APAP Prescribed for Central Sleep Apnea?

[richb]

I should mention, this is from a day where I took off my mask while sleeping, which I did a lot at first, so the data for the night is incomplete.  This also shows my settings before they were changed by my sleep dr from 6-16 to 4-16.

The CSR pattern that you see is just a more extreme form of your Central Apnea. The machine escalates the "Periodic Breathing" that is evident in the chart you posted to CSR from time to time. If you, as I do, have Central Apnea NOT associated with Congestive Heart Failure you are going to see Periodic Breathing and Central Hypopneas during your sleep study. These will escalate to include many periods of CSR when you are on a traditional CPAP or APAP machine. Your data will show that your CPAP machine has failed to treat your Central Apnea. The next step might be to have a titration on an ASV machine to show that ASV is an effective treatment. You are on the right track.

Rich

[Sleeprider]

I agree with Rich and just want to contrast your example with the one I posted earlier. True Cheyne Stokes is a gradual waxing and wainng of the respiratory effort usually including a central apnea at the nadir of the cycle. In congestive heart failure, this may be associated with fluid in the lungs that make the central apnea appear to be obstructive as in the closeup of the example I posted before; however this is still a central event. Just as the machines don't always get it right, Sleepyhead doesn't either, but you can fix it. You can change the label for CSR to PB and Periodic Breathing, which is what it is. Just go to the Sleepyhead Menu File/Preferences/Events, and double click on Cheyne Stokes Respiration and change to Periodic Breathing, and change the abbreviation from CSR to PB. Your graphs will look a lot less alarming and what you show above is periodic breathing. This is Cheyne Stokes, but the graph is labeled PB. Note the duration of these apnea (over 40 seconds) and the very gradual transitions in and out of apnea. It is the gradual transition that is the hallmark of this disease.

[NeverRested]

This is both helpful and reassuring. Thank you. I've had a little trouble with the VA, it was a challenge to even get a smaller mask when the one I started with was much too big, so I imagine an uphill battle to get the right therapy, but at least I'm on the right track. Thank you again for all your help, I really appreciate it.

[Sleeprider]

The new administration seems intent on improving the treatment our service men and women get from the VA, so hopefully they will become more responsive soon. Your case is pretty straight-forward in that you have already had a positive diagnosis for central apnea. The procedure to trial CPAP is a formality that few people understand, but it is written policy and procedure for the approval of the more expensive ASV device. I think your doctor should be supportive and transparent about this process. Let him know what you know now.

[mymontreal]

Following...

[Reznik]

My guess is that the FOT pulses that the machine is sending during your centrals are disrupting your sleep without actually waking you up.

[Reznik]

You may wish to (1) find a machine that doesn't send pulses during apneas, (2) find a fixed pressure to use, and (3) disable EPR.

Also, bear in mind that (1) central apneas can often be reduced by lowering your pressure, (2) periodic breathing may be an indicator of some other issue that you need to address or may be just be how you breath, and (3) treating centrals/periodic breathing with ASV has not proven to prolong life or improve sleep, and for certain categories of heart patients, has actually been shown to hasten death.

My personal experience has been that my periodic breathing had central apneas in between the episodes when my pressure was too high. As I lowered the pressure, the centrals went away, but the periodic breathing continued. When my machine sent FOT pulses, the FOT caused my Resmed machine to incorrectly score hypopneas as central apneas. When I turned off FOT pulses, the hypopneas got scored correctly. My sleep doctor indicates that centrals/hypopneas are not as issue for her if they occurs as clusters during REM sleep.

I also found that my hypopneas vary greatly from day to day depending upon whether I exercise or not and how much caffeine that I consume.

[SarcasticDave94]

You may wish to (1) find a machine that doesn't send pulses during apneas, (2) find a fixed pressure to use, and (3) disable EPR.

Also, bear in mind that (1) central apneas can often be reduced by lowering your pressure, (2) periodic breathing may be an indicator of some other issue that you need to address or may be just be how you breath, and (3) treating centrals/periodic breathing with ASV has not proven to prolong life or improve sleep, and for certain categories of heart patients, has actually been shown to hasten death.

My personal experience has been that my periodic breathing had central apneas in between the episodes when my pressure was too high.  As I lowered the pressure, the centrals went away, but the periodic breathing continued.  When my machine sent FOT pulses, the FOT caused my Resmed machine to incorrectly score hypopneas as central apneas.  When I turned off FOT pulses, the hypopneas got scored correctly.  My sleep doctor indicates that centrals/hypopneas are not as issue for her if they occurs as clusters during REM sleep.

I also found that my hypopneas vary greatly from day to day depending upon whether I exercise or not and how much caffeine that I consume.

Reznik, I’m going to disagree with you on the ASV not prolonging life or improving sleep. Before I had my ASV, my AHI was over 73. With the ASV, they’re consistently under 5. I believe lower AHI is better for one’s longevity. Without the ASV addressing my Central Apnea segment, I potentially would not breathe for long periods of time if using a different xPAP device. The ASV cancels out my CA. Secondly, aspects of studies of ASV and certain heart patients being at risk for increased health issues has some potential flaws as I understand it.