Sleep - wake transition central apnea

[drmaestro]

Hi,

I've read that 40% of the general population tend to have central sleep-wake transition apnea. I assume that rate is higher in CPAP/APAP/VPAP therapy patients, especially in the begining of the therapy. It is considered unimportant if it isn't accompanied by desaturations. The question is, what if it is accompanied by desaturations? In my case, I don't get centrals most nights, as I probably got used to the treatment emergent cetrals after 1 month of CPAP use, however when I get it, it is invariably at sleep-wake transition and they tend to be clustered (I get 5-6 of them in 4-5 minutes, after transtioning to the sleep they disappear). The breathing efficiency provided by the VAuto probably plays a role on this. I wonder if using a ramp for a brief period would decrease the probability of having these. The duration is not a concern, as the total apnea time is rarely over 1 minute in total (for the whole night) and it isn't very different than holding my breath for 1 minute, however I may see saturations as low as 78-79% at these periods, which is what concerns me. The desaturation periods are very brief (1-2 seconds), so I still assume it is unimportant, but would appreciate any input on how to prevent them.

[SarcasticDave94]

I am not certain of prevention, but I'd not recommend adding Ramp. It could make things worse rather than the targeted improvement you seek. Ramp can reduce or hinder effective therapy during its usage time.

I see the desat level is worth possible action, but the length of time is too short to act upon. I'm not saying it is definite in this situation, but it's possible the negative aspect you're chasing is something that may cause more stress and concern than what's actually warranted. In other words, you may be considering the adding of actions that may not be required to some aspect you might not be able to control regardless of effort.

[srlevine1]

Does anyone have a guideline for ignoring sleep/wake junk that normally appears at the beginning or end of a recorded sleep session in some individuals? Would it be prudent or helpful to add the ability to select a time range in Oscar to get a more accurate picture of one's sleep session?

[Gideon]

Not a bad question.
How do you determine sleep latency?
It's just instinctful for me to glance at the lidex then the charts and determine what looks meaningful

[drmaestro]

For me, I look at the tidal volume. My tidal volume when I start using the mask but not sleeping is significantly higher compared to when I start to sleep, so any events happening during this period is not really a sleep event for me. I understand that isn't completely true, as I probably start sleeping before the tidal volume falls completely but the transition period isn't demonstrative of what the actual sleep is, so I don't care about it.

     

The problem with being able to deliberately remove some events, without the confirmation by EEG,  would probably be the risk that OSCAR reports may be manipulated to change scores. I understand that OSCAR isn't legally used for this purpose but many of us also use it to show our results to sleep doctors, and the ability to manipulate the results would decrease its trustworthiness.

[srlevine1]

Not a bad question.  
How do you determine sleep latency?
It's just instinctful for me to glance at the lidex then the charts and determine what looks meaningful

I am unfamiliar with the term "lidex," could you please explain?  -- Thanks, steve

[Gideon]

Index typo

[srlevine1]

Thanks...