frequent CSR

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

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…..

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.

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

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

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

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.

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