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CSR - What causes & any concerns?
#1
Two nights of lower AHI then CSR events last night (have had these off and on).  Is there any normal cause for these events and should I have any more concern about CSR events than other AHI events?  I reduced pressures from 9-12 to 8.6 to 11.6 cutting my AHI in half but now last night had CSR back into the events?  CA's at least still remain less than half of the event total but it is still a very mixed bag of event types.  Past & new charts link included in IMGUR album.

Thanks to all for all the past help and I hope someone has an explanation for these CSR events.

http://imgur.com/a/QaxVN
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#2
Just read another reply on CSR.  Would like your interpretation of my charts.  Just happened to have seen my heart specialist yesterday and EKG and his impression everything looks fine.  Thanks in advance for your impression.  Really happy to hear that this is probably just PB.
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#3
(05-17-2017, 01:32 PM)TexasTiger Wrote: Just read another reply on CSR.  Would like your interpretation of my charts.  Just happened to have seen my heart specialist yesterday and EKG and his impression everything looks fine.  Thanks in advance for your impression.  Really happy to hear that this is probably just PB.

Have you gained any weight? Have you switched sleeping positions? Have you had a recent echocardiogram and did your doctor look for any potential signs of sub-clinical liquid retention? Did they rule out possible pulmonary hypertension and/or possible transient congestive heart failure (liquid retention)? I asked my cardiologist about my episodes of CSR (aka PB) and they prescribed a short course (7 days) of a low dose diuretic (12.5 mg hydrochlorothiazide) and the problem disappeared after three days and has not returned. Keep track of the episodes and note the trend -- increasing/decreasing/stable, the amount of time, and the percentage. 

Do not be afraid to consult your cardiologist again -- especially when some causes of CSR are not detected by an EKG. Continued or increasing CSR does require investigation unless your physician can provide assurances that your health is not being harmed.

Have you asked about any potential benefits from transitioning to a bi-pap or ASV (special heart conditions may rule this out)?

Make sure that your mask's CO2 venting system is not clogged (if appropriate) and that you are not periodically desatting (requires a recording pulse-oximeter).

Best of luck.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#4
(05-17-2017, 05:19 PM)srlevine1 Wrote:
(05-17-2017, 01:32 PM)TexasTiger Wrote: Just read another reply on CSR.  Would like your interpretation of my charts.  Just happened to have seen my heart specialist yesterday and EKG and his impression everything looks fine.  Thanks in advance for your impression.  Really happy to hear that this is probably just PB.

Have you gained any weight? Have you switched sleeping positions? Have you had a recent echocardiogram and did your doctor look for any potential signs of sub-clinical liquid retention? Did they rule out possible pulmonary hypertension and/or possible transient congestive heart failure (liquid retention)? I asked my cardiologist about my episodes of CSR (aka PB) and they prescribed a short course (7 days) of a low dose diuretic (12.5 mg hydrochlorothiazide) and the problem disappeared after three days and has not returned. Keep track of the episodes and note the trend -- increasing/decreasing/stable, the amount of time, and the percentage. 

Do not be afraid to consult your cardiologist again -- especially when some causes of CSR are not detected by an EKG. Continued or increasing CSR does require investigation unless your physician can provide assurances that your health is not being harmed.

Have you asked about any potential benefits from transitioning to a bi-pap or ASV (special heart conditions may rule this out)?

Make sure that your mask's CO2 venting system is not clogged (if appropriate) and that you are not periodically desatting (requires a recording pulse-oximeter).

Best of luck.

Thanks for your input srlevine1.  Going to monitor as noted and see if there is any pattern.  Have not had it yet on consecutive days - more than a week or more apart.  Had an eco & stress test a few years ago and all was fine then - A-Fib but under so-so control with medication (not blood-thinners).  My mother passed due to CHF so I need to keep a watch on it.  No real changes in body or health - have had SCR episodes tracked for the 9 months I have had the AirSense 10.  Before that did not even know there was a problem cause the DME or doctors never said anything except be sure to stay 100% compliant!  So far doctor has not looked beyond the A-Fib in testing.  Will monitor further and see if I need to get him in the loop.

