New to CPAP and not experiencing relief...

[Sleepster]

I'm thoroughly bummed about the whole thing. Indications are that my hope of treatment for my OSA is ineffective for CA, which isn't helpful given my cognition complaints.

I understand how you feel, but it's way to early to draw that conclusion. That CA index will likely drop as you get acclimated to CPAP therapy. If after a week or two you are still concerned you can talk to your doctor about lowering the pressure. That's the classic approach to treating CPAP-induced central apnea.

[Extrospect]

If after a week or two you are still concerned you can talk to your doctor about lowering the pressure. That's the classic approach to treating CPAP-induced central apnea.

How long is the typical acclimation period to evaluate whether central events are worth addressing?

[zimlich]

Only a sleep test in the lab will accurately diagnose central apnea. If you talk to your sleep doctor about your fears you can have a sleep test with a trial of an ASV machine. This getting adjusted to 'PAP is a process and for some it's a long one. It took me four years of changing between machines and about 7 sleep tests to end up on ASV. Might be feasable for you- the ASV.
Good Luck. This whole process can be incredibly easy or very hard as you know, Extrospect

[Sleepster]

How long is the typical acclimation period to evaluate whether central events are worth addressing?

That's a question that can't be answered. Just wait at least a week or two to see if the CA index goes down. If it doesn't you can call your doctor and have your prescription pressure lowered.

I know it's hard, but patience is called for here. You're doing better than you were before, so just wait now and see what happens. I know it's hard because you're focusing on this new CPAP machine in your bedroom and its effect on your life, but try to spend your time thinking about other things. Things in your life that make it worth living. That's the real reason you're on CPAP therapy anyway.

If you really can't wait then call your doctor and explain your concerns.

[vsheline]

You should also look at the airflow graph for central apneas. See how long they last and how completely you stop breathing. If you're only stopping breathing for 11 seconds, or are only partly stopping breathing, that's a lot better than a long, complete cessation of breathing.

Prior to the beginning of each central event, I have some pretty erratic flow activity (as shown in the attached file). I'm not breathing for the duration of each event, with some events lasting between 30-40 seconds.

Hi Extrospect. I think you are to be congratulated for persevering on a path to get your sleep problems correctly diagnosed and thoroughly treated. I trust you will not give up prematurely, before you have arrived at the destination.

Your attached file looks like an example of Cheyne-Stokes Respiration (CSR), an extreme form of Periodic Breathing (PB). The Wiki says Cheyne-Stokes respiration is a pattern of breathing with gradual increase in depth and sometimes in rate to a maximum, followed by a decrease resulting in apnea; the cycles ordinarily are 30 seconds to 2 minutes in duration, with 5–30 seconds of apnea.

If you continue to see these events in your sleep data, you may benefit from an adaptive servo-ventillation (ASV) machine. An ASV machine calculates the tidal flow through your lungs, and changes the pressure as much as needed, both to avoid obstructive apneas and to maintain adequate tidal flow into and out of your lungs even when you completely stop attempting to breathe.

Maybe it would be helpful to give paper copies or pdf electronic copies of your data to your doctor (zoomed-in close-ups from many nights, like the example you posted) and ask for a prescription for an overnight ASV titration.

By the way, this is what I did, and my sleep doctor has recently given me a prescription for an overnight ASV titration. I want to find a facility which has a ResMed machine available for the ASV titration, so I can be titrated using the exact algorithm used in the S9 VPAP Adapt (the ASV machine I would try to get).

I don't really know whether the ResMed ASV algorithm is much different than the Respironics algorithm, but I am familiar with my present ResMed machine and want to be able to monitor the data from the ASV machine and bring to my doctor's attention any issues I find, and I am simply unaware how well I would be able to monitor the data if using a Respironics ASV machine. For all I know, a Respironics setup might also allow me to monitor the data adequately.

Take good care of yourself.

[archangle]

Prior to the beginning of each central event, I have some pretty erratic flow activity (as shown in the attached file). I'm not breathing for the duration of each event, with some events lasting between 30-40 seconds.

Even supposing we want to say these events aren't long enough to cause significant drops in oxygen, they're still probably disruptive to sleep.

Keep working with your doctor.

Keep an eye on it, especially if you start getting lots of apneas and they have a long duration. Somethings are not that concerning for a few nights, but are harmful long term. If your AHI or the duration gets too high, you should get more concerned.

We need your pressure graph, too.

