[Diagnosis] Very high amounts of periodic breathing / CSR ?

[Dormeo]

This is really encouraging. Stick with these settings for a while and see how it goes.

The pattern in the second zoomed-in view isn't at all CSR-ish. It also looks to me as though you weren't really asleep during that interval. The deeper breathing that comes before each CA has (to my eye) the appearance of arousal breathing.

I wonder whether you'd benefit from trying a weighted blanket. For some people, they cut down on tossing and turning during the night. Of course it's hard to say what's cause and what's effect, but if you can afford to try one, it might be a good experiment.

[gregbe2000]

Just curious, did your sleep study show a lot of PLM's (Periodic Limb Movements)?  PLM's can cause significant arousals.

Hi Jay51.
My titration sleep study a couple weeks ago had a PLMS index of 7.0 with 34 total, and a PLMS with arousals index of 3.7 with 18 total.  This study was horrible though, I didn't feel like I slept at all and was very uncomfortable due to the high pressure I was getting.
My diagnostic sleep study 4 years ago had an index of 7.4 with 46 total, and a PLMS with arousals index of 0.2 with only 1 total.

My overall arousals index was 46.6 for the titration and 31.7 (198) for the diagnostic sleep study.  These are really high!  If I could only find out why.

[gregbe2000]

This is really encouraging.  Stick with these settings for a while and see how it goes.

The pattern in the second zoomed-in view isn't at all CSR-ish.  It also looks to me as though you weren't really asleep during that interval.  The deeper breathing that comes before each CA has (to my eye) the appearance of arousal breathing.

I wonder whether you'd benefit from trying a weighted blanket.  For some people, they cut down on tossing and turning during the night.  Of course it's hard to say what's cause and what's effect, but if you can afford to try one, it might be a good experiment.

Thanks Dormeo.  I'm very encouraged, I sure hope it's repeatable.  I'm going to stick with these settings and cross my fingers.  I tried a weighted blanket once and wasn't able to get comfortable with the weight on me....that was a while ago though, maybe I should try again.  It is always very difficult for me to get comfortable in bed.

[Jay51]

Dr.'s can prescribe medications to help stop PML's also.  It would probably be worth it to mention this during your next appointment.

[gregbe2000]

Dr.'s can prescribe medications to help stop PML's also.  It would probably be worth it to mention this during your next appointment.

Thanks.  I did recently get a prescription for gabapentin.  My sleep doctor thinks this is worth a try.  I'm holding off on this until after I get my diagnostic sleep study.  I'm not sure how the sleep study I did accurately tracks this - they put a sensor on each leg but nothing on my arms.  Most of my movement when I fast forward in my video to spots in the night with respiration disturbances have to do with repositioning my head or moving my arm in a better spot (not jerky type of movements, but it's as if I'm awake).

[Dormeo]

While I'm thinking of it: people are sometimes advised not to use CPAP for a week before a sleep test. There's (quite limited) evidence of a possible wash-out effect:

https://repository.uantwerpen.be/docman/...d/9276.pdf

[gregbe2000]

Hi Dormeo -

That's interesting.  My next sleep study is about 2 months out there's a good chance it will happen prior to this if I get someone's cancellation.

I kept 7cm, EPR of 1 for a 2nd night.  Last night wasn't as good in terms of how I feel or the AHI numbers, but still much better than the last month.  I would say nearly all, or at least 75% of the central apneas have a respiratory disturbance/arousal immediately prior to them.  I'll keep this cpap setting for at least another day and then make a minor change - I'm hoping that my arousals are at least partly caused by the pressure/change in pressure of the cpap and I can fine tune this.  Not sure whether to lower the pressure by 0.2cm or change the EPR from 1 to 2.  One of these two seem like the logical next change.  What do you think?  Also, my ears are have been sensitive to noises and I experienced a little breathlessness yesterday - I assume that's a direct result of messing with the pressure settings.

[HenryECole81]

Sorry for the delay. Issue with changing my Apnea Board email, Now corrected.

I too saw that most of my CAs occurred after awakening and returning to resting half asleep, mostly comfortably and often for several hours. When I subtract those off, my score was much better, though showing only the hours of deeper sleep. Later, lowering my EPR reduced the number of those CAs and bettered the score, but not sure more deep sleep.

[gregbe2000]

Thanks HenryECole81.  7cm static seemed better for me but the results were inconsistent.  I've been using 6.6cm with EPR of 1 the last 7 days and while my CAs are relatively better, it's still very inconsistent.  Last night was a bad number night with my CA index at 10.2 and CSR flagged for 11.4% of the night (I felt better than normal in the morning though).  CBT-I hasn't helped with the numbers - I don't really have a hard time falling asleep.  My issue is that I think most of my apneas have an arousal/awakening/irregular breathing right before the CA - and then sometimes this sets off a series of them and they are flagged as CSR.  This is always in the 2nd half of the night.  If I could resolve why I'm having all these arousals then that would be a huge breaththough.

I'll lower EPR further (set it off) soon to see if that does anything for me.  To confirm, when you say you lowered EPR, do you mean you used less EPR (from 3 to something less)?

BTW - I had a bunch of other questions for you in an earlier message in this thread if you care to answer.  I'm really interested the relationship between a low heart rate and central apneas and how a pacemaker improved your Central Apneas.