CSR - What causes & any concerns?

[TexasTiger]

looks interesting.  I would say that the exhales during the rattle-jack CA episodes are suggestive of highly agitated possibly restrictive (or throttling) airflow.  This is also just before waking so it may be associated with your "I'm done sleeping for a while" business.

Sleeper noted in some recent posts that exhale pressure is an important key to retaining an open airway, and reduction of OAs.

I suggest you raise the starting point to 9.0 or 9.5, and keep your maximum at 10.6 for now.

and look into Vagus Nerve pressure points.  pressure points can also be places to apply balm such as vaporub or hotfreeze.

QAL

Thanks for the input QAL but the last time I tried raising the lower pressure it felt really bad and the events almost doubled.  Felt better with the last changes so going to make minor adjustments around them and see what happens.  Right now believe that getting rid of the CAs as they feed my CSRs is what I would like to work on.  Not sure if the Vagus Nerve has any pressure points that will help but it is a good suggestion that I have not tried - thanks.

[TexasTiger]

Flow limit is not on the graphs, but the summary indicates they are not a problem. That makes me question the OA events. How are you feeling these days compared to before the CPAP?

Flow limits are barely on the chart so did not include them.  With this mixed bag of events it is hard to chart a course for improvement - minor changes from where I was the night before last night seems a better course as I felt better the following day.  It has been so long since I have not been on CPAP it is hard to remember (I'm now 78 & retired in 2010) - started on PAP treatment in 2003 - very stressful work with long hours and constant travel - lucky to have a doctor in the seat next to me waking me up to inform me I had a serious problem.  The last couple of years I have not felt I was getting restful sleep being too tired and irritable.  April this year is when I started doing my own research and found the great help on this forum.  Only then found that I had a problem which was not corrected as I thought it was and am grateful to be on a path to get a better night's sleep.

Going to drop .4 cm from the better night before last (11.6 max.) to 11.2 and see if results are better as that night's sleep seemed pretty good.

[srlevine1]

A couple of thoughts to discuss with your doctor ...

(1) A simple and cheap BNP (brain natriuretic peptide) blood test can be used to look for retained fluids and CHF.
(2) Might a trial of supplemental oxygen at night be beneficial since CSR can produce oxygen desaturation?

A little light reading .... (too bad the sample size is too small to project onto a larger population -- but it is an indication that can justify question #2)

RESULTS:

Central apneas occurred during Cheyne-Stokes respiration in 18 of 20 patients and two patients had idiopathic central apneas. Without oxygen, the median number of all central apneas and hypopneas was 33.5 (range, 8.0 to 52.0) per hour of sleep. These episodes decreased to 5.0 (range, 0.0 to 31.0)(p < 0.01) during oxygen therapy. In 17 of 20 patients, the frequency of central apneas was reduced by more than 50%. Central apneas were reduced by oxygen irrespective of the presence or absence of heart failure or Cheyne-Stokes respiration. The arousal frequency was reduced during oxygen treatment. Daytime sleepiness, difficulty falling asleep, snoring, and self-scored awakenings were reduced in seven patients who were given nocturnal oxygen at home. Obstructive and mixed apneas were unaffected by oxygen. 

https://www.ncbi.nlm.nih.gov/pubmed/8996011

[srlevine1]

Remember ... don't let all of this insider talk scare you. Common things happen commonly ... and it might be a machine sensor error. The thing about sleep apnea is that the consequences usually take time to develop -- and that should provide you with a margin of comfort as you are already taking the appropriate action.

I was just thinking back on all of the dire warnings and consequences I was given prior to my sleep study. Somewhat like those drug ads on television that promise a wonderful life IF you survive the drug's terrible side effects.

So keep the faith and know that it will all work out. -- Again, best of luck.

[TexasTiger]

Good night last night even though I had some other medical problems.  Reduced max. pressure to 11.4 and only had 1 CA the entire night (and it did not look to have any CSR attributes)!  Going to stay here for a while and see if the CA events have settled down.  Chart link included...

http://imgur.com/a/4r9iR

[Sleeprider]

I told you less pressure is more for you. Glad that upper limit seems better. Good luck!

[richb]

Seems like you are finding the sweet spot where you are having a minimal number of CAs and OAs. I'm glad that you posted your Hypopnea graph as well. It shows that your CAs did not fall back to Hypopneas when the CAs were eliminated. To me this indicates that your CAs (including Central Hypopneas and CSR) were machine induced. You should begin to feel better with these latest results.

Rich

[TexasTiger]

Seems like you are finding the sweet spot where you are having a minimal number of CAs and OAs.  I'm glad that you posted your Hypopnea graph as well.  It shows that your CAs did not fall back to Hypopneas when the CAs were eliminated.  To me this indicates that your CAs (including Central Hypopneas and CSR) were machine induced.  You should begin to feel better with these latest results.  

Rich

Thanks very much for the input - sure hope that is the case - tried to improve on the sleep but doing something wrong - see next post....

Thanks again

[TexasTiger]

Tried to improve on the sleep quality as still not as good as I believe it should be.  Raised/lowered pressures just .2 cm and all got worse plus the CSRs came back.  Pulled the card from my last machine (27 mo. on a System-1 60 series & stats in the IMGUR album) - found that there were at least 5 PB events or more on every day I looked at.  Last CPAP set at Fixed 9.0 cm CFLEX+ X2. 

Hope that RichB is right about these being machine induced CSRs - charts of several event clusters in the charts on IMGUR link - hope someone can determine a next best course of settings.  Going back to where the best results so far for 7 days running - 8.6 Min.  11.4 Max.  No EPR  No Ramp  Comfort Response = SOFT

Charts Link:    http://imgur.com/a/RjSnt   

Waiting for an appointment at a new doctor and findings from my Heart Dr. checking my last Echo and EKG.

Thanks again for all the assistance.

[richb]

Even though we can call your CAs machine induced, it is your body's response to the machine that characterizes your particular results. You have a sensitive "setting" in your CO2 feedback mechanism that triggers the CAs more quickly for you than most other people. In my own case my setting is so sensitive that just being asleep puts me into Central Hypopnea and periodic breathing. You can continue searching for that "sweet spot" in your settings but if you can't consistently get your AHI under 5.0 you probably need an ASV machine. Your sleep doc would characterize your condition as mixed apnea that is not successfully treated by fine tuning your traditional CPAP machine. You would most likely need a titration on an ASV machine to show that it solves the problem. Good luck with your search for the best settings. Keep in mind that if you can't find the sweet spot you just might need that ASV machine.

Rich