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+--- Thread: [Treatment] Lot of central apneas at beginning of sleep last night (/Thread-Treatment-Lot-of-central-apneas-at-beginning-of-sleep-last-night)
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Lot of central apneas at beginning of sleep last night - pvols1979 - 03-18-2021
Can someone help me understand what might have caused the high number of central apneas as I was falling asleep last night? Is there anything in the graphs that can provide some clarity? I felt horrible last night as I fell asleep on the couch watching TV a few times before the wife and I went to bed. I fell asleep still feeling off and then I felt like I slept fairly well until I saw the graphs this morning. I assume I was having some form of apneas.
RE: Lot of central apneas at beginning of sleep last night - Gideon - 03-18-2021
We would need a 3-minute zoomed view to evaluate. Being where they are I would say SWJ (Sleep Wake Junk) and are fairly common. We mostly just ignore them.
RE: Lot of central apneas at beginning of sleep last night - pvols1979 - 03-18-2021
Does this help?
RE: Lot of central apneas at beginning of sleep last night - Gideon - 03-18-2021
As I suspected, that is an awake breathing pattern. See how irregular it is.
(edit) It also has a lot of flow limits in there.
RE: Lot of central apneas at beginning of sleep last night - pvols1979 - 03-18-2021
Thank you for the interpretation. I still need to do some learning on flow limitations. From some reading, I thought that had a lot to do with neck position and causing worse airflow. However, I purchased a few new pillows and have been trying them out. One of them is a cervical pillow that is supposed to hold my neck in a good position. I guess it might not be working as intended.
RE: Lot of central apneas at beginning of sleep last night - Gideon - 03-18-2021
As I said a little.
RE: Lot of central apneas at beginning of sleep last night - Gideon - 03-18-2021
For descriptive purposes Flow Limits come in two types.
The first is just narrow and restricted airways. We treat those mostly with PS (EPR) and not Flex.
The second is the kinked garden hose type, These are what we call "positional Apnea" or "Chin Tucking". These we typically \suggest a soft cervical collar for. They show via clusters of obstructive events.
RE: Lot of central apneas at beginning of sleep last night - Geer1 - 03-18-2021
As mentioned SWJ during sleep transition, nothing to worry about.
I see a couple things to work on though. As Gideon mentioned there are flow limitations present. The ones during that SWJ are not a concern but the ones later in the night appear to be a possible issue. It looks like you had at least two periods of increasing flow limitation that lead to RERAs (1:50 and 2:20) and possibly more at 5:10 and 5:40.
The two flow limitations at 1:50 and 2:20 had flagged flow limitations that drove pressure up. This did not appear to make flow limitations better and perhaps made them worse. I am not aware of your history and prevalence of obstruction apneas etc but if the data consistently shows pressure increasing due to flow limitations and no improvement at higher pressures then you might be better off lowering max pressure or possibly even using a set pressure. The auto nature of these machines is only helpful in some cases, not all.
The other thing I notice is the large quantity of leaks which you need to get under control. I see your machine is set to full face mask but it appears you are using a nasal mask, N30i. My guess is mouth leaks if using the nasal mask. Everyone is a bit different but I prefer a full face mask because it fixed my mouth leak issue (which is/was due to nasal congestion) and because the F20 is far quieter and less air blowing around than any nasal mask. Other people that prefer nasal masks often tape their mouths or sometimes can get by with a chin strap. Sometimes lowering EPAP can help too (but not if it causes obstructive apneas).
RE: Lot of central apneas at beginning of sleep last night - pvols1979 - 03-22-2021
I had a rough night last night. While I was awake and watching TV, I kept dozing off and waking in a panic and felt like I was having apneas even while awake, but definitely upon waking from a very short snooze. Then I pulled up my report from sleeping last night and this scared the hell out of me. Why am I having so many central apneas? CAs scare me. I can understand the obstructive events and how CPAP can help, but when my body doesn't remember to breathe...not something I am accepting well. I really want to know why there were so many last night. I know that you can have some garbage at the beginning of the reports as you are falling asleep, but I can tell you that I was awake for at least an hour with my mask on feeling like I was gasping, so I feel like these are real. Last night was a rough one.
Look at that AHI graph. That is ridiculous.
RE: Lot of central apneas at beginning of sleep last night - SarcasticDave94 - 03-22-2021
It's not a massive amount, and I'd still flag it as SWJ AKA sleep wake junk. For some reason, you have quite a bit of the SWJ for 30-45 minutes after starting to fall asleep. Personally I'd rather you work on leak control.
I've seen other's charts with very bad trainwrecks with CA all over. This isn't it.