Centrals on the rise!

[saltydawg2]

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.

[saltydawg2]

Maybe a look at the events section, rather than the pie chart from last night will explain my concern; they seem nonstop. Thanks, again.

[retired_guy]

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.

[quiescence at last]

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

[TyroneShoes]

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.

[vsheline]

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

[PaytonA]

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

[TyroneShoes]

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".

[PaytonA]

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.

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??

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.

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

[eseedhouse]

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.