Weird flow graph during a 17 second CA

[Peter_C]

Been working on my leak rate, and last night it stayed under 2 the entire night. AHI was only '1.0' - yay, but I did have a 17 second CA.

I have been looking at and trying to get used to my flow graph, which doesn't make a whole lot of sense to me. Below is an image of the graph during the 17 second CA, with the time just before and just after. No flow restriction, and zero leak at this time period.



Just wondered what folks thought about this? My sleep doc is in the process of trying to get Medicare to approve switching me to an AVS machine, as I am having more CAs than OAs now.

[justMongo]

I seldom have any CA -- and then they are short (like 10-12 secs.)
Your flow waveform doesn't look much different than mine when I have an OA.

If last night's stats are typical; I cannot see a need for an ASV.

Peter: Is your profile up to date? Are your using an Autoset or a VPAP.

[Peter_C]

It is up to date. Medicare would only buy me a CPAP. Then I just had a titration for an ASV, The reason for the ASV is a combo of me having more and more CAs, and my pain meds get changed on me (both type and dose) fairly often, so there is a real risk of me just forgetting to breathe - so my sleep doc wants the backup of an ASV machine. So he is now beginning the process to get it approved via Medicare.

My AHI goes all over the map, from last night's 1.0 to the night before of 26.4 I am for the next 4-6 weeks wearing a leg brace that is forcing me to sleep on my back the entire night, which also does not help me.

My biggest issue is I have yet to find a FFM that I don't have to cinch down painfully tight to stop leaks (yes, I have so tried the very loose, let the seal do its thing, but it doesn't work on my face)

[Whitewabit]

I have an ASV machine in the Resmed VPAP Adapt and my Centrals, which usually had lasted at or around 50 seconds, don't look like that but that may be because of the effort of the machine recognizing the central and trying to get me to breathe .. my centrals have gone down from 27 an hour to last nights .69 AHI with no centrals !! Mine may also be due to a strong pain medication which I wear in the form of a skin patch and also take other pain medication due to a high breakout pain level I have at times .. My pain level stays at a 5-7 out of 10, due to a back injury that happened back in 2000 .. my medication also changes in strength from day to day, according to how much I need to take to function each day which differs day to day ..

your graph doesn't look to me like my central because there is no loading up of O2 before the central episode which occurs with me in the minutes before the central starts ! A central is because the mind believes it has a high O2 blood level and thinks it doesn't need to breathe and then when the CO2 trigger goes off and your O2 level can drop very low .. you breath again finally !! Mine would drop into the mid 80's sometimes !

I see your pressure levels are much higher then mine and high pressure levels can be a cause of addition centrals to occur.. have you tried to reduce your pressure to reduce the number of centrals you have in a sleep period ??

Is this how others peoples centrals look if not on an ASV machine ??

[DeepBreathing]

Peter, I think what you're seeing there is the machine diagnosing the CA. It sends a series of short pressure pulses and measures the return echo to determine if the airway is open. As far as I know your machine can't teat a central but it can diagnose and record it.

[justMongo]

It is up to date. Medicare would only buy me a CPAP. Then I just had a titration for an ASV, The reason for the ASV is a combo of me having more and more CAs, and my pain meds get changed on me (both type and dose) fairly often, so there is a real risk of me just forgetting to breathe - so my sleep doc wants the backup of an ASV machine. So he is now beginning the process to get it approved via Medicare.

My AHI goes all over the map, from last night's 1.0 to the night before of 26.4 I am for the next 4-6 weeks wearing a leg brace that is forcing me to sleep on my back the entire night, which also does not help me.

My biggest issue is I have yet to find a FFM that I don't have to cinch down painfully tight to stop leaks (yes, I have so tried the very loose, let the seal do its thing, but it doesn't work on my face)

Actually, I questioned why your profile says S9 Autoset, then in comments says you're using a VPAP. Do you mean a VPAP auto ?
I do now understand why your doc would want you on an ASV. Pain meds lower central respiratory drive.

I have an ASV machine in the Resmed VPAP Adapt and my Centrals, which usually had lasted at or around 50 seconds, don't look like that but that may be because of the effort of the machine recognizing the central and trying to get me to breathe .. my centrals have gone down from 27 an hour to last nights .69 AHI with no centrals !! Mine may also be due to a strong pain medication which I wear in the form of a skin patch and also take other pain medication due to a high breakout pain level I have at times .. My pain level stays at a 5-7 out of 10, due to a back injury that happened back in 2000 .. my medication also changes in strength from day to day, according to how much I need to take to function each day which differs day to day ..

your graph doesn't look to me like my central because there is no loading up of O2 before the central episode which occurs with me in the minutes before the central starts ! A central is because the mind believes it has a high O2 blood level and thinks it doesn't need to breathe and then when the CO2 trigger goes off and your O2 level can drop very low .. you breath again finally !! Mine would drop into the mid 80's sometimes !

I see your pressure levels are much higher then mine and high pressure levels can be a cause of addition centrals to occur.. have you tried to reduce your pressure to reduce the number of centrals you have in a sleep period ??

Is this how others peoples centrals look if not on an ASV machine ??

You are wearing a Fentanyl transdermal patch? That's strong stuff.

Peter, I think what you're seeing there is the machine diagnosing the CA. It sends a series of short pressure pulses and measures the return echo to determine if the airway is open. As far as I know your machine can't teat a central but it can diagnose and record it.

