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CSR concerns
#1
Question 
    I've been on an auto-CPAP for 6 months. My pressure setting since day one has been 7-9. I have 3 CSR events since April 18th. I would like to know if I should seek medical advice. Im on BP meds, and pressure is controlled. Saw my cardiologist 2 months ago,no problems. I would like opinions on the graph i have attached. Thanks
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#2
The software by default labels all periodic breathing as Cheyne Stokes Respiration. I strongly recommend you simply change the default lable fo this to Periodic Breathing (PB), in file/preferences/events. What you posted is not CSR, but it is periodic breathing, and it looks like disrupted sleep at the end of the night. This is very different from characteristic CSR. If you want to compare, I can find examples. CSR is a frequent symptom of congestive heart failure, a very serious and progressive disease. You ain't got it.

There are many reasons for the disrupted breathing pattern you posted, but your graphs suggest you are near the top of your pressure settings. That may, or may not be related.
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#3
If you saw your cardiologist a couple of months ago and you don't have a history of heart failure, I think you can probably not get too worried about this.

There are a couple of things you should be aware of with regards to what SleepyHead calls Cheyne-Stokes Respiration.  Most machines that claim to detect CSR-type breathing are actually detecting a more general (and often benign) set of breathing patterns loosely grouped together under what is called periodic breathing (PB).  Any kind of breathing, including CSR, that has a certain repeating regular pattern of increased inhalations followed decreased inhalations can be called periodic breathing and if a breathing pattern even barely meets the manufacturer's definition of "repeating pattern", it will be flagged as PB.

Classic CSR is a specific type of PB that is strongly associated with congestive heart failure.  In CSR, the crescendo/decrescendo phases are symmetric and there is typically a central apnea scored at the nadir of the breathing cycle. If there's not a CA at the nadir of the cycle, there usually is a (central) hypopnea instead.  Here's an example of what CSR looks like on a sleep test :

[Image: jcsm.10.1.65b.jpg] The top graph labeled "Flow" is the trace of the breathing as it would be recorded by a CPAP.

If you compare this sample of what classic CSR looks like to your data, you'll notice that the patterns are not really all that similar, and in particular, the bottom of your cycles are not long enough or deep enough to be scored as either CAs or Hs.

Still, if you are worried about the amount of PB being recorded by your machine, you could contact your cardiologist's office and mention that you've started CPAP and that your machine is detecting some PB.
Questions about SleepyHead?
See my Guide to SleepyHead
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#4
Hi NanaPainter,
WELCOME! to the forum.!
Hang in there for more responses to your post and good luck to you with CPAP therapy.
trish6hundred
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#5
Thank you for your response. The experience , and knowledge on this forum is valuable to so many that can"t get advice from anywhere else.
With that said. My question from your response is - should i consider raising my max pressure? And can disrupted sleep , and/or peroiodic breathing come from sinus problems, or things like paiin from Carpal Tunnel ?
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#6
Since you are bumping up to your max pressure for most of the night, I would raise the maximum pressure to 11 and keep watch on it.

Good job on posting a screenshot....next time, leave off the pie chart, and include the snore and leak graph.
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#7
(05-11-2017, 08:10 AM)NanaPainter Wrote: My question from your response is - should i consider raising my max pressure?
My (nonmedical) guess is that raising your max pressure is unlikely to change the amount of PB being flagged.  The machine is not programmed to increase pressure in response to directly to PB.

I am also far more cautious than most of the long time posters here on encouraging pressure increases.  But quite frankly, I don't see anything in the data you posted that screams: Increase the Pressure!

Yes, you are running at 9cm most of the night. So what? In your case, 9cm controls the obstructive stuff, and there's no need to allow the machine to go higher just because you're bumping up against 9cm all night.  And sometimes a machine will go higher than is strictly necessary. For most people, it's not a serious problem.  But for a few people, higher pressure can trigger a host of problems that range from the irritating, (additional leaks, aerophagia) to the more serious (lots of real centrals, an uptick in the PB scored, or a combination of the two).  So in regards to whether you should increase the max pressure, I'd say no.  Your current data shows no compelling need to increase the max pressure, and there is a slight risk that increasing the max pressure may make things worse, not better.

Quote:And can disrupted sleep , and/or peroiodic breathing come from sinus problems, or things like paiin from Carpal Tunnel ?
Disrupted sleep can come from all kinds of things that are not related to sleep disrupted breathing.

Pain by itself can disrupt the sleep patterns.  Pain medication can sometimes affect the breathing---opiods in particular can trigger chains of CAs.  And sometimes chains of CAs are associated with PB that is not CSR.

Sinus issues can disrupt the sleep.  Serious sinus problems and a constricted nose can cause the machine to register what are called "flow limitations" (this is not the same as PB).  The machine will increase pressure when flow limitations are detected, but if the problem is a congested nose or a sinus problem, the extra pressure is unlikely to make the flow limitation go away.  And when that happens, the machine is likely to zoom up to whatever the max setting is and stay there most of the night. Without actually improving the looks of the flow limitation curve and without improving the subjective quality of sleep.
Questions about SleepyHead?
See my Guide to SleepyHead
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#8
the chart you showed had min 7, max 9, and CPAP (exhale is same as inhale pressure). you do have a ramp, apparently starting at 4. you probably are not being served by having the ramp on, and could turn it off if you wish.

I agree there is not much reason to increase the max pressure, and I would only do it if you felt your sleep was being disturbed. [and only after trying other things, like to increase slightly the minimum pressure].

if you do not feel uncomfortable leave just as you are.

As explained elsewhere in the forum, a good pressure to set as minimum is usually approximately the median pressure (the pressure your machine is at (or above) for at least half the time.) [for the night you showed in the chart, that number was 8.90]

So, if you wish, trying a minimum of 8.5, maximum 9, see if this brings you closer to AHI less than 1.

Whatever you choose, rest easy.

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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