[CPAP] High AHI but technician says all OK...

[SarcasticDave94]

That would be a good indicator to shop for a new doctor. When you find another one, ask about CA when making the appointment, so you don't replace one clueless Dr. Duck with another.

[Benzi]

That would be a good indicator to shop for a new doctor. When you find another one, ask about CA when making the appointment, so you don't replace one clueless Dr. Duck with another.

And he seems to have a license to practice medicine. I wonder whether there are requirements before a doctor can specialize in sleep medicine. Or whether all they need is a general license. Probably different in every country.
Mind you, I could use Skype to consult with a doctor in the US. With the crazy situation we're in now, I use video to visit my GP... If I can't find someone in my town, maybe I'll try it.

[Benzi]

Is a BIPAP machine helpful in treating central apneas?

[SarcasticDave94]

I'd think any BPAP other than ASV could make CA worse. A ResMed ASV would be the best tool to fight CA.

[Gideon]

ASV is a BiLevel that treats Centrals and is designed to do so.
BiLevels with a backup rate can treat centrals BUT you are always at elevated pressures and PS to initiate a breath, even when it is not needed. This can cause other issues.

CPAPs and BiLevels without backup cannot in any way treat Centrals. These BiLevels will not, when properly set up, be ant worse than a CPAP machine.

[Benzi]

OK, I said I would update: I took the doctor's advice and increased pressure to 12. Accomplished nothing but a horrible night. So I went back to 6-8, AHI around 8 and the same sleep quality as before (poor). I guess my next step is indeed a different doctor, though what is a bit disconcerting is that in all the local sleep medicine sights I can find no mention of using ASV to treat central apnea. Is it possible that it's simply ignored here?

[Sleeprider]

Many doctors simply have no expertise in central and complex apnea and treat all sleep disordered breathing as obstructive. The best weay to screen for a new doctor is to call their offices and inquire whether they can treat central and complex apnea. You can follow that question with, will you prescribe ASV where it is indicated as appropriate? You are looking for a couple affirmative answers with no hedging or hesitation. I'm sure you know how your own doctor's office would respond, and that is not what you want.

[Benzi]

So I went and consulted with a "sleep specialist". At least, that's what he calls himself. Talks as though he's the Almighty. He said that in cases where central apneas occur after the obstructives have been resolved, he treats the centrals as though they were obstructives. He told the CPAP technician to increase my max pressure from 8 to 10, and see what happens. When I asked how this was going to help, he showed me the door and told me that if I didn't want to follow his instructions I could leave.

I swallowed my pride, and increased the pressure. It made almost no difference to the AHI (around 8) and made me even more tired.

Yesterday, after a week of doing this, I went back to him for some more aggravation and asked him what to do. He said that the apneas were not enough to make me tired, that maybe I'm waking up at night without knowing, and suggested a sleeping pill. He also suggested I try adding a humidifier attachment to the CPAP when I told him I the air feels hot and dry.


So last night I added the sleeping pill. I slept for about 6 hours with the mask, then took it off and slept about an hour more. AHI according to the machine was 4.4 (Oscar shows it as 3.82 for some reason). Nearly zero obstructives, and only 2.99 clear airways. On paper, a terrific improvement, but I feel drugged. Maybe I need to get used to the sleeping pill.

Also, it shows a lot of leaks, so maybe the mask wasn't tight enough. Hard to know whether the mask is tight enough to prevent leaks without being too tight and causing them.

This morning I consulted an ENT who told me that a sleeping pill could definitely reduce the number of centrals.


What do you guys think? Does the data indicate that I might be on the right track for handling the centrals?

[Sleeprider]

Well you clearly did not find a doctor that fits the need I described in post #57. You really need to get leaks under control, and consider reducing EPR to 1. With pressure range from 5 to 8 and EPR 2, your pressure range with EPR is only 5/4 to 8/6. The basic strategy here has to be to control OA with higher EPAP pressure, and minimize CA with less EPR. You can do both by reducing EPR by 1.

[SarcasticDave94]

I'd say that unfortunate but this doc isn't interested in treating CA in a method that is known to work. I do realize that sometimes CA respond well to CPAP, but not in your case. I'd try another doctor that fits the description Sleeprider mentions or by editing settings he says above.