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[Health] Is this CSR? How much should i panic?
#1
Gross 
Is this CSR? How much should i panic?
So, I hate being the newbie asking a million time asked question, but I am paranoid enough to do it anyway.

Long story short, I got divorced at the end of last year, and it was the final butt kick I needed to get myself back on track. Many years ago I had done the sleep study, but never had success.  However, this time around, my body seems to be receptive to my new machine, and I have been 100% compliant for the week+ I have used it.

That said, now that I have been doing all the reading and learning that I can, I have managed to get myself scared (as opposed to happy from greatly reducing my AHI), based on the periodic breathing reported.  I am really afraid that it is CSR, and that it is too late to truly fix me (100% disclosure, I am something of a hypochondriac, and places like WebMD are my arch enemy..)

If people don't mind, could I get some feedback on the three shots?  The gap in the second picture was me waking up, and adjusting the mask for better fit (I turn the machine off to avoid corrupting the data with leak rate, etc).  Following that of course is me going back to sleep (ironically where a bulk of the PB/CSR is...)

[Image: fuscJcg.jpg]

[Image: AMigduX.jpg]

[Image: PBh4QM8.jpg]
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#2
RE: Is this CSR? How much should i panic?
I wouldn't worry about the periodic Breathing. However your leaks are out of control. I wouldn't trust your results until you get your leak rate down.
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#3
RE: Is this CSR? How much should i panic?
G'day Madcat207. Welcome to Apnea Board.

The total recorded periodic breathing only lasts a few minutes and the episode in the first plot starting at 04:48 looks more like an obstructive situation to me but is also likely a transition to sleep event. The episode starting at 22:05 is probably during or immediately after your transition to sleep, so is also likely irrelevant.

True CSA CSR usually has lots of central apnea associated with it but you're not showing any centrals. CSA CSR is also associated with congestive heart failure and other nasties which your doctor can quickly eliminate at your regular checkup.

Personally (and remember I'm not a doctor, just another internet opinion) I don't see anything to worry about here. Your hypochondria is likely to do you more harm (by stress) than these few minutes of periodic breathing.
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#4
RE: Is this CSR? How much should i panic?
(01-06-2018, 09:38 AM)Walla Walla Wrote: I wouldn't worry about the periodic Breathing. However your leaks are out of control. I wouldn't trust your results until you get your leak rate down.

WW the OP is using a Philips machine which (as I understand it) reports leaks differently from our Resmeds. I don't think there is a problem here going by the reported leak rate.
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#5
RE: Is this CSR? How much should i panic?
(01-06-2018, 09:47 AM)DeepBreathing Wrote: G'day Madcat207. Welcome to Apnea Board.

The total recorded periodic breathing only lasts a few minutes and the episode in the first plot starting at 04:48 looks more like an obstructive situation to me but is also likely a transition to sleep event. The episode starting at 22:05 is probably during or immediately after your transition to sleep, so is also likely irrelevant.

True CSA usually has lots of central apnea associated with it but you're not showing any centrals. CSA is also associated with congestive heart failure and other nasties which your doctor can quickly eliminate at your regular checkup.

Personally (and remember I'm not a doctor, just another internet opinion) I don't see anything to worry about here. Your hypochondria is likely to do you more harm (by stress) than these few minutes of periodic breathing.

Thank you both, I appreciate the feedback. 

So, with regards to the PB, I know that's not good either - but should I be overly concerned (in your opinion of course)?   Looking on my data, I have maybe 5-6 marked CA in the whole use of my machine (since the 27th). 

I admit, my hypochondria is a bad thing, and believe it or not, I am probably the worse kind.. I have a tendancy to self diagnose, get VERY worried, and then....... worry. I cant seem to bring myself to a doctor for many things; deep down (and this is so stupid, but I cant fix things if I am not honest) I hate being told I have something wrong (or have done something wrong). So more often than not, I will just worry myself until I forget about it.  It has been a little while since seeing a doc, but they didn't report a bug concern other than my blood pressure (which is a huge risk I know for CHF, so...). 

Sorry for rambling.  I am really trying not to worry, and get it out of my mind that I will keel over in the next few months.  This has been hard for my daughter, and that is the last thing I want to put her through.

(01-06-2018, 09:50 AM)DeepBreathing Wrote:
(01-06-2018, 09:38 AM)Walla Walla Wrote: I wouldn't worry about the periodic Breathing. However your leaks are out of control. I wouldn't trust your results until you get your leak rate down.

WW the OP is using a Philips machine which (as I understand it) reports leaks differently from our Resmeds. I don't think there is a problem here going by the reported leak rate.

I do have to agree there DB - I don't possibly see how I could improve it.  when I first lay down, the seal is excellent, but the mask (hose) has the vent holes, so it will "leak" no matter what.  When I do wake, the leaks I have adjusted for feel minor, but I guess I cant be certain..
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#6
RE: Is this CSR? How much should i panic?
I agree about no leak problem. I even own a Dreamstation and know the difference between total leaks and leak rate. I just flat out missed it. Sorry about that!
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#7
RE: Is this CSR? How much should i panic?
I think we have all experienced some periodic breathing from time to time. This does not resemble CSR and you do not have any of the requisite central apnea events. Among other things, you seem to have a very healthy tidal volume and minute vent, although you "appear" to have a slightly high resp rate, that is often due to the machine improperly counting respiratory irregularities. With pressures at 14.5-20 and you are using the upper end of that range, I think you might be better off with a bilevel machine for both comfort and efficacy.

It takes some time to settle into CPAP therapy, and these periodic events and other irregularities are not uncommon in new users. Give it some time, and it should look more settled. If you have any discomfort with pressure, a bilevel may be a better solution long-term, but don't worry about it for now.
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#8
RE: Is this CSR? How much should i panic?
Hi Madcat207,
I agree with the others, don't worry about it. This is your first week, for some of us the beginning is the worst for CAs and periodic breathing. This was my experience with periodic breathing. One my first few days on therapy is shown on the link. After the PB was reduced quite a bit. After 6 months, I very rarely see it.
https://i.imgur.com/5xYgmmH.png
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#9
RE: Is this CSR? How much should i panic?
For me, after reading about it, I was a bit concerned since I had a "marked" PB at least once a night (though no more than a few a night at most). But I am still starting, so I am not sure where my body will settle.

Believe it or not, but the higher pressure doesn't really deem to bother me.  Or if it does, I am not realizing it.  I am sleeping pretty well, though I wake a few times (most of it I think is to fix the mask, but its hard to say; it doesn't feel like a chocking event, but I am not sure).
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#10
RE: Is this CSR? How much should i panic?
If people don't mind, I just wanted to run two other shots of "PB" and see what people thought.

This first one just feels like the machine is perhaps over sensitive?
[Image: Bjn2ndA.jpg]

This is the other kind of "PB" that I see marked (again, don't have a ton of these things in general, and looking at it, it looks like about 90% are within ~30-40 minutes of laying down to sleep.
[Image: cxq1OSg.jpg]


Do either of these raise significant alarms?
Finally, here is one with some of the very rare CA's that are marked...
[Image: P0kzMfP.jpg]

BTW, I acknowledge that I should ask a provider these things... only, I don't have a provider, having moved recently, I don't anyone I am working with right now. Thus, while I know its not "medical", I really do appreciate all the feedback and support. Forums like these are amazing for the knowledge they hold, and I am so thankful to be able to pick experienced brains.
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