Is this CSA? - need help

[sleephd]

I suspect that I have sleep apnea and my pulmonologist has ordered a sleep study but it is taking forever to even arrange an in-home sleep study. In the meantime I was unable to sleep for about 9 nights. Constant waking up.

I was desperate and decided to get a cpap from craigslist and started the cpap therapy to see if I find anything (got an inline filter to catch any particles given this machine is under recall). I have attached the screenshots from my first night of cpap. Requesting the experts to help me understand what this data indicates? Looks like I have CSA? 

Some of my current symptoms are -

1. Cannot sleep on the back, have to sleep on the side. Even then I don't get much sleep and wake up 3-4 times a night.
2. Feeling that my diaphragm has permanently contracted inwards. I have been in a lot of stress the last 3 months and wonder if that is related.

I do get a feeling that my brain is not sending breathing signal to my body even during a day time. Due to these issues I am unable to sleep and my head feels heavy the whole day.

Any help will be appreciated!

[Sleeprider]

You are using a CPAP at 8.0 pressure and seem to be experinecing mostly central apnea and hypopnea. The easiest way to interpret this is not from the events, but to zoom into the respiratory flow rate at a resolution of 2-3 minutes so the wave-form is clearly visible. That lets us see the flow variations, periodic breathing and allows us to interpret if there are obstructive or central issues within the respiration. The ideal view is during a period of sleep, which is typically very even, regular breathing rate. The graph of the daily details shows a cluster of central apnea and obstruction at the beginning of the night, and a period of data loss, followed by a cluster of hypopnea. Between 2:00 and 5:30 you are relatively free of events, and I think this is the area we want to focus on to make the full-night more like this.

The possibilities are sleep onset events that are pretty common in new users, and possibly positional obstructive apnea, which is usually associated with chin-tucking. You can see some examples of what this looks like in this wiki article http://www.apneaboard.com/wiki/index.php...onal_Apnea CSA is a possibility, but since you have long periods that are free of central apnea, this could just be a matter of adapting to the new CPAP therapy.

[sleephd]

Highly appreciate your response. Attaching a more detailed flow rate, not sure if that helps? I can produce more.

1. I am wondering if I should push my doctor for a in clinic study as the in home study might not detect the root cause in my case?
2. Do I need to get my brain checked if this is a CSA?

[Sleeprider]

Please read this section on how to create a zoomed image: http://www.apneaboard.com/wiki/index.php...Chart_View The result should look something like this:

[SarcasticDave94]

After seeing a correct zoom we will be able to see better what is going on.

Having CA doesn't necessarily mean your brain is damaged. Simply having too low of carbon dioxide is going to create Central Apnea, as the low CO2 will not signal need for a breath. If you have CA, this can be due to use of the PAP, what's called treatment emergent CA. It could be the CA that's pre-existing like mine, or yet it could be idiopathic-unknown cause.

We can't rule out pre-existing CA because you've not had your diagnostic sleep study yet. When you do, request your detailed report. HIPAA law permits you to request and receive it.

[sleephd]

thanks.. see attached.. not sure if I did this right?

[sleephd]

another zoom image set at 3.. previous one was at 6

[SarcasticDave94]

I'm not the best or sharpest knife when it comes to charts, so I'll defer to these guru chart readers. Even so, your second zoomed in chart, there appears to be maybe a flow restriction indicted by that flattened inspiration top. The CA in the first zoom is shown but there's details I'll miss that others won't. Standby for the cavalry.

[sleephd]

Also my heart rate is constantly below 55 and when I go to sleep it goes below 50.

[Sleeprider]

Good charts, and confirms that you have characteristics of unstable respiration we usually associate with CA. Based on this, I think your best therapy will come from ASV, although not very easy to get. I would really like to see you have a clinical polysomongram sleep study, preferably a split study that attempts to titrate CPAP. I don't know why your doctor seems unable to arrange even a home sleep study. This test equipment is readily available, but will not offer the detail needed to establish anything other than whether your AHI qualifies for CPAP treatment. Some home tests include a chest belt that measures respiratory effort and may identify central apnea, but will lack the ability to determine sleep stage and respiratory effort related arousals usually requiring an EEG channel. Where the potential for more complex sleep disordered breathing exists, a clinical study is preferred. Have you considered consulting a different practice.