Sleepyhead Data/APAP/Centrals

So I tried to take a nap, lying supine, yesterday evening and had a flurry of centrals and never was able to fall asleep. Last night I chose to make every effort to stay on my side or stomach and it was a very different story. Here are some screenshots to look at. So far, it seems the machine is wiping out the hypopneas I had in my PSG, with very little pressure, and that my centrals are truly positional. I now know what is causing me to wake up feeling slightly anxious and to have a bit of trouble falling back to sleep...central apneas.

I'm not sure if these are even loading correctly as I can't see them when I sign off. Anyway, my AHI seems ok at 2.17. The time in apnea might be an issue at 4+ minutes. There are leak issues with the mask it seems, though they don't seem to be impacting my AHI. In contrast to my in lab sleep study, it seems like the apap is removing most all of the hypopneas and leaving me with the centrals, which I guess is to be expected. Any thoughts?

Thanks for the information about the spam filter and the machine advice.

I’ll ask about EPR adjustments tomorrow with the respiratory therapist.

I am a bit concerned about the positional nature of the centrals. I’ve read where it’s often about Cheyne Stokes respiration, heart failure or possibly some sort of brain stem problem. While I need to get these centrals minimized as much as possible, I’m thinking it might be equally important to try and determine the cause. It just seems odd that positional centrals would be idiopathic.

I’ll work on that this evening.

You have centrals, Sierra. I see mine ranging from 11 seconds up to 40. 40 seems terribly long. Is that at all typical of centrals?

Another thing to ask about is the maximum pressure setting for your machine. What I have found is that my AirSense 10 tends to chase the hypopnea events with more pressure. My feeling is that some, or even most of the hypopnea events are central in nature, not obstructive. So what you end up with is the machine chasing central hypopnea events with more pressure, and that pressure causes even more central events. So what you should ask about is significantly reducing the 15 cm max pressure to something much lower -- perhaps as low as 7 cm or so.

Here's a zoom. And now I'm showing CSR! This just keeps getting better and better.

Central Apneas tend to increase with increased pressure, or with increased pressure variance. It is not uncommon for one who has Centrals, and not enough to justify an ASV machine (which is designed to treat Central Apnea) to end up on a fixed pressure. Keep in mind that your current machine cannot treat Central Apnea, the auto algorithm will do nothing when a central is detected. Centrals are "treated" by avoiding them.

Treat your CSR indication as Periodic Breathing. While CSR is Periodic Breathing your pattern is not that typical of CSR. That said your Periodic Breathing should be brought up with your doctor.

Last night was my best night thus far. 5 CA and 3 Hypopneas. I've been below 5 since the 2nd night with most nights being 2's or 3's. I'm curious why the centrals are going away when my machine isn't really capable of treating them. It leads me to believe that the CA was being brought about by hypopneas and awakenings.

Another possibility is that with CPAP you are breathing better, and your arterial CO2 drops triggering a Central Apnea. The setpoint at which Centrals are triggered changes with sleep and over time your body adjusts and fewer centrals are triggered. Better breathing actually can wash out more CO2 resulting in the failure to trigger a breath.

It sounds like you might be one of the ones where your centrals disappear or greatly dimish with time.

My AHI is now regularly below 1 with some nights occasionally between 1 and 2. However, I still feel like garbage when I wake up and feel groggy for much of the day. Almost like I’m dealing with sleep inertia that won’t subside. Interestingly on nights when I just don’t sleep well I tend to feel better in the morning. On Tuesday night I was up until nearly midnight and was out of bed before 6AM, a full 2 hours less sleep than usual and I woke up a lot that night. Somehow I felt better on Wednesday after that short night of sleep than usual. I do have a lot of awakenings at night, probably close to 8 if I had to guess. I’m not up for long but it’s an interruption. I’ve started taking melatonin, 1.5mg, for last few nights to see if that helps. So far it hasn’t. Thoughts?