Apneas or Cheyne-Stokes Respirations?

[Reznik]

Hi Everyone, 

I'd appreciate thoughts on whether the attached graph reflects Cheyne-Stokes Respirations, or apneas, and if the latter, whether you have an opinion on whether they are central or obstructive?  This strip reflects 5 minutes of breathing.

[jaswilliams]

To me it looks like periodic breathing central in nature not sure the interval is right to be CS breathing. How much of this occurs ?

[Reznik]

Thank you very much for responding.

Almost all of my apneas and hypopneas during the night look like these, but sometimes they are in smaller groups, i.e. you might just see two or three of these at a time instead of ten as here.

The frequency varies wildly depending upon a number of factors.

They tend to occur more frequently the longer I sleep.  So, if I sleep 6 hours, my AHI will be between 5 and 10.  If I sleep 8 hours, my AHI for the night will jump up to 13-20, with most of the activity clustered during the last two hours of sleep.  Because the AHI is a nightly AHI of 13-20, the last two hours will have AHIs that are much higher than that.

If I exercise that day, or consume caffeine, they tend to occur less frequently and my AHI will be lower.  I recently started a modified alternative day fasting diet (500 calories one day and then whatever I want the next day) and the AHI tends to be inversely proportional to the amount of food that I eat that day.  However, the pattern depicted in the graph has been around since long before I started this diet.

[Gideon]

as an experiment drop your pressure to 6.4 to see if that helps the cumulative effect.

I'm guessing you are sensitive to CO2 washout so this is an attempt to minimize the cumulative effect.

[Reznik]

Bonjour,

Thank you for your response.  I realize now that my details posted on Apnea Board are out-of-date.

I was running my machine at 8.0/8.0 until mid-2018.  At that point, I'd been on CPAP for about 9 months and I began waking up in the middle of the night because I was awakening after I would puff air out of my mouth.  I lowered the pressure to 7.0/7.0 and that helped, but eventually the puffing started again.  I then started experimenting with bi-level, and am currently at 5.0/8.0.  

5.0/8.0 is very comfortable and the puffing has stopped, but the AHI has actually gone up.

Does that change your recommendation, or does that perhaps support your theory?

EDIT:  I've done some more research on CO2 Washout/blowoff, and I think I understand that adding pressure support (as I've done) does, in fact, increase CO2 washout.  Thus, my results would seem to support your theory.  I'm going to try going to 6.4/6.4 tonight to see what happens.  Please let me know if I've misunderstood anything here.

And, as always, I welcome further comments from everyone. 

[Gideon]

Somewhat, try 4.4/7.4 maintaining your PS of 3
If you haven't read it read this, http://www.apneaboard.com/wiki/index.php...ace_(EERS)
I'm assuming the increase in AHI was at your current pressure.

[Reznik]

I believe that the AHI increase got worse with my addition of pressure support.

My apneas have almost always looked like the ones depicted on these graphs and they've always been worse later in the morning.

[Gideon]

Central Apneas can get worse with either an increase in Pressure Support and/or an increase in pressure.

It would be good if you could post your daily SleepyHead charts, see the Organize link in my signature to see what to include.

[Reznik]

Central Apneas can get worse with either an increase in Pressure Support and/or an increase in pressure.

It would be good if you could post your daily SleepyHead charts, see the Organize link in my signature to see what to include.

I've never used SleepyHead.  I use ResMed's software.  Also, I've been tinkering with the pressures recently.  I originally had real trouble sleeping with pressure support, and so I started out slow, i.e. .2, then .4, then .6, then .8, then 1., etc.  Eventually I got to 3.0 PS.  As a result, there's a possibility that the charts wouldn't be helpful to you until I get a set of data over a period of time with the same numbers.

Is there anything that I can get you from the ResMed software?

[Reznik]

I looked over the organizing link you posted, and I think I can get you the same data set from Resmed.  Do you just want one random night over an 8 hour period?