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Upset about central apnea
#1
I've been looking at my Sleepyhead results for the first time these last couple of days. (I had to get a new hard drive to get it downloaded.) I was surprised to see that I have so many central apneas. Well, not really a lot since my AHI is pretty low with treatment. But, without counting, it seems like the central and obstructive events are pretty equal on the graph most days. My sleep doctor never mentioned that to me and just told me I have OSA. I was wondering if the SleepyHead data would be accurate on that account. I didn't sleep long during my sleep study - about 4.5 hours, so maybe those results weren't that comprehensive.

I guess my question is this: would you believe the Sleepyhead data about central apena to be accurate? I suppose that sounds silly - I guess I just didn't want to have central apnea - it sounds more scary to me. I was just getting used to being 'very severe' and now this makes it seem even worse. Any thoughts?

Thanks in advance for your responses.
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#2
A few initial thoughts. The field of medicine loves to create yardsticks and lump people into groups based on that. So "severe" is just relative to that yardstick and the other groups. They could have called it low, medium, and high or Fred, Bam Bam, and Wilma. I would not get too upset over a label. And AHI is a pretty crude yardstick at that. If you stop breathing for 10 seconds 5 times a hour, you have an AHI of 5. If you stop breathing for two minutes 5 times an hour, you have an AHI of 5. Try holding your breath for 10 seconds and then two minutes and you will see what I mean about a crude yard stick. Both are "Mild" sleep apnea.

Central apnea can only be accurately diagnosed in a real sleep lab, based on data from multiple sensors. And 4.5 hours of sleep is a pretty good time for a sleep lab. You are not the first one to have trouble sleeping. I doubt I slept much more than an hour in mine. The machine is just guessing that it is central apnea based on air flow.

If these central events happen mostly while you are going to sleep, or waking up, or when you might be turning side to side in bed, or otherwise not really fully asleep, then I would ignore them. The machine is just mis-interpreting your awake breathing irregularity. Or it could be the machine is causing you to have these events through "CO2 washout". I forget how long you have been at this. I had quite a few for the first couple of months, then they mostly stopped. SleepyHead shows a few a week at most.

Finally, just how many of these events are you having in a nightly basis?
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#3
Central apnea is just a different type of apnea that may require a slightly different type of PAP unit but as long as there are not too many centrals and they are not too long duration they are nothing to worry about.

Another thing to consider is when the centrals are occurring. If they are mostly occurring while still awake or when you are falling asleep or when you are awakening, we call them sleep/wake junk and they should be ignored.

One other thing about centrals is that sometimes new users get them even though none showed up in their sleep test. This can be a temporary thing and may go away after a while.

One last thing which is actually a repeat. Central apneas are no worse than obstructive apneas just a different cause.

Best Regards,

PaytonA
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#4
Chill and PaytonA, Loved that you responded so quickly so I could read what you had to say before retiring. You both helped me put it into perspective - perhaps it's not as 'central' as it appears on Sleepyhead; or, even so, it is what it is.

I went back to Sleepyhead and noticed that the clear airway events were often during my semi awake hours - when I would first retire or when I would wake up and leave the machine on for a while longer in case I dosed. But there were some in-between too. Maybe 4 on average in the middle of the night. For the last 30 days my stats were: CA 1.10 - Hypo .08 - Obstructive .62 = AHI 1.81. I started treatment 4 months ago. I am pleased that my AHI is low, so I suppose I'm a little whiny.

This forum is so good for me!
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#5
(12-03-2016, 01:12 AM)sleepytimegal Wrote: I went back to Sleepyhead and noticed that the clear airway events were often during my semi awake hours - when I would first retire or when I would wake up and leave the machine on for a while longer in case I dosed. But there were some in-between too. Maybe 4 on average in the middle of the night. For the last 30 days my stats were: CA 1.10 - Hypo .08 - Obstructive .62 = AHI 1.81. I started treatment 4 months ago. I am pleased that my AHI is low, so I suppose I'm a little whiny.

This forum is so good for me!
sleepytimegal,

There's a perfectly normal phenomenon called a "sleep onset central apnea" that is NOT even scored on an in-lab PSG. When we go from WAKE to SLEEP, the control for our breathing is handed off from the voluntary nervous system to the autonomous nervous system. As part of this handoff, the CO2 level for triggering inhalations is reset to a slightly higher amount of CO2. As a result, it is very common for people (even people with NO apnea at all) to skip a breath or two just as they fall asleep. These are called "sleep onset central apneas.", and they are considered perfectly normal and have no clinical significance.

If you spend time dozing with the machine on, it's highly likely that you are actually drifting between WAKE and Stage 1 SLEEP, and as you do that, it's not uncommon for a few CAs to be scored. Sometimes they're sleep onset centrals; sometimes they're just normal wake breathing being mis-scored as a CA by your machine. (Normal wake breathing is much less regular than normal sleep breathing, and xPAP machines can mis-score all kinds of events when people are using the machine while not being fully awake.)

As for the middle of the night CAs scored by your machine. It's possible that some of them are real CAs, but there's not enough of them to worry about. It's also possible that some of them represent sleep onset CAs that are occurred after a spontaneous arousal or brief wake and as you settle back down into real sleep, you miss a breath or two as the control of the breathing is once again handed off to the autonomous nervous system.

Your machine cannot tell when you are actually asleep and when you are dozing or awake. Hence it cannot tell when a CA is just an ordinary old "sleep onset central" or when it happens to be a real central apnea that occurred when you were asleep.

But with an total AHI that is less than 2 and a CAI = 1.1, there are simply not enough CAs to worry about even if every single one of them was a real central apnea that occurred when you were soundly asleep.
Questions about SleepyHead?
See my Guide to SleepyHead
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#6
Robysue, Thank you for your thorough explanation. I am so grateful that you gave us the Beginner's guide to reading Sleepyhead. It was so helpful to me. And beyond that, I am grateful that you are so willing to share your knowledge on the Forum. Without this forum I would feel like I was on my own, which wouldn't have worked well for me. I needed support and answers to many questions. (Many times I would find the answers I was looking for in other posts.) And I also appreciate the way my posts have all been answered in such a timely manner. The Apnea Board rocks!!
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#7
The only time to be concerned about the central events is when their count alone (the CI, so not including any other events) go over 5 consistently. A few here and there each night is not worrisome and is, for the most part, quite normal.

The thing with gathering data via SleepyHead and other software is to determine what is normal for YOU. You will start to see patterns in your sleep. Maybe a few CA events before true sleep and when awakening, perhaps a few during the night. Perhaps more OA events the nights after a big meal (and drinks) with friends. You'll know as soon as you see a night that it is with the normal for YOU, and your sleep habits that follow your day habits.
PaulaO2
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www.ApneaBoard.com


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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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