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Worried about new centrals
#1
Worried about new centrals
Hey everyone,

I've been on cpap treatment for a little over two months now, and things have been going very well (although I might've jinxed myself by posting in the success thread). Anyways, I'm starting to notice an alarming trend. My rates of central events are starting to go up slowly over time. They started out almost non-existent, but now they seem to be happening more and more frequently. For example, today I had an AHI of over 5 which is the highest it's ever been. 

I've attached some of the charts. I'm just trying to be proactive and stay on top of this in case this really is a problem. 

The only things I've noticed in the past few weeks (and I don't know if this would explain the centrals), is that my heated hose came unplugged slightly for about a couple of weeks and so I was actually getting cold air all that time. Luckily, I fixed it a couple days ago. And then the other thing is I've started an extended water fast the other day (which I'm about 36 hours in now), but I don't know if that has anything to do with it.

I've read that sometimes a small percentage of people on CPAP end up developing centrals. I sure hope I'm not one of them, but if so, then I'll need to do something about it. From my very inexperienced view, it seems that almost all of these centrals are clustered toward times when I'm falling asleep, either at night or in the morning, and also during sleep transitions. For example, I often remember waking up several times per night to change sides so my legs don't get sore. Sometimes, I might get a random central here or there when that happens. 

Anyways, I'm hoping someone can shed some light to on this and possibly make the centrals go away, or tell me when I should start having a conversation with my primary doctor. I don't want to overreact if this can be fixed. 

Also, I don't know if this is related, but I have consistently seen my mean tidal volume decrease over the past couple of months. It used to be around 380 - 400. And now it's usually hitting 360 and today it sinked to 340. It's really starting to scare the crap out of me. It makes me wonder if I have some lung condition like COPD or something. I'm 30 years old, I don't smoke, but my mom smoked all the time when I was growing up. Anyways, those are just my thoughts. 

Thank you and have a nice day,

Ted


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#2
RE: Worried about new centrals
Your centrals are getting up a bit but not enough to panic about. They seem to be clustered during your transitions in and out of sleep - what we call "sleep / wake junk" to some extent they can be ignored. The very tight clustering of events suggests positional apnea, and the section you zoomed in looks more like clusters of positional obstructive apnea than central. A couple of tricks you might try to get things back under control:

1. Reduce your EPR setting to as low as you can comfortably take it, preferably off. This should suppress many of the central apnea.

2. If that doesn't help, try a soft cervical collar to support your chin - tucking the chin to the chest can compromise your airway which sometimes looks like central apnea.

3. Try to reduce your time in sleep / wake transition. Practice good sleep hygiene at night, and in the morning get up when you wake up. Don't lie there dozing for an hour - that's what I do and it doesn't work!
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#3
RE: Worried about new centrals
Looks like your central are happening in REM sleep. Your clusters are all almost 90 minutes apart which is the average sleep cycle length. I'm not even sure they are central apneas events. Look like your taking couple of big breaths than just wait before taking a new one (which is normal, just try it while you are awake). REM sleep breathing can be messy compare to the steady flow you get in NREM sleep. I get the same problem sometimes when I change my pressure settings but it usually goes away after couple of days.

Did you make any change to your EPR setting recently? EPR can cause this problem to some people and it may go away on its own once your body gets used to it. Hopefully, more experienced members can chime in.
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#4
RE: Worried about new centrals
I agree with Alex.  The exaggerated breaths that take place in between the episodes of 'CA' events in the expanded view would very likely be part of the rapid breathing that often accompanies something 'interesting' happening in a vivid dream.
Serial Tapist
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#5
RE: Worried about new centrals
On the COPD issue, it probably would have more negative influence than just your tidal volume. I have stage 1 plus, as in not quite stage 2. Not sure offhand, but my TV seems pretty good. Anyway, COPD would probably include shortness of breath chronically, possible difficulty breathing again chronic, feeling like one has some cold or flu symptoms near chronic. Those are what I deal with, so there may be other ways COPD manifests itself.