It's a little troublesome that you're getting these "central" apneas at a pressure of 7. Centrals usually go up with pressure. On the other hand, your centrals didn't seem to go up that much on the ResScan chart when pressure went up. Maybe they'll go away over time.

They do sort of look like "real" centrals, not simply miscategorized obstructives.

However, as has been pointed out, your current condition is much better than before CPAP, assuming your sleep study was done right.

Watch the gabapentin. That's serious medicine. In particular, I think you have to be very careful to increase or decrease the dose very slowly. And follow the other instructions and watch for side effects.

[archangle]

Your attached file looks like an example of Cheyne-Stokes Respiration (CSR), an extreme form of Periodic Breathing (PB). The Wiki says Cheyne-Stokes respiration is a pattern of breathing with gradual increase in depth and sometimes in rate to a maximum, followed by a decrease resulting in apnea; the cycles ordinarily are 30 seconds to 2 minutes in duration, with 5–30 seconds of apnea.

If you continue to see these events in your sleep data, you may benefit from an adaptive servo-ventillation (ASV) machine. An ASV machine calculates the tidal flow through your lungs, and changes the pressure as much as needed, both to avoid obstructive apneas and to maintain adequate tidal flow into and out of your lungs even when you completely stop attempting to breathe.

It's way, WAY, WAY!! too soon for Extrospect to start worrying about that sort of stuff unless this goes on for a long time, or the "central" apenas get a lot longer or more frequent.

It could come to that later, though.

In particular, I think you need a lot longer time period of weird breathing before you can start talking about CSR or even PB.

This is the worst 4 minute period of the whole night. It looks like the rest of the night was much better.

We may be having a geekasm talking about the technical aspects and possibilities, but let's not scare the newbie into hypochondriac insomnia with all the horror stories.

[vsheline]

In particular, I think you need a lot longer time period of weird breathing before you can start talking about CSR or even PB.

This is the worst 4 minute period of the whole night. It looks like the rest of the night was much better.

Thanks archangle - very good points.

[Extrospect]

It's way, WAY, WAY!! too soon for Extrospect to start worrying about that sort of stuff unless this goes on for a long time, or the "central" apenas get a lot longer or more frequent.

I'm a pretty well-adjusted guy and can appreciate information without unnecessarily obsessing over it. If anything, it's helpful in preparing me for more productive conversations with my doctor.

This is the worst 4 minute period of the whole night. It looks like the rest of the night was much better.

Though it is a small sample, I've been confused by that pattern since beginning CPAP. The spike in erratic respiration precedes every single CA event recorded. Additionally, it's present at other times and followed by similarly depressed breathing where the duration is not long enough to warrant detection as an apnea.

Makes me curious if this can be linked to my heart pain complaints.

I'd like to reiterate my thanks to all of your for the commentary! It's great to benefit from the wealth of experience this community holds.

[vsheline]

Watch the gabapentin. That's serious medicine. In particular, I think you have to be very careful to increase or decrease the dose very slowly. And follow the other instructions and watch for side effects.

I have about 95% permanent hearing loss and loud tinnitus from taking various medications, mostly antibiotics. At no time did my doctors ever warn me that hearing loss or tinnitus or vertigo can be permanent side effects of these medications. Recently I found a great resource (book) for easily looking up the ototoxic (toxic to the ears) effect of many common drugs. I'll give the link below to the author's web site, where the book can be purchased for about $40 for a pdf copy. (Warning - do not buy this book on Amazon, because I just checked and to my shock the rip-off prices from unethical re-sellers of "used copies" were outrageously astronomical. I am going to suggest to the author to sell his books on Amazon, to force prices down to resonable levels.)

Anyway, Neil G Bauman in the book "Ototoxic Drugs Exposed" classifies many many drugs in a scale ranging from Class 1 (least ototoxic risk) to Class 5 (worst ototoxic risk). In his judgement, gabapentin is a Class 4 risk, which is high. It can harm both eyes and ears, especially if taken for months. But if stopping, one must taper off slowly, under doctor's supervision.

Also, when taking any medications, be very careful of drinking much grapefruit juice, because (as explained in the book) it contains a substance which can greatly increase the potency of some drugs, by slowing down the body's normal process of eliminating drugs from your system. As you continue to take your regular dose of whatever medications you are on, if the drugs are not being eliminated at the normal rate expected, the drugs build up to higher concentrations in your blood than desired.

Link to author's web site:
http://www.hearinglosshelp.com/products/books.htm