central Apnea then Chyene stroke pops up

[Jessher]

Never had a problem with Chyene stoke, CSA pops up after being on a Airsense 11 auto  for a year.  Had foot surgery and heart arrhythmia  and CSA pop up. Went from  AHI of less than 3 to all over the map  19 the highest.
Doc said your fine.

   

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[Sleeprider]

Unfortunately, Resmed labels all periodic breathing as CSR. As you probably know, CSR is a specific abnormal breathing pattern and there are many others including idiopathic periodic breathing which is more likely the case here. You have a lot of centrals in this example, was central apnea identified in your sleep study? Anyway, we probably need to zoom into the events to learn more about whether they are actually obstructive or central.

[Jessher]

Thank you sleeprider,
I was thinking that was the case

   

[Sleeprider]

Need a closer zoom. Total time on chart 3-4 minutes. That allows the visualization of the respiratory cycle flow wave.

[Jessher]

   

so during a CA event, breathing is shallow not a true CA

[Jessher]

sorry missed a question,

out of 35 AHI  40%  central apnea. this was from my home sleep study

[Sleeprider]

Jessher, since your original sleep study had a very high central apnea rate, we cannot rule out that what we are seeing in your results is real CSA or at least complex apnea. We can optimize CPAP for obstructive sleep apnea, but we cannot fully treat CSA. There is evidence of OSA in your chart, but the symptoms of clusters of central apnea would not be unexpected if your diagnostic study included that event at 40% of total.

You have been on CPAP therapy for at least a year, and are starting to experience increasing levels of CSA and periodic breathing with events from 3 to 19 per hour. With this event rate and pattern, it is very difficult for a clinic to diagnose or titrate for the treatment of CSA because you probably have long periods where no events occur, then a cluster causes a large number of events. In nearly all cases, a clinical titration will incorrectly identify a pressure that provides efficacy, but in real-life practice, it makes no difference. This is part of the problem in getting an appropriate diagnosis and treatment for individuals like you. Your options are to try to deal with this through your doctor, or to experiment with other options to see if they work.

[Jessher]

Thank you  sleeprider

Need to get educated here to ask better question at the doctors Office.

thank you again. 
Jess

[stevew77]

The problem is diagnosing Central Apneas vs. Obstructive Apneas. One of the problems is when sleep studies require the patient to lie on their back most of the time. Mine did, and because I mostly sleep on my sides and could not go to sleep, even after a few hours of not sleeping while being titrated with a mask, I turned on my side and the sleep tech blasted the door open and demanded "What are you doing? Do you want to leave?!!" I replied "What did I do wrong?!!" He said, "You turned off your back!!!" I told him, "You said it was ok to sleep on my side sometimes." He did not reply. I did not sleep more than about 15 minutes for the rest of the night. The sleep study was f***ed because it showed I had less than 50% centrals due to supine sleep position. I got f****d, but due to previous data to my sleep doctor from OSCAR showing CSR, I got my ASV!!!

[Sleeprider]

The ironic part is a titration is rarely needed for ASV because it is so automatic. You can basically put a person on ASV auto and just observe whether their conditions resolve over several nights. Of course no sleep clinic or doctor is going to give up the income from performing unneeded tests an analyses.