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+--- Thread: [Diagnosis] Very high amounts of periodic breathing / CSR ? (/Thread-Diagnosis-Very-high-amounts-of-periodic-breathing-CSR)
RE: Very high amounts of periodic breathing / CSR ? - gregbe2000 - 09-19-2024
Thanks for the info. I didn't see this until the morning. I ended up using static pressure at 5.4cm. This pressure didn't make me feel like I wasn't getting enough air, FWTW. Unfortnately, same results of a lot of central apneas (though I think several may be false) and CSR pattern. I don't feel like I slept much and again feel very fatigued in the morning. When I go through the flow, I have a lot of respiration that's waxing and waning that isn't tagged CSR. I don't know what to do for trying different settings at this point. I don't think a range of 7-9cm is going to be much different than my normal settilngs since my pressure seems to usually however between 6 and 8 with my original 5-15 setting.
Anyone have any suggestions?
RE: Very high amounts of periodic breathing / CSR ? - Jay51 - 09-19-2024
You have some other suggestions by Red (Crimson Nape) and Phaleronic to try. If you are still having this pattern after trying these suggestions, you may have real CSR. If you are having this many CA's, you are most likely on the wrong machine also. The ASV is for CA's (and no lung or neurological diseases). The ST and ST(A) can stop CA's, but they require a lung disease, neurological disease diagnosis etc. to get one.
RE: Very high amounts of periodic breathing / CSR ? - Dormeo - 09-20-2024
As you probably know, CSR is a sub-category of periodic breathing. What distinguishes CSR is a pattern of waxing and waning breathing punctuated by central events. In CSR breathing, if you connect the tops of the inhalation traces in the flow rate, the result is a sinusoidal pattern. More here:
https://www.apneaboard.com/wiki/index.php?title=Cheyne-Stokes_respiration
I don't have the background to say whether your charts indicate CSR or not, but I do think it is quite important to investigate this further. Your sleep doctor sounds incompetent, incurious, and uncaring. I would suggest talking with your primary care physician; with luck he or she can refer you to a pulmonologist and/or neurologist to evaluate further.
Meanwhile, I strongly recommend that you get a recording O2 monitor, one that is compatible with Oscar. (See the oximetry wizard on the main Oscar page.) This will give you and your doctor a sense of how your O2 levels are doing during the night. Your doctor can then equip you with a medical-grade monitor if necessary.
In the event that your O2 levels are below 90 for sustained periods of time during the night, you can use an oxygen bleed into your PAP machine while things are getting sorted out. Again, that's something your PCP may be able to help you with.
RE: Very high amounts of periodic breathing / CSR ? - gregbe2000 - 09-20-2024
Hi - Thanks for the reply. I have an appointment with my sleep doctor early next week. I'm also going to get scheduled for a CPAP titration sleep study. Hopefully they can see the waxing and waning in my respiration. I didn't have a titration study 4 years ago due to COVID. I also wonder if my waxing and waning would show up if I wasn't wearing a CPAP. It wasn't flagged in my sleep study 4 years ago, or the ones I did in 2008. The report I got doesn't show the respiration flow charts.
I thought I was only a side sleeper, but I video'd my sleep and I sleep on my back 50% of the time. I correlated this to my oscar data and the CSR stuff was only flagged when I was on my back. I slept with a backpack on last night to force side sleeping. While me sleep was horrible, CSR wasn't flagged. However, the waxing and waning of my respiration at certain times of the night was still there.
