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Cheyne-Stokes – Is it?
#1
Cheyne-Stokes – Is it?
My first diagnosis was 15 years ago which I had very little information and did not know what to ask. That doctor did my first surgery for nasal polyps and prescribed CPAP at 10.  That was from an over-night Lab study. My RemSTAR Plus c-Flex broke last year. Like everyone, I questioned my need for CPAP but feeling tired and headache, I went to ENT for evaluation again. My first doctor had retired.  I chose a Home study as did not like the Lab experience but now wish I had another lab study. One doctor passed me off to another doctor that just prescribed full auto from 4 to 20.
 
I have only been using OSCAR for few days so still in deep learning curve. But I have to say the developers are great because this software has so many features and very well designed.

I have Cheyne Strokes showing up. Is it really? My doctors have never explained my test other than I needed CPAP. So I see, after my recent surgery I am doing OK for Obstructive events. It appears that Central Apnea and now what ever Cheyne is, are my main problems. Doing a little reading on Cheyne, it appears can be falsely diagnosed with other CA events.

I have an Oximeter on the way. I could not find any of the recommended. I have a Emay Wrist in shipment already. Hopefully I can import CSV. 
 
So without the oxygen, does this look like Cheyne? And what are the implications?


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#2
RE: Cheyne-Stokes – Is it?
Was not prepared for the 3 attachment limit. So I posted the focus on question and not the overview. Here is the overview.


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#3
RE: Cheyne-Stokes – Is it?
Welcome to the forum.

No. ResMed calls any and all periodic breathing "CSR". Yours definitely is not CSR.

Your 95% Flow Limits are high. I do suggest 2 changes

Set Min Pressure =7 (up from 4)
Set EPR =3, Fulltime

This is to better manage your flow limits. EPR does wonders for treating flow limits. Min of 7nis needed to allow the EPR to work.
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#4
RE: Cheyne-Stokes – Is it?
Thanks I did not realize the event was close to disconnect. So misdiagnosed because of wake-up. 

So the CA events seem to be my only current problem. Do you think an Oximeter would be a good investment to see how bad the shallow breathing is affecting me or would just be a minor data point? If so where can I get an Oximeter that OSCAR would sync with?
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#5
RE: Cheyne-Stokes – Is it?
Thanks Gideon for explaining I only have periodic breathing CA. Concerned about how my CA looked, I purchased a Oximeter. Actually 2 because I had to learn what OSCAR used. So, I now am using a Contec CMS50F.

Now that I have one, I am trying to understand the O2 values in relation to the CPAP measurements. I am guessing from holding my breath type test, that there is a significant delay between the action of stop breathing and the time that the O2 starts to drop. But my O2 start increasing in steps while my CA was almost flat line. Totally confused.

          

I will post but the preview is not showing my images. ?

But they did go through.  Strange
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#6
RE: Cheyne-Stokes – Is it?
Please explain the Flow Limit, Tidal Volume and what the CPAP reacted to at 23:24.

I thought pressure increase would be response to event of diagnosed blockage, but I don’t see it.
Isn’t the Tidal Volume the amount of air moving which did not change significantly. The Flow Limit increased as the Pressure increased.
So I am confused.
1.) what the pressure increase was in response to 
2.) why the increased pressure appears to not have moved any additional air
3.) Tidal volume changes but not significantly

   

   

   
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#7
RE: Cheyne-Stokes – Is it?
Could it be the Hypopnea at 23:17? Is it normal for a 5 minute delay for a machine response?
To me it looks like symptoms stabilized before the response.
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#8
RE: Cheyne-Stokes – Is it?
I can't believe I still don't understand. Trying to search the Apnea Board wiki and general internet for my question on Tidal volume and Flow Limit.

Found few threads on another CPAP talk board that just degenerates to insulting dismissals and never answers the question. Thankfully I have not seen that on this board.

Apnea Board Wiki:
Tidal Volume - The amount of air that is inspired or expired in an ordinary breath. Usually expressed in milliliters per second (mL/sec). Used with the respiratory rate to calculate Minute Vent. (Minute Ventilation in L/min = (Tidal volume in mL/1000) * (Respiratory rate in breaths per minute)
Flow Limitation (FL) - Partial closure of the upper airway, which impedes the flow of air into the lungs.

So I believe a FL should impact all measurements of air flow.

For me this example appears at 23:17 when minor FL event and the Tidal Volume dropped from 770 to 254.

But at 23:24: More severe FL and increase pressure response. But Tidal Volume minor change.

Should not the Flow Limit be explained by change in Flow Rate and Tidal Volume? At 23:23 a step pattern of FL starts with 5 step peaking at 23:24. Pressure increase from 7.5 to 10.2. But during this period, only minor changes in Flow Rate and Tidal Volume.
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#9
RE: Cheyne-Stokes – Is it?
Would it be the pressure increase did a great job of maintaining the Flow Rate and Tidal Volume and it there was not a pressure increase, these numbers would have changed more?

Is the Event / Machine Response so sub-second timing that the cause and response is not always obvious?
At 23:17 it seems obvious. At 23:24 it is not.
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#10
Continue or Stop Pap after wake-up
Less than half of my nights I wake up anything from middle of night to just before time to get up. Sometimes for the usual reasons. But since I switched to AirSense 11, my mask gets wet and starts leaking. But in any case, after waking my number usually get worse. 

 I don't think it matters to my insurance but it just makes my number look worse. And I question the benefit since I am only half asleep, it usually aggravates me a lot. 

For the attached screen shot, I first woke about 4 am and would continue APAP again at this time. Later about 5:50 am I woke again. I did not go back to sleep completely. So everything went bad. So about 35 events.  So before my AHI would probably be 0.5 instead of 5.5

So my question is, if it is later than middle of the night should I continue APAP.

   
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