[Symptoms] Periodic breathing

[garywych]

WHi I'm new to this. I was diagnosed with mild to moderate sleep apnea a few moths ago. I also suffer from paroxysmal atrial fibrillation. I'm having an ablation on the 3rd may. 
I saterted auto CPAP about 8 weeks ago and it was set at 4-20. I had my review after 4 weeks. My AHI on DreamMapper was between 7 and 18. The technician said, when she downloaded the sd card "oh dear your having cheyne stokes respirations. She was una Kennedy to explain what this meant. I also asked if I could set the apap to say 8-12 a sample my average 90% pressure was 10.5. She said no it's fine as it is. Anyway I later set it to 9-13. My AHI has been mainly 2-6.7 since, with an occasional 13 or 16. It's spread evenly between oa,can and hypopneas. It says I'm having 16% average periodic breathing. Can anyone say what might be going on?

[Crimson Nape]

Hi garywych - Welcome to the forum!

I would recommend that you download #SleepyHead analytical software to obtain more detailed information on your sleep patterns. This will help in seeing what needs to be adjusted.  Just click on the #SleepyHead name to download the software.

[garywych]

I only have an iPad. My lap top is really old and has Linux which won't let me download sleepyhead

[Crimson Nape]

There is a Linux version of #SleepyHead. It works faster than my Windows version on data import.

[garywych]

I'm not used to using Linux and I very time I try to get sleepy head it's says no, then instructions for configuring that's like another language

[Crimson Nape]

The only other thing I can offer is, "Do you have any kids in your neighborhood that you trust with your computer?"

[xxyzx]

WHi I'm new to this. I was diagnosed with mild to moderate sleep apnea a few moths ago. I also suffer from paroxysmal atrial fibrillation. I'm having an ablation on the 3rd may. 
I saterted auto CPAP about 8 weeks ago and it was set at 4-20. I had my review after 4 weeks. My AHI on DreamMapper was between 7 and 18. The technician said, when she downloaded the sd card "oh dear your having cheyne stokes respirations. She was una Kennedy to explain what this meant. I also asked if I could set the apap to say 8-12 a sample my average 90% pressure was 10.5. She said no it's fine as it is. Anyway I later set it to 9-13. My AHI has been mainly 2-6.7 since, with an occasional 13 or 16. It's spread evenly between oa,can and hypopneas. It says I'm having 16% average periodic breathing. Can anyone say what might be going on?

you will need more data

machine can cause CA
the tek may think it is CSR but not necessarily so
and if it is so what its just a label

i have slow shallow breathing with occasional long deep breaths every ten or so , at times
and i have had central apneas for decades

the bipap brought out more CA so the doc is switching me to a different machine that might handle them better

if your oxymeter does not go too low then i would not worry if you got your ahis down to under 7

I would not do anything without seeing a doctor if you have afib
but i am ultra cautious type person

[trish6hundred]

Hi garywych,
WELCOME! to the forum.!
Good luck to you as you continue your CPAP therapy, hang in there for more answers to your question.

[garywych]

Last night AHI 15 night before 6.7 before that 16, last week with a few at 1.3 and 2.0. Pressure now at 10-12 and 90% at 12. Seems sometimes when AHI was low the 90% was around 9-10.5. Seems also I can't get enough air into my nose. The Dr won't see me untill 17th may. He says I have mild oa based on a study 18 months ago. 4mimths ago I had a polysomnograph is spain and he said I have ca predominantly. In Spain they also did a three night titration apap bipap CPAP and said my optimum pressure is 10 and did best on fixed CPAP. The U.K. Dr dismissed this and put me on apap. I have my catheter ablation on 3rd and don't know what to do.

[Sleeprider]

Gary, what portion of the AHI is central (CA or CAI)? Cheyne Stokes is a form of periodic breathing most often associated with congestive heart failure, and has a very characteristic pattern. There are other forms of periodic breathing that can be a part of complex apnea, or even obstructive apnea. It is hard to advise you on the specifics without seeing the data including events and flow rate charts.

The PSG results you have had are apparently mixed, and you may have complex apnea. The fact you presented with CA events in your PSG in Spain strongly suggests an element of centrals. These can become more pronounced on CPAP, especially with variable pressure. Your results cited in post #1 reinforce this conclusion because at open pressure of 4-20 you had relatively poor results due to the open pressure situation. The improvement, but inconsistency at higher pressure is typical of complex apnea. What I can say is that, if you do not have a history or diagnosis of congestive heart failure, your complex apnea problem has a solution, and it should not be referred to as CSR.

Complex apnea responds best to adaptive servo ventilation (ASV) as provided by the Resmed S9 VPAP Adapt, Resmed Airsense 10 ASV and Philips Respironics Auto SV Advanced machines. Those are expensive, and require that you pursue a diagnosis of your condition in order to get the appropriate prescriptions, however, you need to strongly point to suspected complex apnea with your doctor and determine if he has any familiarity with that situation.

Meanwhile, the best option for optimizing a CPAP, including an auto machine, is to find an optimial fixed pressure that gives you the best results. This is most likely a fixed pressure between 6 and 10 cm with the comfort CFlex or AFlex settings off or set to 1. My best advise is to switch to CPAP mode or use minimum and maximum pressure in auto mode that are the same; then begin a trial and error process of finding that optimum pressure. Since you are now at 9-13 pressure, I would start at fixed pressure of 9.0 and work downwards. The problem with complex apnea, is it fools the machine into responding to obstructive cues like flow limits and what it perceives is obstructive apnea, and this ends up making the situation worse. So use fixed pressure, no Flex and see what you get.