I think he's referring to the flow waveform just before the central.
But, if he's talking about the oscillation that starts 4 seconds after the beginning of the central, that would indeed be the FOT algorithm modulating the pressure to score the type of apnea.

[Juanito]

Just wondered what folks thought about this?

My flow pattern is almost identical at CA. It's always a pleasure to notice the regular respiration that follows and realize you are still alive.

[Peter_C]

I have an ASV machine in the Resmed VPAP Adapt and my Centrals, which usually had lasted at or around 50 seconds, don't look like that but that may be because of the effort of the machine recognizing the central and trying to get me to breathe .. my centrals have gone down from 27 an hour to last nights .69 AHI with no centrals !! Mine may also be due to a strong pain medication which I wear in the form of a skin patch and also take other pain medication due to a high breakout pain level I have at times .. My pain level stays at a 5-7 out of 10, due to a back injury that happened back in 2000 .. my medication also changes in strength from day to day, according to how much I need to take to function each day which differs day to day ..

your graph doesn't look to me like my central because there is no loading up of O2 before the central episode which occurs with me in the minutes before the central starts ! A central is because the mind believes it has a high O2 blood level and thinks it doesn't need to breathe and then when the CO2 trigger goes off and your O2 level can drop very low .. you breath again finally !! Mine would drop into the mid 80's sometimes !

I see your pressure levels are much higher then mine and high pressure levels can be a cause of addition centrals to occur.. have you tried to reduce your pressure to reduce the number of centrals you have in a sleep period ??

Is this how others peoples centrals look if not on an ASV machine ??

Actually, the titration they just did (a couple of weeks ago) show I need to raise my pressure even more??! But I am waiting to see if Medicare will approve the AVS machine before changing pressure. They want me to go to 15 - right now the autoset has me averaging between 12.2-13.6

The nights where my leaks are under control well, my AHI is usually low, usually all centrals, and usually with a pressure under 13. My longest central to date has been 25 seconds and my O2 (separate program) hit me dropping to 83% for about 10 seconds. I don't wear the O2 sensor every night.

[Peter_C]

It is up to date. Medicare would only buy me a CPAP. Then I just had a titration for an ASV, The reason for the ASV is a combo of me having more and more CAs, and my pain meds get changed on me (both type and dose) fairly often, so there is a real risk of me just forgetting to breathe - so my sleep doc wants the backup of an ASV machine. So he is now beginning the process to get it approved via Medicare.

My AHI goes all over the map, from last night's 1.0 to the night before of 26.4 I am for the next 4-6 weeks wearing a leg brace that is forcing me to sleep on my back the entire night, which also does not help me.

My biggest issue is I have yet to find a FFM that I don't have to cinch down painfully tight to stop leaks (yes, I have so tried the very loose, let the seal do its thing, but it doesn't work on my face)

Actually, I questioned why your profile says S9 Autoset, then in comments says you're using a VPAP. Do you mean a VPAP auto ?
I do now understand why your doc would want you on an ASV. Pain meds lower central respiratory drive.

I have an ASV machine in the Resmed VPAP Adapt and my Centrals, which usually had lasted at or around 50 seconds, don't look like that but that may be because of the effort of the machine recognizing the central and trying to get me to breathe .. my centrals have gone down from 27 an hour to last nights .69 AHI with no centrals !! Mine may also be due to a strong pain medication which I wear in the form of a skin patch and also take other pain medication due to a high breakout pain level I have at times .. My pain level stays at a 5-7 out of 10, due to a back injury that happened back in 2000 .. my medication also changes in strength from day to day, according to how much I need to take to function each day which differs day to day ..

your graph doesn't look to me like my central because there is no loading up of O2 before the central episode which occurs with me in the minutes before the central starts ! A central is because the mind believes it has a high O2 blood level and thinks it doesn't need to breathe and then when the CO2 trigger goes off and your O2 level can drop very low .. you breath again finally !! Mine would drop into the mid 80's sometimes !

I see your pressure levels are much higher then mine and high pressure levels can be a cause of addition centrals to occur.. have you tried to reduce your pressure to reduce the number of centrals you have in a sleep period ??

Is this how others peoples centrals look if not on an ASV machine ??

You are wearing a Fentanyl transdermal patch? That's strong stuff.

Peter, I think what you're seeing there is the machine diagnosing the CA. It sends a series of short pressure pulses and measures the return echo to determine if the airway is open. As far as I know your machine can't teat a central but it can diagnose and record it.

I think he's referring to the flow waveform just before the central.
But, if he's talking about the oscillation that starts 4 seconds after the beginning of the central, that would indeed be the FOT algorithm modulating the pressure to score the type of apnea.

Before I got on Medicare, I had a VPAP Auto 25, but because it was only Doc's notes changing me to a bi-level, Medicare would only allow me to get a CPAP, which is why I am currently using a CPAP Resmed S9 AutoSet (in APAP mode). We just did a titration for an ASV (the reason for putting me on an ASV is the real risk of the combo of my apnea and pain meds, so having the backup rate is insurance) - and I forgot to update the comment line -oops

[Peter_C]

Just wondered what folks thought about this?

My flow pattern is almost identical at CA. It's always a pleasure to notice the regular respiration that follows and realize you are still alive.