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dragon800 - Therapy Questions
#21
RE: Hello I think I have Cheyne-Stokes breathing
Best way is to post the full night, then any sections of concern.  Below are 3 examples of different zoom levels.  Generally a zoom level of 3-4 minutes is adequate as in the third image, but some CSR patters can be represented in longer segments. For example here is an example of CSR that runs for 7-minutes. You can see how Resmed flags CSR and what the pattern looks like and how prevalent it is through the night. A longer segment follows.  So the best zoom level is the one that shows the issue with either individual breaths, or longer periods of breathing patterns like CSR. 

[Image: attachment.php?aid=12475]


Here is an example that runs nearly 45 minutes and shows the pattern, but not the individual breaths. 

[Image: attachment.php?aid=5122]

Here is an example of a 3-minute zoom showing the individual breath waves, in this case showing an arousal from diminishing flow.

[Image: attachment.php?aid=43377]
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#22
RE: Hello I think I have Cheyne-Stokes breathing
ok thank you I'll post some screenshots. Thanks for your time helping me I really appreciate it very much!
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#23
RE: Hello I think I have Cheyne-Stokes breathing
Hopefully these are helpful. this is one of my worst nights although I dont see the pattern of cheyne-stokes like i did in the other one on sleephq and i forget what night that was. Im guessing I jumped to conclusions thinking I have that.

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#24
RE: Hello I think I have Cheyne-Stokes breathing
I don't see CSR, but the repeated central apnea events may require ASV to effectively treat. CSR occurs on a longer interval of gradually waxing and waning breaths as you saw in the examples above. Your events are repeated CA with initial recovery breathing (large volume) that diminishes into the next CA very quickly. It's certainly periodic breathing in that there is a pattern, but these events seem to arise out of an idiopathic imbalance in PCO2. In practice this is an alternate hyperventilation / hypoventilaiton that follows a hypercapnia/hypocapnia respiratory drive signal. You seem to get into these feedback loops which result in rapidly alternating respiration. Adaptive servo ventilation works to equal out the respiratory volume on a breath by breath basis, providing pressure support to maintain respiration as needed and allowing spontaneous respiration when support is not needed.

These examples of "worst conditions" are not typical for you, but they serve to show your sensitivity to the "apneic threshold" which is how this respiratory instability occurs. If your apnea were predominately central and consistently at a high enough level, then there would be no question that ASV would be appropriate and prescribed. Normally your doctor would recognize predominately central apnea and do cardiac screening to ensure you don't have a significant risk factor for ASV (generally left ventricular ejection fraction less than 45% associated with heart failure), and then schedule a titration study to evaluate bilevel and ASV as possible therapy alternatives. The Oscar Statistic tab should show your event rate and types over different periods of time and might be useful to see how severe this problem has been over the course of your therapy. What have you done so far to discuss this with your doctor? Do you monitor SpO2 and pulse? Are you located at high altitude?
Sleeprider
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#25
RE: Hello I think I have Cheyne-Stokes breathing
Yeah one of mine I found had the waxing and waning of CSR but I think it was a fluke because I haven't seen it since. Im not at a high altitude I think somewhere around 2400 ft above sea level. I'm going to call my doctor tomorrow because I got the CPAP from a supply store which i dont think helps me any further and my doctor told me all they do is compliance in that they just make sure I wear it. I had zero clue about CPAP until I found CPAP Reviews on youtube and this forum. All I know about my original sleep test is that they were worried about my o2 level and I did order a simple o2 finger monitor yesterday. Im gonna try to save up for a good one. My heart doctor was really short with me not wanting to answer questions so I think I will try to get what paperwork I can and find someone online that can look at it. Someone told me I should change my CPAP from auto to CPAP with the pressure at 12 so I think I'll try that out tonight. 
Thank you for all your help I really appreciate it!
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#26
Help with data if you have the time
Hi i posted here yesterday and thank you for the help! I did some adjustments last night and was wondering if anyone has any thoughts if you have the time to spare. I feel weird asking for help to be honest. Anyway, I set my machine from auto to cpap and set the max pressure to 11.4 and my 95% max pressure last night was 11.4 so should I set it higher? I had an AHI of 13 with 9.4 being centrals which worries me. Thanks for any insight and/or suggestions.

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Also, from here on should I post in this thread or make new threads? I don't want to clutter up the board.


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#27
RE: Hello I think I have Cheyne-Stokes breathing
dragon800 - Since both your threads deal with questions about your therapy, I have merged them. We prefer that a member keep their therapy questions in a single thread. This is to allow others easy reference to your history on this subject.

To make your title more inclusive, I have renamed your thread title to, "dragon800 - Therapy Questions". I am sending a confirmation PM to you as well to notify of this change.

- Red
Crimson Nape
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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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#28
RE: dragon800 - Therapy Questions
sounds good, thanks
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#29
RE: dragon800 - Therapy Questions
my latest night it shows me stop breathing for over 10 seconds 3 times every minute for about a half hour straight. clear apneas so no obstruction. Could this somehow be a machine error? If that's accurate it's scary as all hell!

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the reason the pressure is even in the first half is i had set the machine from auto to cpap but then set it back to cpap when i woke up because my AHI was in the 50's


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#30
RE: dragon800 - Therapy Questions
Somewhere along the line you turned on EPR. I recommend that you turn it off. That might help some with the CAs.

Do you yet have an appointment with the sleep doctor? I would think your high AHI, along with the high index for CAs, would get a doctor's attention. Sleeprider has explained the importance of getting a titration with a bilevel machine and an ASV machine. (That's short for adaptive servo-ventilation.) That would mean you'd be in a sleep lab and they'd try out the different kind of machine settings on you while you slept to see what worked best.

If the doctor doesn't bring up a titration with bilevel and ASV machines, or doesn't mention ASV at all, I think it will be important for you to ask, politely but firmly, whether a titration of this kind would be valuable. If the doctor says no, ask why. Also ask the doctor what the alternative plan is to reduce your AHI. (I bet there won't be one.)

With luck your doctor will be well informed and sensible. But think ahead of time about how you will respond if you get some kind of brush-off.
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