If you believe you've gotten COPD, take the concern to your pulmonary doc. He or she should order you to take a pulmonary function test. OSCAR shows my median TV as 920 on a recent sleep session.

Coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Worried about new centrals
Any healthy person who is falling asleep has centrals, its just how falling asleep works. As long as you have no %sat drops below 92% oxygen, its fine.
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#7
RE: Worried about new centrals
(08-23-2019, 10:29 AM)DeepBreathing Wrote: Your centrals are getting up a bit but not enough to panic about. They seem to be clustered during your transitions in and out of sleep - what we call "sleep / wake junk" to some extent they can be ignored.  The very tight clustering of events suggests positional apnea, and the section you zoomed in looks more like clusters of positional obstructive apnea than central. A couple of tricks you might try to get things back under control:

1.  Reduce your EPR setting to as low as you can comfortably take it, preferably off. This should suppress many of the central apnea.

2. If that doesn't help, try a soft cervical collar to support your chin - tucking the chin to the chest can compromise your airway which sometimes looks like central apnea.

3. Try to reduce your time in sleep / wake transition. Practice good sleep hygiene at night, and in the morning get up when you wake up. Don't lie there dozing for an hour - that's what I do and it doesn't work!

Thanks for the info. I slept with a cervical collar the other day and that seemed to do the trick. Originally, I had EPR to 3 to help stop flow limitations, but I might reduce in the future if the centrals keep increasing. Also, good tip on the sleep hygiene. I have a very bad habit of sleeping in before I stumbled into the world of CPAP.
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#8
RE: Worried about new centrals
(08-23-2019, 11:15 AM)SarcasticDave94 Wrote: On the COPD issue, it probably would have more negative influence than just your tidal volume. I have stage 1 plus, as in not quite stage 2. Not sure offhand, but my TV seems pretty good. Anyway, COPD would probably include shortness of breath chronically, possible difficulty breathing again chronic, feeling like one has some cold or flu symptoms near chronic. Those are what I deal with, so there may be other ways COPD manifests itself.

If you believe you've gotten COPD, take the concern to your pulmonary doc. He or she should order you to take a pulmonary function test. OSCAR shows my median TV as 920 on a recent sleep session.

Coffee

I see. Well in that case, I haven't noticed anything being affected negatively with my breathing. I can take deep breaths, but for whatever reason I revert to shallow breathing when I'm sleeping. Somebody told me that you have a lower respiration rate during deep sleep, but I guess we are all different. Thanks for chiming in.
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#9
RE: Worried about new centrals
(08-23-2019, 10:33 AM)alexp Wrote: Looks like your central are happening in REM sleep. Your clusters are all almost 90 minutes apart which is the average sleep cycle length. I'm not even sure they are central apneas events. Look like your taking couple of big breaths than just wait before taking a new one (which is normal, just try it while you are awake). REM sleep breathing can be messy compare to the steady flow you get in NREM sleep. I get the same problem sometimes when I change my pressure settings but it usually goes away after couple of days.

Did you make any change to your EPR setting recently? EPR can cause this problem to some people and it may go away on its own once your body gets used to it. Hopefully, more experienced members can chime in.

No, I've always kept it at 3 since I got started CPAP treatment a couple months ago. It was there originally to help reduce flow limitations. One thing I've noticed is that if I breathe too quick when I put my mask on, I feel the pressure and mask jumps off my face. I found if I wait a second after taking a breath, then the pressure goes away and I can breathe normally. Not sure if that's anything though. I wear a full face mask.
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#10
RE: Worried about new centrals
I've had to remind myself in the past to just breathe at my natural pace whatever that is. The PAP will do it's job regardless.

As for TV numbers, despite my COPD induced shallower than earlier in life breathing pattern, apparently I still take in a lot of air.

Keep with it. Trust me, it does get better.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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