(08-22-2015 11:31 AM)xdocgx Wrote: What number value should be a concern for me in three weeks or so, for Periodic Breathing and/or CSR?
Not sure whether there is a specific threshold in number of CPAP-induced CSR-like events per hour, above which we would be concerned and below which we are fine. I think we need to pay close attention to how we feel, fatigued or refreshed, upon awakening.
If CSR is occurring without CPAP therapy, this "real" CSR is often an indicator of very serious illness. But when a similar breathing pattern is induced/caused by CPAP therapy, the same breathing pattern can be called "CSR-like" rather than "true" CSR.
When Positive Airway Pressure therapy causes smoothly-varying Periodic Breathing without CA pattern (depth of breathing gradually increases (Tidal Volume gradually increases) to a peak followed by a slow transition again into excessively shallow breathing, and the cycle slowly repeats with a period between 30 seconds to a couple minutes, without apneas occurring) I think this usually causes no problems. That is, I think blood oxygen levels usually do not drop enough to disturb sleep, and therefore little or no stress or fatigue or mental fogginess accompany this. Maybe this mild form of PB would be keeping us in shallow sleep, preventing us from reaching the deeper and more restorative sleep stages while PB is occurring, but if this is happening only during a small portion of the night I think the overall effect of the mild form of PB is nothing to worry about.
(Tidal Volume is the estimated amount of air we are breathing in or out in each breath.)
However, when Positive Airway Pressure therapy causes smoothly-varying PB with CA events (CSR-like pattern, where one or more breaths are completely skipped) I think these may be of concern, especially if accompanied by SpO2 desaturations of 4% or greater, disturbed sleep and resulting fatigue and mental fog.
Some patients sometimes have a pattern of repetitive central apneas which is not CSR-like, in which the decrease in breathing depth (Tidal Volume) is smooth and gradually transitions into central apnea but when the apnea ends the Tidal Volume restarts suddenly, jumping sharply. I think this may be a combination of central apnea plus obstructive apnea, where the apneas start as central apneas but during each apnea it transitions into obstructive apnea, in which case higher pressure may decrease the obstructive component, but higher pressure may also make worse the central component. So, to find best overall pressure settings, a small adjustment in the Min Pressure and/or the Max Pressure setting may need to be made every week or month, in order to empirically achieve lowest overall sleep quality.
For most patients, the RDI is considered a good indicator of overall sleep quality. RDI is the Respiratory Disturbance Index, which is the average number per hour of the total of apneas plus hypopneas plus RERA. RERA is Respiratory Effort Related Arousal, which is an arousal (an arousal can be an awakening but usually is merely a change into a very shallow stage of sleep in order to breath more strongly) which has been caused by the effort needed to breath when the airway has become restricted, partially obstructed.
A recording Pulse Oximeter would be able to keep a record all night of your SpO2, which is the percentage of Oxygen saturation in the blood. (The "p" in SpO2 signifies it is measured through the skin, percutaneously, using a Pulse Oximeter.) The type like a watch with separate finger sensor is less likely to fall off during sleep and is far more comfortable to wear all night once in a while (like once a week or once a month). Supplier 19 sells Pulse Oximeters and has a good reputation. A link to the Supplier List is at the top of every forum webpage.