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Central Apnea or Not?
#21
RE: Central Apnea or Not?
(10-17-2019, 06:50 PM)sheepless Wrote: while falling asleep is likely the only time you'd notice.  most of us are never aware of the apnea itself because we're asleep.  I'm not saying your problem and solution is like mine (not enough info yet) but I will tell you that I had the same problem as I was falling asleep until I used an asv machine to nudge me to breathe when I stopped.  because I have mixed apnea, I assume but don't know that this occurs all night long.  I'm assuming your breathing pauses while drifting off are central but I suppose they could be obstructive as well.  I defer to other more knowledgeable folks to help you further.

I do believe that my challenge is something stupid, one that is easy to fix and should have been obvious to me the whole time.  Often times it's not as bad as we make it out to be.  I expect that to be the case here.  Perhaps my own ignorance and trying to find something out of nothing.  

Regarding not being aware of the actual apnea because one is asleep, that's what the sleep people told me.  That's one of things pointed out to me regarding my nightmares and me waking up gasping for air.  Simply, you're generally unaware and thus wouldn't have even known you had an event.  You just feel it the next day while you're awake.  So, why would I wake up gasping for air?  Am I just imaging it?  I'm not, but perhaps it really is something else.  Maybe a nocturnal panic attack, it's not uncommon to gasp for air while you're panicking, and a nightmare is brewing ground for panic.     

If you don't mind, would you care to describe your experience as you'd fall asleep prior to ASV?  That sounds interesting to me sheepless.  I'm super curious now!
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#22
RE: Central Apnea or Not?
Hope this doesn't sound like a broken record, but I've been there before xPAP therapy. The gasping for breath is real, and it's likely pointed to the apnea events. For now, I'd lean towards saying your central events are possibly due to the newness to apnea therapy. If so, it should resolve between a few weeks to a few months and it probably won't be a big issue. Keeping track of the numbers will tell.

I'd try that pressure bump still. Get your manual in the link at the top banner. Match your machine name exactly, enter the Clinician Mode and edit from there. To enter clinician mode hold that knob and home both for about 5 seconds then make your adjustments.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#23
RE: Central Apnea or Not?
what your sleep people told you is weird. we don't need to be aware of apnea to wake up gasping for air. it happens because of imbalances in O2 and or CO2 (over simplified, I really don't know the mechanics of breathing). before apap and asv, I learned over many years to 'know' when I had been in apnea because of the cyclical dreams / nightmares it produced. the dreams were repetitive (stop breathing, breathe, stop breathing) and often involving boundaries, boxes, containers of some kind. or I'd dream about some story over and over and over again. I think all these reflect repetitive breath holding. other dreams were about breathing under water (more like sipping very small amounts of air to enable me to stay underwater). not to mention waking up to find myself sitting at the edge of the bed gasping panting sweating etc. so I've never been aware of the actual event but sometimes I can infer it after the fact.

as for falling asleep, I've been on asv for 16 months so it's hard to remember. the short adjustment period necessary for most using asv is because of this failure to breathe as we're transitioning or first into light sleep. the machine pressure 'nudged' me to breathe and that was awkward and disruptive for a few days until I got used to it and haven't ever noticed it again.

if I nap without the machine, like sitting on an airplane or in the passenger seat of a car, failure to breathe can be brutal and panic inducing. talking about napping, so it's very light sleep. picture me nodding, dozing, then realizing I can't breathe and having to struggle to wake enough to literally force a breath with great effort. that I'll never forget so I try never to nap without the machine.

btw, you have one up on your sleep people and that's oscar. you can do as you're doing and note whether apnea or flow limitations or other form of disordered breathing is causing arousals. it's ridiculous to say or imply that your nightmares and awakenings can't be related to breathing because you aren't aware of apnea events (if that's what they're saying).

so far flow limited breathing is the most visible potential issue for you. others will tell you how to use pressure and epr to deal with that. you have some ca but aside from your complaints about problems while falling asleep, there's no reason at this point to conclude it's more than treatment induced that will dissipate in time.

you should try to get a detailed copy of your sleep study. it's almost universal to be first diagnosed obstructive, even in the presence of central apnea because of insurance requirements to fail simpler modes of therapy before moving on to more sophisticated and expensive machines.

early in this thread you asked if centrals can occur some days and not others. the answer is yes, inconsistency is a hallmark of ca.
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#24
RE: Central Apnea or Not?
Looking at the screenshots you posted it does seem the therapy is starting to work - your AHI on that particular night is well within the acceptable range. AHI is not everything, but it's a good benchmark to base any therapy changes on. Can I ask you to read up on the instructions for organising your Oscar charts? You should turn off the pie chart and calendar and arrange the graphs in a slightly different way. That will give us the most important data to work with. The instructions are here: http://www.apneaboard.com/wiki/index.php...ganization

Going back to your "tl;dr" post - I did read it right through and I'd like to answer a few of the points you raised, in no particular order...

Heart palpitations in their various forms are closely linked to sleep apnea. I used to get them frequently but they disappeared once I got my sleep therapy under control. The underlying mechanism is that when you have an apnea and stop breathing your body goes into the "fight or flight" phase. A huge dose of adrenaline is dumped into your bloodstream - frequent exposure to too much adrenaline can affect the heart.

Waking up gasping for breath is the normal symptom of obstructive apnea and also central apnea (to a much lesser extent). Mostly we don't remember this but sometimes we do - it sounds like you remember it frequently and vividly.

