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Centrals on the rise!
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saltydawg2 Offline

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Post: #1
Centrals on the rise!
I am sleeping better on my side, but have noticed centrals are beginning to get carried away. I am posting a few shots from recent sessions to show what I mean. Any input would be appreciated.


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03-05-2015 05:46 PM
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saltydawg2 Offline

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Post: #2
RE: Centrals on the rise!
Maybe a look at the events section, rather than the pie chart from last night will explain my concern; they seem nonstop. Thanks, again.


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03-05-2015 08:59 PM
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retired_guy Offline

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Post: #3
RE: Centrals on the rise!
Looks like back sleeping to me Salty. I'm thinking for some reason your pillow is not keeping you up the air as much as it used to? Anyhow, try to avoid the back for a night or so and see what happens.

The only other thing I can think of is maybe "Sailingaway" sent you too much of that Tahitian rum stuff.
03-05-2015 09:21 PM
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quiescence at last Offline

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Post: #4
RE: Centrals on the rise!
yeah it could be response to back sleeping, but I don't think so [except maybe Mar 2]. since it is INTEREPRETED as CA, these did not present as flow limitations resulting in obstruction. so you have CA identified, but good news is the length of these are very short. since these are either central or fake centrals, these are just pauses that your machine should not react to. in fact they come when no other fluctuation is noticed (as the pressure relaxes).

look closer at several of them, and see if they are usually after larger or speedier breaths [like hyperventilation].

I would just ride it out, myself.

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.
03-06-2015 12:22 AM
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TyroneShoes Offline

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Post: #5
RE: Centrals on the rise!
Im in agreement with QAL (often a great place to find yourself!)

My sleep doc told me that my centrals are mostly false positives and nothing to worry about (I am a classic OSA patient who had no centrals during both the home test and the titration/PSG), especially those that flag when I am NOT EVEN ASLEEP.

Still, it is good to check the lengths. Also, look to see if the CA events cluster with REM. That is kind of normal, but you also want to be vigilant over time to make sure you do not develop real long or excessive CA events for whatever reason. You might also notice more CAs during higher pressure (assuming APAP).

I think side-sleeping has more effect on OSA than it might on CSA, due to the physical change in the airway; I can't imagine how it could affect CSA.

@SaltyDawg2: I notice in each of your graphs that you are topping out often at your max pressure setting. You are averaging a 5 AHI, or so, but maybe you should consult with the sleep doc regarding raising your max pressure a cm or two.
(This post was last modified: 03-07-2015 10:26 PM by TyroneShoes.)
03-07-2015 10:20 PM
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vsheline Offline

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Post: #6
RE: Centrals on the rise!
(03-05-2015 05:46 PM)saltydawg2 Wrote:  I am sleeping better on my side, but have noticed centrals are beginning to get carried away. I am posting a few shots from recent sessions to show what I mean. Any input would be appreciated.

Hi saltydawg2,

The Central Apnea Index was less than 5 (per hour) each night.

I think most US health insurance companies do not cover treatment for central apnea unless the CAI (all by itself) is at least 5 and accompanied by excessive daytime sleepiness.

If you think you would like to try an ASV machine, I would suggest printing out several nightly full reports where the CAI was at least 5 (I suggest each one should include a close-up view of the longest cluster of central apneas) and give the reports to your doctor and ask him to apply for pre-authorization for an ASV titration.

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 03-08-2015 02:19 AM by vsheline.)
03-08-2015 02:17 AM
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PaytonA Offline
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Post: #7
RE: Centrals on the rise!
(03-07-2015 10:20 PM)TyroneShoes Wrote:  My sleep doc told me that my centrals are mostly false positives and nothing to worry about (I am a classic OSA patient who had no centrals during both the home test and the titration/PSG), especially those that flag when I am NOT EVEN ASLEEP.

What is your definition of a "false positive"? Do you mean that the event was falsely scored as a central or that it was falsely scored as an apnea?