RE: Very high amounts of periodic breathing / CSR ? - HenryECole81 - 09-29-2024
CSRs. Independent verification important: Have you asked your cardiologist? My cardiologist and electrophysiologists chuckle at my CSR readings as indicative of underlying heart issue -- even though the OSCAR matches perfectly the CSR form. This is based on my recent and past record of Echocardiograms.. Pulmonologist agrees, and avers to Cardiologists. He also adds reducing CAs due to response to user-machine parameters and possibly anxiety may end the CSR readings Important to have Cardiologist involved since heart is central to the CSR issue. Possible irregular heart rate such as AFIB or AFlutter might be a cause of the OSCAR CSR data, but asymptomatic AFIB is not necessarily a CSR or any issue for a patient. They suggest taking a full, in-lab, fully wired sleep test if further assurance is desired (at home will lack critical data and, if there is somehow an issue, lack of data will leave open questions)
RE: Very high amounts of periodic breathing / CSR ? - gregbe2000 - 09-29-2024
(09-29-2024, 09:56 AM)HenryECole81 Wrote: CSRs. Independent verification important: Have you asked your cardiologist? My cardiologist and electrophysiologists chuckle at my CSR readings as indicative of underlying heart issue -- even though the OSCAR matches perfectly the CSR form. This is based on my recent and past record of Echocardiograms.. Pulmonologist agrees, and avers to Cardiologists. He also adds reducing CAs due to response to user-machine parameters and possibly anxiety may end the CSR readings Important to have Cardiologist involved since heart is central to the CSR issue. Possible irregular heart rate such as AFIB or AFlutter might be a cause of the OSCAR CSR data, but asymptomatic AFIB is not necessarily a CSR or any issue for a patient. They suggest taking a full, in-lab, fully wired sleep test if further assurance is desired (at home will lack critical data and, if there is somehow an issue, lack of data will leave open questions)
Hi - Thanks for very much for the insight. I did a titration sleep study a few days ago but wasn't able to sleep for long enough for a good set of data. My sleep was very interrupted. A ton of transitions between wakefulness and sleep. I had CAs but they didn't see CSR. At least half of my CAs were arrousal-based CAs. I guess that's good news. I now need to schedule a regular diagnostic sleep study where I'll have a better chance of sleeping. I've been recording myself sleeping at home and it does seem like a twitch or have some movement before I have CAs - been getting flagged for CSRs the last couple of days and there is usually some movement in the CSR session.
I have a really low heart rate (resting heart rate of 35-40) and during the day if I'm not moving it's typically 40-45. Due to this and the CAs that were assumed to be falsely flagged 18 months ago (before I knew there was OSCAR data) my sleep doctor sent me to a cardiologist to rule out a heart issue. I wore a 10 day chest patch and had an EKG and everything was normal (besides that I have bradycardia which I've known forever). I now have a cardiologist appt for an echocardiogram to rule out any valve issues. No one expects this but it's worth ruling out and would have to be done if I ever need an ASV.
I've been tweeking my cpap settings every day to try to find heaven (EPR on/off, static pressure, changing min and max on dynamic settings) - so far no luck.
Have you had any success on lowering your CAs/CSR? If so, what did you do? I will start doing CBT-I soon as I have insomnia as well. My sleep doctor thinks I should try gabapentin and I might - just hoping to find something that works before using it.
RE: Very high amounts of periodic breathing / CSR ? - Dormeo - 09-30-2024
A full work-up would include some more tests:
https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148
It could bring you peace of mind to rule out CHF definitively.
About tweaking your settings: make only one change at a time, and give each new setting at least 3 days before trying to evaluate its success (unless it's a total disaster). Sleep is so variable from one night to the next -- you need several nights to spot a meaningful difference.
I'm glad you'll be scheduling a regular sleep test.
Feel free at any time to post another chart.
RE: Very high amounts of periodic breathing / CSR ? - gregbe2000 - 09-30-2024
(09-30-2024, 11:31 AM)Dormeo Wrote: A full work-up would include some more tests:
https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148
It could bring you peace of mind to rule out CHF definitively.
About tweaking your settings: make only one change at a time, and give each new setting at least 3 days before trying to evaluate its success (unless it's a total disaster). Sleep is so variable from one night to the next -- you need several nights to spot a meaningful difference.
I'm glad you'll be scheduling a regular sleep test.
Feel free at any time to post another chart.
Thanks Dormeo. I've had or will have most of the the non-invasive tests. I thankfully don't have any signs of heart issues beyond the CSR concern and I sure hope it stays that way. I'm dong the echocardiogram (and injection fraction measurements as part of it) in about a week to be sure. I do run quite a bit, and just ran a 5K - if I have an issue it's never given me any of the classic symptoms. Last night I tried 4-8cm with EPR off. The charts below are about the best I've had, at least recently. I still have general waxing and waning and CSR was flagged - but I think many of the CAs that were flagged came after an arousal - so not the traditional kind. Even with a night this clean (for me), I still felt bad in the morning and worse a couple hours into the day. It seems like I need to find the root cause of why I have so many arousals that lead to transitioning between wakefulness and sleep and therefore crappy sleep. If anyone has suggestions on this, or other tweaks to settings, I could use the help. I'll be starting CBT-I this week.