Would still like others to look at the charts and let me know if they think it is CSR or just plain PB.

Again, thanks to all for their help in understanding apnea and assistance in getting my AHI under better control.
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#5
WOW - just looked at my history and there are a lot more CSR events then I thought! 
Really thought the sleep doc or the DME or someone was looking at this stuff! 
Have created an album of these past events on IMGUR and would sure like some feedback on these....

THANKS IN ADVANCE.

http://imgur.com/a/RSLII
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#6
I noticed all these nights the EPR was on 3 expect for the latest one that EPR was on 1 (which seemed better).
if you are getting the same sort of thing with EPR off, I would contact the doctor.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#7
(05-18-2017, 09:27 AM)quiescence at last Wrote: I noticed all these nights the EPR was on 3 expect for the latest one that EPR was on 1 (which seemed better).
if you are getting the same sort of thing with EPR off, I would contact the doctor.

QAL
Thanks QAL - If I cannot determine that these are simple PB events I will need to have a doctors opinion - probably a new one.

Actual makeup up past events that I have a record for:

12 Nights  9/14/16 to 11/23/16  9.0 CPAP mode 3 cm EPR
8 Nights   11/30/16 to 4/28/17  9-15 APAP mode 3 cm EPR
1 Night     5/3/17 9-15  APAP mode 1 cm EPR
1 Night     5/16/17  8.6-11.6  APAP mode NO EPR

Still hope to get some of the experienced board members comments on these CSR or PB events.....
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#8
(05-17-2017, 10:54 PM)TexasTiger Wrote: WOW - just looked at my history and there are a lot more CSR events then I thought! 
Really thought the sleep doc or the DME or someone was looking at this stuff! 
Have created an album of these past events on IMGUR and would sure like some feedback on these....

THANKS IN ADVANCE.

http://imgur.com/a/RSLII

Your pattern does look like CSR. I am not qualified to diagnose, but the classic gradual onset to CA, followed by gradual increase in respiration, followed again by slow attenuation to another CA is not just periodic breathing.  Only your cardiologist can advise.  If you have heart failure with left ventricular ejection less than 40% you will not qualify for ASV, otherwise, that may be your best course.  I'm not going to sugar coat this.  Your pattern is concerning, and it may be progressive. It is unrelated to CPAP pressure, and we will minimize it in the same way that we try to minimize CA.
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#9
(05-18-2017, 05:04 PM)Sleeprider Wrote:
(05-17-2017, 10:54 PM)TexasTiger Wrote: WOW - just looked at my history and there are a lot more CSR events then I thought! 
Really thought the sleep doc or the DME or someone was looking at this stuff! 
Have created an album of these past events on IMGUR and would sure like some feedback on these....

THANKS IN ADVANCE.

http://imgur.com/a/RSLII

Your pattern does look like CSR. I am not qualified to diagnose, but the classic gradual onset to CA, followed by gradual increase in respiration, followed again by slow attenuation to another CA is not just periodic breathing.  Only your cardiologist can advise.  If you have heart failure with left ventricular ejection less than 40% you will not qualify for ASV, otherwise, that may be your best course.  I'm not going to sugar coat this.  Your pattern is concerning, and it may be progressive. It is unrelated to CPAP pressure, and we will minimize it in the same way that we try to minimize CA.
Thank you for the "heads up" sleeprider.  I already have an appointment with my PCP on this coming Monday and will address these issues to hopefully get scheduled with the proper specialists.  That along with A-Fib makes for a very messy treatment plan.  Last night was one of my best nights in a long while - not sure if it was the pressure reduction (now 8.6 - 11.6 no EPR) but going to stay there for a while.  Switching to the AirFit F20 also took care of the leak problems.  4 day average at these settings is AHI = 3.81.  Chart from last night is attached....   http://imgur.com/a/ASLtz
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#10
Nice to see the CSR is not a regular visitor. In cases like yours, OA is not always accurately reported, and may have CA origins. The machines are only "so" good at making the determination. We might try keeping pressures lower by limiting max APAP pressure. I'm thinking along the lines of 10.0 to 10.5.
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