Yes the machine is stupid. It can't tell whether you are asleep or awake so it scores events by the rules given to it. It depends on the intelligence of the user to discriminate whether it has scored a sleep apnea or an "awake apnea".

Best Regards,

PaytonA
03-08-2015 11:14 AM
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TyroneShoes Offline

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Post: #8
RE: Centrals on the rise!
A central event is an "apnea" event by definition. Its a subset of "apnea". You can't distinguish between two things that are not different, so there is no accurate answer to your question.

Centrals also do not occur when awake, because no one just stops breathing while awake, unless they are doing it on purpose. So that makes it a "sleep apnea" event, again, by definition. Unless you are awake, and then it is neither, regardless whether the machine flags what it thinks is an event or not.

Any apnea event flagged by an xPAP that is not defined as a sleep apnea event and therefore did not really occur is a false positive, again by definition.

Not sure, but I think I might still be smarter than the machine.

"Apnea" is defined as a cessation of breathing, especially when asleep. So while there can be an argument for "awake apneas", on a forum board about "sleep apnea patients helping one another", the focus is on sleep apnea, and not really at all on "awake apnea" since that has little if anything to do with the condition or the therapy. So when folks on the forum speak of "apnea", you can be assured that they are probably speaking about "sleep apnea".
03-09-2015 04:28 PM
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PaytonA Offline
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Post: #9
RE: Centrals on the rise!
(03-09-2015 04:28 PM)TyroneShoes Wrote:  A central event is an "apnea" event by definition. Its a subset of "apnea". You can't distinguish between two things that are not different, so there is no accurate answer to your question.

The definition of apnea is, "a temporary cessation of breathing". I agree that a central apnea event is an apnea event by definition.

(03-09-2015 04:28 PM)TyroneShoes Wrote:  Centrals also do not occur when awake, because no one just stops breathing while awake, unless they are doing it on purpose.


All of your "false positives" are when you are awake and stop breathing on purpose??

(03-09-2015 04:28 PM)TyroneShoes Wrote:  So that makes it a "sleep apnea" event, again, by definition. Unless you are awake, and then it is neither, regardless whether the machine flags what it thinks is an event or not.

Any apnea event flagged by an xPAP that is not defined as a sleep apnea event and therefore did not really occur is a false positive, again by definition.

The event did occur just did not fit your definition.

(03-09-2015 04:28 PM)TyroneShoes Wrote:  Not sure, but I think I might still be smarter than the machine.

"Apnea" is defined as a cessation of breathing, especially when asleep. So while there can be an argument for "awake apneas", on a forum board about "sleep apnea patients helping one another", the focus is on sleep apnea, and not really at all on "awake apnea" since that has little if anything to do with the condition or the therapy. So when folks on the forum speak of "apnea", you can be assured that they are probably speaking about "sleep apnea".

The fact is that we all have temporary cessations of breathing (apneas) while awake and they are by definition central apneas but they are not central sleep apneas.

Our machines do not attempt to identify central apneas because they are missing one part of the required condition for a central apnea - the existence of a signal to take a breath. The machine discriminates between obstructive apneas and apneas that occur when the airway is clear or not obstructed.

Best Regards,

PaytonA
03-10-2015 12:30 PM
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eseedhouse Offline

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Post: #10
RE: Centrals on the rise!
(03-10-2015 12:30 PM)PaytonA Wrote:  Our machines do not attempt to identify central apneas because they are missing one part of the required condition for a central apnea - the existence of a signal to take a breath. The machine discriminates between obstructive apneas and apneas that occur when the airway is clear or not obstructed.

I think this bears repeating. A lot of people seem to just sort of assume that the machine's "CA" means "Central Apnea" when in fact it just means "Clear Airway", that is the machine detected that the airway was open and not obstructed. To be absolutely certain that is a real central apnea you have to record brain waves.

Ed Seedhouse
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Actually you know, it is what it isn't.
03-10-2015 02:48 PM
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