RE: Very high amounts of periodic breathing / CSR ? - HenryECole81 - 10-01-2024
Hi Gregbe2000. Follow up on our previous exchange. We have some similarities. -- Very competitive swimmer but much older -- 80ish. I have ( had) a very low heart rate for forever. 35-40 bpm resting, 30 at night. No concern for cardiologists. But evolution from that may be useful to you, at least for later on. Please ignore the rest of this paragraph in not relevant: In the last several years, my low heart rate began showing as asymptomatic Aflutter and AFIB, and my heart rates dropped even further with occasional night reading of 12 and 24 bpm and awake resting 32!!). At same time, tests showed that my heart rate was not accelerating as well as it should from rest to higher exercise level rates. Eventually I had proactive treatment for AFIB/ heart rate -- cardioversion, ablation(failed) and finally pacemaker (the new, wireless version, great)). The pacemaker settled my resting HR to 60 and allowed the rate to rise with exercise to 140 bpm when exertion and rate to rise above by itself in competition or workouts to 160+. AFIB remains, but still mostly asymptomatic. Note that OSCAR reports that my Apnea events were much better controlled with pacemaker, with 5 out of 7 nights with considerable quality, though still some nights with CAs and some occasional CSRs. Aside: The shift from low heart rate to AFIB can partially be ascribed to aging, but do give possible attention for AFIB impacts from long term, high use of NSAIDs for aches and pains.
CPAP and Apnea history: Lab sleep test and pulmonologist prescribed and guided CPAP for Apnea 2009 -2015; then pulmonologist tests said too mild for CPAP but try mandibular device – so so results, but of course not quantitatively recorded since no CPAP. Later 2019 lab tests said Apnea again and CPAP . Most of past CPAP use history has been a struggle of equipment and awakening, with lots of Apneas adn HAs, The latest CPAP 2019 -2021 prescription had lots of CA and use was called to Stop by pulmonologist as the CPAP device aggravating Apnea after many trials and also since pulmonologist sleep test showed I was doing better with mandibular alone. That was not satisfactory for me, particularly with identified link of apnea to AFIB even if asymptomatic. I played around with AirSense 11 on CPAP mode and found that I could keep my throat fully clear using mandibular device comfortably in my mouth withing CPAP mask with pressures around 12. Since I sleep on my back due to a shoulder rotator cuff, I added a cervical collar to keep my chin up and throat clear. and open. Voila, sorta. I still can have CAs and some occasional CSR events, but definitely get six or so hours of self-sensed clear sleep as mostly validated by OSCAR readings over a usual 8-hour night. I ascribe most CAs to pre and post awakening events and anxiety laden partial sleep hour(s) after middle of night awakenings usually due to need to pee - BPH) Since some CSRs show up, cardiologists have done extra ECHOS including particularly ejection fractions, plus required EKGs for AFIB which have real but very different look with pacemaker. No sign of heart physiology or electrical causes for CSRs. They and pulmonologist ascribe CSRs to CPAP use, OSCAR interpretations, and itself and mental state at awake or near sleep. Cardiologists are having me take a Max Heart Rate Stress Test to make sure the heart rate acceleration and the high above average max rates are ok with the rest of heart systems.
Hope this helps some. HEC
RE: Very high amounts of periodic breathing / CSR ? - Dormeo - 10-01-2024
gregbe2000, I'm glad to hear about the cardio testing you're having done and about the CBT-I, which I really hope will help you. I agree that a couple of those CAs look like post-arousal CAs, though I'm not sure I see that in every case.
Spontaneous arousals are a bear. I hope the upcoming sleep test will help you figure out how many of your arousals are spontaneous and how many are respiratory-effort-related.
I do just want to return to the possibility of your getting a recording oximeter compatible with Oscar. Your O2 levels, especially during the periods when you have a lot of CAs or Hs, could be a significant factor in how you and your doctors want to proceed.