function is different to some other physiological functions in that it is controlled both, voluntarily and involuntarily. For example you cannot voluntarily stop hearing sounds or seeing images (as long as you are wide awake and not under influence of drugs, of course), but you can voluntarily stop breathing, which means you can voluntarily stop your brain stem from sending a respiratory signal to your diaphragm for the expansion of your lungs, through the Phrenic nerve.

However when a cessation of breathing occurs (whether or not it is voluntary while you are awake ( "during the day" ), or it is an involuntary cessation while you sleep like in the case of "Central Apnea" ), your brain will automatically attempt to OVERRIDE this cessation of respiration, after a few seconds, which is why you can only "HOLD YOUR BREATH" intentionally, for so long before your brain overrides your action and takes over, EVEN if you are under water without an oxygen mask, which is why the lungs of drowning victims fill with water (main cause of death by drowning).

So back to your question, there is no known reasons for anyone to involuntarily stop breathing while they are awake and even if they do stop breathing involuntarily, the body will override it after a few seconds, without the person even feeling it. So its not like "Oh, jeez, I forgot to breath again, what should I do now?" :-)

In conclusion: There is no such a thing as a day-time awake Central Apnea.:-) But if you think you have day-time apnea, you need to see a specialist of some kind to look into this phenomenon.

yep

We also have both, a Resmed Airsense 10 like yours and a Dreamstation-1 APAP which my wife uses for he OSA. (and no, she does not use the "FOR HER" feature of the Resmed for good reasons...See below) She finds the difference between the 2 machines, like night and day in that she now refuses to use her Resmed altogether.

1- Resmed Airsense algo does what Resmed wants to do, not what the patient wants it to do and thus its response to patient comfort is very limited, even when the EPR is turned on, where as according to my wife, she doesn't even know she is wearing a mask when she is on her DS-1. That is because Dreamstation algorithm to treat OSA is not only more responsive during inspiratory-Expiratory transition, but also much smoother in when changing pressures, unlike Resmed which according to her tends to have a much sharper (jerkier)n transition. so it is not that DS is "slower" than Resmed but that the DS algo makes the transition between IPAP and EPAP a lot smoother so patients can't feel the change with Dreamstation patented C-Flex technology..

2- Resmed's Auto PPAP algio essentially fakes mask pressure on data because they do not have separate sensors for the mask pressure built in, so they just derive this from calculation. The displayed mask pressure therefore is hypothetical, not an actual one, so I wouldn't place too much emphasis on that feature.

3-In contrast, Dreamstation-1 APA reports FLOW rate, precisely measured as you can see in my wife's chart. Her flow rate is perfect breath by breath, in comparison to your Airsense chart which reports a flow rate that is far from perfect, not necessarily because you are not breathing well naturally, but because you are not breathing well BECAUSE of Resmed's faulty pressure delivery. Worth looking into.

4-"For Her" algorithm that Resmed keeps coming up with (yes they have them on their latest model 11 too), is more of a sales gimmick than it is a real medical feature.A pap machine algo should respond to one's respiratory needs, regardless of their gender. Dreamstation machines algos are "Gender-Blind" and this even more "politically correct":-)

5-Her Dreamstation also has all the comfort settings that her Resmed has, including a cool Ramp feature that truly "RAMPS" the pressure up over the period that ramp has been set to, unlike how Resmed controls Ramp which at times jolts her awake. Ramp function should be true to the meaning of the word, a linear increase in pressure, divided precicely over TIME setting, which is what Dreamstation delivers.

At any rate, as the original inventors of PAP technology and their sizeable investment into the development of these essential medical devices, it is natural that Philips-Respironics software has been worked on a lot longer and naturally at a much deeper level than Resmed systems. Problem here is Resmed algorithm clearly does NOT recognize clear apnea events and ignores them, thus reporting a much lower AHI while not delivering full therapy. This is simply wrong .

Doctors don't like getting into debates about brand efficacy, because of its implications with insurance companies and their unpaid involvement which can then become open-ended. They just write a prescription for a machine. They do NOT specify which brand of machines and leave that entirely to the DMEs and that's where the problem lies because the DMEs in turn use Philips recall, as an opportunity to flog their Resmed machines because they know there is a huge potential with duplicate business with Philips Respironics users who are now desperate to find an alternate machine to their Philips brand.

I do keep a meticulous SpO2 record and no, my SpO2 doesn't change between machines, however the purpose in the treatment of Central Apnea is not to control SpO2 because otherwise supplemental Oxygen would have just been fine instead of ASV therapy and yes, my sleep quality improves monumentally on my Respironics machine, which is why after 4 months of tinkering with my brand new Resmed Aircurve 10 ASV machine, I went back to my Respironics machine, despite the "recall".

The point that I am trying to highlight in my OP is the fact that Resmed machine algorithm shows false reporting of AHI which Resmed and their resellers then use to claim high efficacy therapy.

Your OP does not indicate specific lengths of time or wether your original study showed Centrals or OSA. That being said, "Treatment emergent CSA" does not necessarily happen to every OSA patient under treatment, nor does it happen after a relatively short period of time. It usual takes over a year of OSA treatment according to studies , but then again I am not sure how long you were recieving OSA therapy before .

Look, your machine is registering way too many Centrals. That is because even though it recognises these events, its algorithm is NOT designed to take action to break them up, so it just observes and reports. You need a machine that can break your centrals , not just report on them and if indeed they ARE legitimate centrals and not false flags, then regardless of how much you tinker with your machine, it is not going to work because it is not the correct machine for central apnea.

All the best and keep us in the loop..

Your Oscar chart shows an incredibly high number of CA events, highly unusual. A BiPap machine algorithm basically looks at the flow rate and if your airway is open but you are not exhaling, then there is no resistance on the flow rate and your machine algo registers this event (if it lasts more than 10 seconds) as a "central" event. I am guessing that you have been given a Resmed machine but without its model, I can't be much help on correcting the titration in order to get rid of the centrals because it could very well be that you are not having that many central events and the machine algo is incorrectly reporting it because of titration. Also, what was the result of your original sleep study? (was it 90% CSA and 10%OSA for example?) I am asking because your doctor should have prescribed a ASV machine instead of a bipap if your CSA events were higher than 20% of the time during your sleep study. The reason you need a ASV type is because the algorithm on an ASV is designed to monitor and react to your respiratory function, on a breath-by-breath basis, so it will constantly adjust its IPAP and EPAP pressures within a wide range in order to "stabilize" your "Minute Ventilation".

A non-ASV BiPAP is only designed to drop EPAP pressures to a preset limit at expiration and vice versa for inhalation. The algorithm does not otherwise attempt to stabilize Minute Ventilation or any other respiratory characteristics. It just provides positive pressure to keep your upper airway open in order to treat your OSA with the added comfort and precision of having a secondary pressure setting for exhalation.

Look up Adaptive Servo Ventilation (ASV) therapy online. There are a lot of very good articles about it. The machine itself looks exactly like a CPAP machine but the turbine and software are designed for ASV function.