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Centrals, hypopneas and sleep patterns
#1
Centrals, hypopneas and sleep patterns
It's been two months since I started PAP therapy with an AirSense 10 machine. After trying a number of masks I've settled on the configuration noted in my profile. I wanted to describe my current situation in case anyone has comments or suggestions.

-- AHI now averages a little over 2 per night. Ranging from below 1 on the low end, to 7 or more on the high end. It can vary for no apparent reason from a very quiet night to one with a much higher score.

-- Events are virtually all a nearly even split of centrals and hypopneas. The hypopneas do not fit the description of obstructive, so they appear to be central as well. Although not logged as events, there appears to be a good bit of flow limitation as well. Pretty much no snoring, obstructives or RERAs.

-- I've experimented extensively with pressure settings. My HMO starts everyone out at 4-20cm. Based on recommendations here, I ended up at 6-10cm for a good while. However, I noticed that pressures at the higher end of that range seemed to wake me and make me want to remove the mask later in the night, so I've recently been trying lower pressures. Currently I have the setting at 4-6cm. Overall the AHI and events seem no different from when I had the upper end of pressure set higher, and as a plus I'm able to sleep through more of the night without feeling bothered by the mask and pressure.

-- My basic sleep pattern is to go to bed around 11 p.m., sleep well until about 4 a.m. and then start waking up and going back to sleep. Eventually around 6:30 a.m. I'll just get up. I feel pretty refreshed in the morning, but I find that I still have a pattern of wanting to take a nap in the early afternoon, which more often than not is just a 20-minute catnap. (I'm in my mid-60s if that's relevant.) The PAP therapy and amount of sleep I get on any night doesn't seem to change this.

-- The central and hypopnea events appear to cluster around two time slots: (1) about two hours into sleep during the night, and (2) during the hour before I get up in the morning.

So I'm trying to decide if there's anything further I should do. Before treatment my AHI was 11.8 on my back, 0 on my side, for a composite of about 7-8 on the night they tested me. My sleep doctor viewed me as only slightly in the range of qualifying for treatment to start with, and if I went back to him to explore the idea of bi-PAP to deal with the centrals/hypopneas I suspect he'd say I don't need it, my scores are already down in the "successfully treated" range.

So do I feel better on PAP therapy? Hard to say. The improvement is pretty subtle, though there are mornings when I feel more thoroughly refreshed. The main thing I'd like to do at this point is to find a way to sleep more soundly in the final couple of hours of the night. The current therapy isn't doing that, and I don't know if there's anything that will. (I've looked at issues like caffeine use, exercise patterns, etc. I definitely don't want to have to use any medication of a sedative nature.)

If anyone has thoughts, I'd be very interested. I greatly appreciate the help I've gotten so far on the forum.
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#2
RE: Centrals, hypopneas and sleep patterns
I was 65 when I was diagnosed with apnea, and then only because I had a sudden onset of atrial fibrillation.  All tests were negative, and in fact they were surprisingly great for a male over 60.  But, it raised the niggling question, and eventually my cardiologist had me go to the sleep lab overnight.  Bingo!! Severe apnea. 

This is important: I was entirely asymptomatic.  No sleepiness, no crankiness, no cognitive deficit, fit cardiovascularly, no naps.  But, as soon as I began to take a beta blocker and to get PAP treatment, I turned into an old man almost overnight.  I get sleepy watching TV, my fitness has all but tanked, I've gained at least 5 kg. I'm a largely different kind of lion; toothless.

My sleep is largely as yours is, except you have to slide everything about two hours later...I'm a night owl.  I sleep really well for about four hours, and then the hose unwrapping, waking and turning, active brain, it all robs me of sleep unless I stick with it and snatch another hour somehow.  Even so, I do manage a solid 6 hours of sleep, including vivid dreaming, most nights, often almost to seven hours.  But the dreams seem to pile up later, often waking me near 0730-0830.

About the centrals:  my feeling is that unless they are frequent, clustered, and endure at least 15 seconds, they are spurious.  Most of us have a few each night, even if they don't get recorded, but they involve holding one's breath and tossing and turning, or sitting up and belching...whatever (we both wear silicone ear plugs, so it's all good.) Huh  So if, like me, you get three to five centrals most nights, it's nothing, but only if they are of short duration.  As proof, your low AHI suggests you are well within the ball park.
Serial Tapist
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#3
RE: Centrals, hypopneas and sleep patterns
(03-09-2019, 07:22 PM)mesenteria Wrote: But, as soon as I began to take a beta blocker and to get PAP treatment, I turned into an old man almost overnight.  I get sleepy watching TV, my fitness has all but tanked, I've gained at least 5 kg. I'm a largely different kind of lion; toothless.

I'm going to file those under "side effects," rather than "mission accomplished."

I have to think those changes are due to the beta blocker rather than the PAP treatment. Some years back I had a prescription for propranolol, which I took occasionally for public speaking. It definitely made me sleepy some time after its use, and if I were to take it on a regular basis I wouldn't be surprised if it would cause a weight gain.

Thanks for the comments on centrals. I'll have to take a look at how long each typically lasts. As mentioned, some nights I only have a couple; other nights, many.
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#4
RE: Centrals, hypopneas and sleep patterns
I have a thread that is similar to yours so I thought I might offer some info. I have a few "centrals" every night, maybe five or six spread out. I have had a shoulder tendon reconstruction operation and have a damaged lumber spine region so sleeping in a comfortable position all night is difficult.  I don't like to admit it but I am 62 years old and a life well lived is starting to catch up with me.  Thinking-about Sleeping flat on my back is the best position but I to tend to move around a fair bit. Looking at my data it seems the centrals coincide with my movements and waking, so I am not too worried by them. Obstructive apnea's are a rare event now days, maybe one or two short ones a week. Long term AHI is around the .7 mark and I am happy with that. I still get anxious about how well I am doing, but that is just overthinking it. A bad habit I know, and I am trying to break out of it.

James W
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#5
RE: Centrals, hypopneas and sleep patterns
Thanks, it sounds like some similarities to my situation. It's interesting that you relate the centrals to your moving around and waking. As mentioned I tend to get a lot of them in the hour or two before I wake up in the morning, which is a time when my sleep probably isn't deep. I tried leaving a webcam on once to get a sense of how I moved around during the night, but the camera wasn't able to pick anything up in the room as dark as it was.
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