Continued difficulty with central sleep apnea

[ckingzzzs]

From June 2015 to December 2015 I was using a CPAP resmed machine. My AHI averaged around 10 and centrals were 6-8. I narrowed down pressure ranges over the course of 3 months and still no improvement. I was removed from the CPAP machine and started the resmed aircurve 10, vauto machine on Jan 2, 2016.

After being on the resmed aircurve 10 for the past 44 days, the numbers show the following:

AI=12.7
Central= 10.6
Obstructive=1.7
AHI=16.7

I am using autoramp, 10 minutes, and machine set to 4-20 range. The results shows a median IPAP pressure of 11.3, and max IPAP at 14.3, and a median EPAP pressure of 7.4 and max EPAP at 10.3.

Based on the results so far, it does not appear that the VPAP machine is addressing the issues with my centrals. My sleep clinic has indicated to me that a two night sleep study (in the hospital back in May 2015) only showed 2 central events at night. So my centrals were a problem with the CPAP and now appear to be a problem with the VPAP as well.

I welcome any thoughts or suggestions from you more experienced people out there who have always been a great help to me.

[Sleeprider]

There is no reason to think the vAuto will resolve central apnea, you need an ASV. You're just on the standard insurance merry-go-round of "patient must fail CPAP to use BPAP, and must fail BPAP to use ASV. You will eventually arrive there. It's ridiculous to think that central apnea is going to respond to anything but breath by breath pressure support servo ventilation. I guess it can happen, but there really ought to be a shortcut to the process.

[ckingzzzs]

There is no reason to think the vAuto will resolve central apnea, you need an ASV. You're just on the standard insurance merry-go-round of "patient must fail CPAP to use BPAP, and must fail BPAP to use ASV. You will eventually arrive there. It's ridiculous to think that central apnea is going to respond to anything but breath by breath pressure support servo ventilation. I guess it can happen, but there really ought to be a shortcut to the process.

I agree totally Sleeprider but I have a bigger issue. In the sleep study I have little centrals and on the cpap vpap I have more centrals. Insurance companies base their determination of allowing an ASV on centrals reported from a sleep study. So then, it looks like I will have to undergo a third sleep study. that would be 3 within a year.

[Sleeprider]

The centrals should show up in a titration study using CPAP or BPAP pressure, however they may not be apparent in an untreated (no PAP) diagnostic study. About 15% of apnea patients have some form of complex apnea, and a small percentage of those actually develop severe complex apnea as a result of PAP. So if a study is required for coverage, then you need to be sure the study is designed to observe your CA under PAP, and can proceed to titrate ASV. Another diagnostic or simple CPAP titration won't do it.