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Flood of centrals
#1
Guys
Been on CPAP with Resmed Airsense 10 and P10 pillows for shortly over year. Had my ups and downs and been royally helped on here. Lately (since April) things have been great with typically min 5 hours uninterrupted sleep (up to 8 hours) and AHI always < 5 (usually < 3).
I review data with Sleepy Head and Resmed. On a couple of nights recently I've noticed I have had episodes lasting maybe 10 mins where I have had 'events' which had peaked AHI up to 9 or so but this average comes down, always below 5 by morning.
This morning I was shocked to see AHI of 8.8! I had long sleep last night which is unusual but I noticed for the last hour I had a huge flood of central apnea's. Well Resmed reported them as central, SleepyHead reported as Clear Airway. This last hour I am often awake so unusual to remain asleep. I don't remember dreaming or struggling etc.
Attached is printout. Should I be worried? Whats causes centrals? I know its only one night in an otherwise great record but I tend too worry - sorry.

Thanks in advance


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#2
Hi ehunter,

Welcome to the Apnea Board. There are several things that can cause "Centrals" in someone otherwise diagnosed and being treated for Obstructive Apnea. My first guess is that what you are seeing is what we commonly call "sleep wake junk". It occurs when one is falling asleep or just waking up. When one is awake breathing is controlled by conscious mechanisms amd when asleep by autonomic systems. The changeover can produce aberrant breathing patterns. The other common cause is CO2 washout that raises blood pH and makes the brain think that you have done enough breathing. CO2 washout is commonly caused by the differential between EPAP and IPAP. Bringing the EPAP setting closer to IPAP can reduce CO2 washout. Pressure relief on straight CPAP machines has the same effect as a lower EPAP setting. Now given that your cluster of Centrals is near the time you woke up, I would suggest that what you experienced was sleep wake junk. If you see more of this you could raise your EPAP setting closer to your IPAP setting. Do this in stages .5 or 1 Cm H2O at a time. One caveat is that Congestive Heart Failure is a cause of an increase in Centrals and Periodic Breathing. You would generally see a more distributed rise in Centrals if this were the case. Keep an eye on your Centrals because they can be diagnostic for CHF. Good luck with your treatment.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#3
Thanks for the detailed response Rich

I don't think (hope) its CHF! Only earlier this year I had some extensive cardiac tests - stressed ECG, ultrasound, CT scan etc - all were really good.

Sorry but Im not familiar with the terms IPAP and EPAP. My machine does auto pressure control. Is this the pressure range? I always considered my treatment range quite flat?

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#4
Hi ehunter,
For your reading pleasure.... Smile

http://www.apneaboard.com/wiki/index.php...efinitions

EPAP - (Expiratory Positive Airway Pressure) - The pressure prescribed for the expiratory (breathing out) phase of an individual on Bi-level CPAP therapy for OSA (obstructive sleep apnea).
IPAP - Inspiratory Positive Airway Pressure. The pressure prescribed by a physician for the inspiratory phase on a Bi-level CPAP device, used in the treatment of OSA.
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#5
The setting Rich is referring to is called EPR on your machine.

My guess is that with an unusually long sleep, your last hour was of very shallow sleep which produced a lot of sleep/wake junk as your brain drifted between barely asleep and barely awake. I tend to lay in bed like this on weekends and my AHI for the last hour is all over the map.
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#6
This appears to be an issue with me too. Always half awake/sleep. I am hoping for it to be pressure related. I am going to see Dr. tomorrow for ECG and Holter monitor. I too, do not think I have any heart issues but then again something is causing this. I am anxious to hear all the replies.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#7
Thanks for the reassurance guys. It was kind of what Zi was thinking.
Last night I went to bed at 10, same a previous but this time woke at 4:30. AHI back down to 2.8.
When Ive seen these episodes (never as long as example posted) I always felt likely to be just "twilight" period of restlessness. Maybe just law of probability I should have one just before waking and so have higher average AHI.
Will review more data and see!
Kerp up the good work!
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#8
[attachment=2871][attachment=2870]Guys, Update!
Had another couple of high AHI nights. Didn't panic but when I came to download data, noticed on one particularly high AHI night. When I checked data, AHI got as high as 30, all centrals and Sleepyhead reports period of Cheyne Stokes breathing! Googled this and scared the whatnot out of myself! Will send report to sleep doc but also thought I'd share on here. Its only happening occasionally, these flood of centrals late in my sleep, but this is first and so far only time of Cheyne Stokes.
What does this mean?
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#9
More info.....
Discussing this with my partner on both recent "periods" of these high centrals, its been broadly aligned with having cold/cough. First time was at the end of a really nasty 2 week cold. This week I've very dry feeling chest and tickle cough though not bothersome. Could this be linked?

I really don't believe I have congestive heart failure. In first quarter of year had extensive cardiac tests, recently had chest CT scan which was clear. Also been exercising last couple of months and getting much fitter and lighter!
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#10
How long have you been taking Phenergan? Do you take it every night?
Do you experience the clear airway events only when you take this medication?

There may be some correlation between the meds and CA events. This is something to discuss with your sleep doctor.

I also wonder if you are rolling over on your back during the time you see the CA events?
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