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Centrals or Obstructive
#1
Centrals or Obstructive
Only problem is on sleep onset.  Completely comes and goes.  Was told by a few Drs (some very respected ones at Ivy league medical schools) that these look like Centrals but marked OAs.

How can you tell the difference?  

I also don't think I am even fully asleep when these happen. 

Posted examples:

   


   
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#2
RE: Centrals or Obstructive
Almost certainly centrals I would say. PR doesn't do a great job of identifying CA events. I would have expected to see pressure pulses here (which is how PR determines if the airway is open, unlike ResMed which uses FOT - Forced Oscillation Technique). Maybe you haven't enable pressure pulse display enabled? The oscillation in the flow waveform here is likely a cardioballistic artifact (i.e your pulse, with heart pushing against lungs causing airflow to vary in the absence of breathing effort), with your pulse rate around 60 (count peaks/time which aligns with the Pulse Oximeter measured rate).
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#3
RE: Centrals or Obstructive
Oh, and to answer the question of how to tell the difference - for some people the cardioballstic artifact will be small or absent with an obstructive apnea, but larger/present with a central/clear airway apnea. But this can vary as indicated in the article above.

Accoding to this article PR also uses the size of the recovery breath at the end of an apnea to classify CA vs OA. So a large breath after an apnea (such as in your flow graphs) will likely be classified as OA compared to if you took small breaths when coming out of the apnea event.

Given that this is happening as you're falling asleep it's probably sleep wake junk - see this wiki page for a good discussion around all these issues...
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#4
RE: Centrals or Obstructive
I agree with the analysis by kappa. The diminishing flow going into the apnea points to potential sleep-onset central apnea. I don't see enough evidence of flow limitation for obstructive cluster here. It's a brief period at the beginning of therapy, and has no real impact on efficacy. Sleep-wake-junk seems to fit this.
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#5
RE: Centrals or Obstructive
Wow that was very informative so fast! Thank you. I will check out these articles within the next day or two. Skimmed them for now and seems a little complicated to grasp.

This has been going on for about a year. Happened suddenly. Comes and goes but when it’s here it crushes me. Takes hours to fully fall asleep.

From the Drs I’ve seen - they have kind of landed at onset central sleep apnea. But they don’t know what to do about it.

The worst part is the accompanying chest pain when it’s happening. And my mental health goes along with it.

Kappa - any tips on how to overcome this?
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#6
RE: Centrals or Obstructive
Also I can only sleep on my right side. If I sleep on my back or left side - this happens much more frequently. Told the Drs this and they looked at me like I was crazy.

I believe people on the boards previously have said that’s common.
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#7
RE: Centrals or Obstructive
Hi NewToSleepApnea,

Another thing of note in your chart is the high pulse change rate of 50.21. Are you able to show the whole night and enable flagging of pulse changes.

      (this was an unusual night with very high pulse change rate - I was likely in AF for those few hours...)

It's probably a good idea to speak to your doctor about any chest pain you're experiencing and get it checked out properly (e.g. using a holter monitor over a period, various other tests like echocardiogram)
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#8
RE: Centrals or Obstructive
Thank you again for the help.

I enabled the flagging of pulse changes.  I usually have between 30-50 show up as the number there.  But it never spikes high like in your picture.  The oximeter is also a year old and seems pretty worn down - lagging from wear and tear of using it every night.

I have went to the Cardiologist and gotten EKGs and Echos.  Thought I was having a heart attack one night it was so bad and prolonged.  And I'm only 35.
But they checked it all out and said its probably just Costochondritis.  

I've had those heart tests and even a brain MRI - and all seemed fine.  

Here is all of last night plus a zoomed in version of 20 mins.   I never actually got asleep until about 3:20am.  Once I get to sleep - I'm golden.

   


   
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#9
RE: Centrals or Obstructive
It would be real nice if it were just the ScreamStation that we could pin this on. That's a maybe easier change.
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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#10
RE: Centrals or Obstructive
Yea I’ve been told the dream station isn’t the best. Is the resmed that much better that can help this ya think?

I’m really hoping it’s anxiety related somehow. But I never had it until this started. Now I never look forward to sleeping.
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