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Long-time cpap user - central apneas and CSR/PB
#1
Long-time cpap user - central apneas and CSR/PB
I am a long-time (17 years) cpap user and have been mostly very satisfied ever since my extreme tiredness was fixed using a cpap.  I rarely miss a night without one. In the past I have worked through issues with mouth breathing but do fine now because I never sleep on my back and wear a cervical collar. I am very happy with my current mask.

I have questions about my central apneas and CSR/PB that I hope someone can help with.

In past years, I've noticed some Periodic Breathing (when using the PR System One) or Cheynes-Stokes (when using a ResMed machine) - averaging between 4 and 5% depending on which time period I look at. The sleep clinic (board-certified) doctor has always said that since my AHI has been OK and I feel good that we shouldn't worry about this. I am 73, heathy and fit with no known heart or lung issues - and take no drugs.

But the last 2-3 years the percentage of Cheynes-Stokes seems to be increasing slightly, or maybe it's just that I've had more noticeable bad nights. Throughout the years I have been using a pressure range of 6-10, 7-10, then 7-9, and then a fixed pressure of 8 as recommended by the doctor. At my last appointment he said to try using a lower fixed pressure, as it may have been higher than I needed and could have been contributing to the periodic breathing. I am now using 7. I have never used, or liked, EPR or A-Flex.

I have also noticed in my OSCAR flow rate charts that there are periods that look like PB or CS that are not tagged by the machine as being such because they must not quite fit the definition. I rarely have obstructive apneas - just hypopneas and centrals that are associated with periodic breathing or breathing that looks similar to periodic but is not tagged.

Using a pressure of 8, from July 2021 through May 2022 the medians were AHI: 1.76 (H: 1.44; CA: 0.41) and CSR 4.71%.
Since June I've been using a pressure of 7 (with a few days at 6.6). The medians are AHI: 2.9 (H: 1.86; CA: 1.37) and CSR: 5.5%

My main problem is that sometimes I have a night, or several in a row, with a  CSR of 10-25% and an AHI of 9-15 (more than half centrals). I seem to sleep through the night and wouldn't know that anything was different about my sleep, but I am definitely more tired the next day.

I would love to hear from some of the knowledgeable people in this group. I am attaching OSCAR data for a couple of the bad nights and a more typical night.

  1. Does anyone have any insight as to why some nights are so different from others? I have found no contributing factor - other than altitude. When traveling at higher altitudes I am more likely to have more CSR and AHI, and then to be more tired. Otherwise, in everyday life close to sea level, I have no idea why, for example, the last four nights all had high AHI/CSR.

  2. Is this level of CSR/periodic breathing anything to be concerned about other than its effect on my overall AHI?

  3. How different are PR and Resmed in coding CSR/PB and central apneas? I've used both in the past and am not sure how to compare them.
Thanks for any insights

   
   


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