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Clustered CA's On Waking
#1
Clustered CA's On Waking
I have been on APAP since 2012 and have been doing very well thanks to help from this board.  I use an ResMed S9 Autoset.  My AHI over the past 7 years has usually been well below 5, normally in the .5 to 1.5 range.  For most of this time I have recorded more CA's than OA's - with APAP the OA's have always been very low.  Recently I have experienced large CA clusters on occasion.  This usually occurs during periods when I am waking up.  Last night I had an AHI of a bit more than 6.  I had about 35 CA's in the hour before getting up.  During this hour I was dozing off and on and at times just laying there awake - mostly on my back.  I use a nasal pillows mask and a chin strap (mouth breather).  The night before my AHI was .9 so this is not a consistent thing but the CA's appear to be getting more frequent.  I am wondering if this is a common thing or something to worry about.  Any advice?  Thank you. 

My settings are 5.8 - 12.6; epr fulltime 2.0.  30 day results:  CA 1.2; OA .2 Hypoapnea Index - .4; AHI 1.9.  6 Month readings show AHI 1.5; CA .9; OA .2; AHI 1.5.

Thank you
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#2
RE: Clustered CA's On Waking
Our breathing patterns when we’re awake are much less regular than when we are asleep, and when we’re awake, we hold our breath off and on. Try zooming in on the flow rate chart for that final hour. Do you see regular breathing interrupted by centrals, or do you see breathing that is more irregular over all?
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#3
RE: Clustered CA's On Waking
Without seeing the charts, this could be a sleep/wake junk thing. Another remote possibility is that time has a way of changing our therapy requirements. You might need those OSCAR charts to see what's happening while sleeping. Maybe your pressure settings are in need of an edit, or a new machine might be in your near future. All guesswork though until charts are posted.
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#4
RE: Clustered CA's On Waking
I get these too, although I also struggle with central events at sleep onset, being constantly awakened unless I take medication, so my causes may not be the same as yours.

But I particularly find if I stay in bed a bit extra long at the end of a night's sleep, with light sleep, especially if I'm on my back, I will get a lot of centrals. During this time, it isn't always clear that I've actually been asleep, but I deduce from the amount of time that has passed that I have been.

Now is the light sleep causing the centrals or are the centrals causing the light sleep? I do not know. But the CO2 setpoint (the amount of carbon dioxide in your system that needs to build up before the natural drive to breathe kicks in) is higher in sleep than in wakefulness. So theoretically if you are drifting in and out of sleep, the setpoint keeps changing, which could lead to centrals (i.e. you breathe enough to lower your CO2 to the awake setpoint, then drift off, and hold your breath until you reach the asleep setpoint, but then awaken and breathe more, and keep cycling between the two).
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#5
RE: Clustered CA's On Waking
Thanks to all for your prompt responses.  I think these CA clusters are mostly taking place during the waking period and I do roll onto my back during these period though I don't sleep on my back at all.  So I appreciate the info on what this may mean.  Also, I checked my flow limitation charts.  The flow varies a lot but during sleep it seems to jump from zero to .20 quite a bit then jumps up to .30-.35 and comes times up to .65 - basically somewhat irregular but in a fairly consistent way.  When the flow jumps way up occasionally I will be OAs which is to be expected, I guess.  When the CA clusters occur, it seems that I will be several minutes at zero, then it jumps way up for several minutes, then back to zero and continues like that until I get up and shut off the machine.  I don't seem to ever get a nice regular consistent flow limitation.  I do have a deviated septum and seasonal allergies which do cause some breathing issues at times.

I will key an eye on this and discuss it with my sleep doc when I see him next.

Thank you all.
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