Ragged or interrupted breathing while falling asleep (and also on waking up) is common, and occurs during the handover period from the part of the brain that controls awake breathing to the part that controls sleep. (Again that's a very rough approximation, but you get the idea). We call it "sleep wake junk". The trick is to let it happen without over-reacting. Your body will take a breath in its own good time, so just accept that this is a normal part of falling asleep.

Multiple toilet breaks. Remember the adrenaline I mentioned earlier - it also stimulates the bladder. One of the unexpected benefits of apnea therapy is that nature will call far less frequently.

Buzzing noise in your head - if it's what I think it is, then I've had it too. A sudden loud buzz like a wasp in your ear - so abrupt it causes the whole body to react. It stopped happening once I got apnea under control.

Your weight, depression, anxiety, never leaving your room. I suspect these are all linked. They're probably not caused by apnea, but you won't have the energy and resources to fight them if you're always tired. I don't want to get into the mental health discussion in this forum, but there are avenues of help and a lot of self-help materials available. What I will say is that if you can motivate yourself to use the machine and also get out in the sunshine a few hours a day, you will be in a better condition to address the other issues.

I hope this has helped. We will provide as much information and advice as we can, but you need to make changes in the other aspects of your life to get the full benefit.
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#25
RE: Central Apnea or Not?
I'll reply to the previous posts sometime a little later, but I'll post my sleep study results that were sent to me today.
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#26
RE: Central Apnea or Not?
(10-18-2019, 06:18 PM)xXZexxMooreXx Wrote: I'll reply to the previous posts sometime a little later, but I'll post my sleep study results that were sent to me today.

I thought I had sent the file, but realized I didn't go through due to an illegal file type.  I converted it to pdf, but only part of it converted thus I took a screen shot of the mission portion.

I asked for the complete data, including the charts, and this is what I was given.


Attached Files Thumbnail(s)
   

.pdf   study.pdf (Size: 213.49 KB / Downloads: 16)
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#27
RE: Central Apnea or Not?
You have mixed apnea and hypopnea, and a very strong positional obstructive apnea when you sleep on your back (supine). The occurrence of CA with CPAP does not come as a surprise with this sleep test. Your central apnea index was 2 per hour during the test, and that is about what your continue to experience with CPAP. You have resolved much of the obstructive apnea, and your results look surprisingly good considering the use of default 4-20 pressure ad EPR at 2.

I think you can greatly improve your results if you will move your minimum pressure to 6.0 and cut EPR to 1. This should help with the residual OA and may reduce CA.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#28
RE: Central Apnea or Not?
(10-19-2019, 09:08 AM)Sleeprider Wrote: You have mixed apnea and hypopnea, and a very strong positional obstructive apnea when you sleep on your back (supine).  The occurrence of CA with CPAP does not come as a surprise with this sleep test. Your central apnea index was 2 per hour during the test, and that is about what your continue to experience with CPAP. You have resolved much of the obstructive apnea, and your results look surprisingly good considering the use of default 4-20 pressure ad EPR at 2.

I think you can greatly improve your results if you will move your minimum pressure to 6.0 and cut EPR to 1.  This should help with the residual OA and may reduce CA.

Would mixed apnea mean some kind of brain damage and/or neurological condition?  Maybe just some good luck?  Regarding being on my back, something in the back of my throat collapses causing me to stop breathing even when I'm just laying down watching TV or reading a book.  If I exhale too quickly, the same thing happens as well.  That's pretty awesome you read and mentioned that. 

I was reading the post perler242 made and the recommendation for the the ResMed 10 Autosense over the DreamStation.  When I had the DS for a month, my AHI readings were never lower than 4, but would be as high as 8 per hour.  With this ResMed machine, I thought it was broken or not as good at detecting because it's been much lower on average.  It seems it's just a better machine. 

Do thanks Sleeprider for posting your recommended settings and Dave94 for posting above on how I'd go about making those changes.
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#29
RE: Central Apnea or Not?
Central apnea at the very low levels you have in your sleep test and CPAP results is generally not considered a problem and is termed "idiopathic", or without cause. It can occur as a result of changes in sleep stage, movement while sleeping and just a skipped breath. Thes are short duration events that have no real impact on your health, and we can see that they are not associated with oxygen desaturation in your sleep test. When taking a sleep test, and starting CPAP it is not uncommon to have a few CA events as you adapt to the new experience. Particularly in your case, they are not worrisome because they are random events rather than clusters of persistent events, or associated with other types of more serious central breathing disorders. My advise is to ignore it, but you can minimize these events by using less pressure variation, and less EPR. That is the basis of my suggested settings. I think you will find your results are better with the Airsense 10 Autoset than with a Philips Dreamstation, mostly because of the way the Dreamstation times and delivers pressure changes from breath to breath.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#30
RE: Central Apnea or Not?
Update:

I've applied the settings and have been using them since they were recommended to me here.  Some days I can go a whole sleep session without any issues, but then I have these stretches where my sleep is disrupted and I end up taking off the mask after only one to three hours into it.  Last night I woke up repeatedly and notice the machine really pumping some air compared to usual, but I managed to keep it on even though I woke up several times. 

With that said, the AHI is has been really good and I haven't been tired at all.  With regards to the mask listed on my profile, does it matter if you sleep with your mouth open?
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