Do I have Cheyne-Stokes?

[cisbrane]

I started my APAP machine last week after being diagnosed with an in-home sleep study kit saying I had 65 OSA events an hour. However, after examining the data from SleepyHead, it looks like I am having several periods of what appears to be Cheyne-Stokes, but as I am untrained I am not certain. Reading about this condition has me very anxious as it could mean congestive heart failure or neurological issues. I did have a cardio stress test performed a few months ago after a sudden chest pain, but the doctor said that the data had looked fine and not to worry. I am wondering if I need to do some other testing, etc. I do have an appointment setup with my ENT for tomorrow who prescribed my APAP to hopefully go over my data, but I am not sure how confident I feel in this doctor's ability as they are not primarily sleep doctors. I am debating if I should go ahead and make an appointment with my cardiologist anyway, but I am not sure. Thanks for any advice.

[Walla Walla]

No, but you do have a bunch of CA's.

[Sleeprider]

Cisbane, turn off EPR on your machine and that should help with centrals. Pressure is set from 4 to 20 which is default It looks like your range is only 4-6 cm. There is definitely periodic breathing and a lot of centrals here. Assuming you have good heart health, it is extremely unlikely this is Cheyne Stokes. All cases I have seen have a longer period between apnea, and much longer apnea.

[cisbrane]

Thanks for the response. How can you tell it is not cheyne-stokes? Is the period length? It did look similar to the simplified graphs I saw on Wikipedia.

But yes, several central sleep apneas. This pattern has repeated every day, where especially at the later time of when I am sleeping this pattern of several CA appear.

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I turned off the EPR last night, and the data output looked almost exactly the same as the ones posted here, even with the pattern of CAs towards the end of the data. It didn't look like EPR was really kicking in anyway as my pressure never went really high. I will keep using it w/o the EPR as it didn't seem to make a difference.

Could this be CPAP induced CA? I will say when I am trying to go to sleep I realize at times that I am holding my breath even though I didn't consciously do it. Maybe I don't like all of the air flowing in?

[Apnea Infant]

Your machine will record it as Cheyne Stokes if it was and will be all green. I have had that a couple of times and it is worrying as we all read on the internet what it might mean. But the guys here reassured me that it is plain old periodic breathing which I do not get much of anyway. And I do not have the contra-indications of CSR.

For quite a few of us CPAP induced centrals do subside after switching off EPR for a while. However there are some for whom it does not and have to have other forms of specific PAP therapy.

[cisbrane]

Thanks for the responses so far, this makes me feel better. I didn't know the machine would mark events as cheyne stokes if it thought it was there. What kinds of things can be done reduce the periodic breathing and/or central apneas?

[Sleeprider]

Thanks for the response. How can you tell it is not cheyne-stokes? Is the period length? It did look similar to the simplified graphs I saw on Wikipedia.

But yes, several central sleep apneas. This pattern has repeated every day, where especially at the later time of when I am sleeping this pattern of several CA appear.

---

I turned off the EPR last night, and the data output looked almost exactly the same as the ones posted here, even with the pattern of CAs towards the end of the data. It didn't look like EPR was really kicking in anyway as my pressure never went really high. I will keep using it w/o the EPR as it didn't seem to make a difference.

Could this be CPAP induced CA? I will say when I am trying to go to sleep I realize at times that I am holding my breath even though I didn't consciously do it. Maybe I don't like all of the air flowing in?

We can't rule out CSR, but it is closely associated with heart failure, and most people are aware of that.  Some more typical examples of CSR follow that show higher rates of CA longer CA duration and a longer period between events.  It is worth noting that a cardiac evaluation that determines your left ventricular ejection fraction may be a worthwhile and simple procedure (echocardiogram) in order to qualify for Adaptive Servo Ventilation (ASV), which can effectively treat central apnea which you do have.  At this point, I suspect you have CPAP onset central or complex sleep apnea, and that it will either pass soon, or you will indeed require a different treatment modality like ASV. The first thing I'm suggesting you try is to turn off EPR. You can see that in the example graph below, that strategy did not work.

[cisbrane]

Thank you. I will spend the next few nights with the EPR off. I did that last night (data not posted) and it didn't show any difference. I do see the differences in the data you posted and my data; thanks for showing that. How long is reasonable to wait to see if CPAP onset CA will clear up? I did some reading on the ASV and it does seem like a good choice to treated compled sleep apnea.

Lastly, is it normal for your chest to start hurting after starting this? I have noticed my chest feels a lot tighter and slightly painful. It did not feel that way prior to starting treatment. Maybe it's just my lungs filling with so much more air?

[Apnea Infant]

It is not normal for our chests to hurt after starting CPAP therapy but some discomfort may be due to a distended belly as a result of aerophagia ie swallowing too much air. I also recall a discomfort and felt really bloated and 'farty'. Sorry can't think of more appropriate term for it. I used to burp a lot too in an effort to get rid of all that extra air. At nights I used to suffer reflux as well as there was just too much in my belly.

In time with leaks subsiding and learning the tongue suck technique less air was persuaded to my belly and the problem ceased.

I do not think your lungs take in more air than you need.

[Sleeprider]

Cisbrane, normally a doctor will require an individual to fail at CPAP for a month or more. Many individuals experience some central apnea when they first start CPAP, and it often goes away in that time. You however had a home test diagnostic and no titration evaluation. You clearly have moderate CSA with CPAP and I don't think this is going to spontaneously resolve.  Your pressures are already low, you have tried with EPR off, and I'm sure the pressure did not exceed 6.0 cm.  This just has all the appearance of an intractable central apnea that CPAP will not treat and you will be moving to ASV.   I'm not even sure you have complex apnea because there is not any indication of obstructive apnea, hypopnea or flow limitation.

I would not wait to bring all of those issues to your doctor's attention. The sooner you can be scheduled for an evaluation of bilevel and bilevel ASV, the better.  It will take some time to schedule a sleep test to perform the bilevel ASV evaluation anyway, and in the meanwhile you will probably need to do cardiac screening to verify LVEF greater than 45%, which is a qualifying risk assessment for ASV. I will post the procedure to determine when an individual can be moved to ASV and how to titrate below.  Let me know if you have any questions.  We have many members that have successfully moved to ASV, and you can expect that the treatment would result in nearly zero events in your case.  You have one of the most straight-forward cases I have seen, and I think you will resolve near the minimum pressures in the titration protocol.  ASV can be expensive, so if you don't have good insurance, let us know and we can talk about lower cost options than the conventional DME-Insurance payment approach.