High Central Apnea, Setting Changes

[lbl82]

   
I only had my EPR on during my Ramp Time.  My Centrals still make up the majority of my AHI and my AHI is over 5.  Should I try this setting for a couple more days and see if it improves?  I don't understand how a BiPAP with ASV is the only BiPAP machine that treats Centrals?  What do the other BiPAP's treat?

[Sleeprider]

This thread has been merged with about 4 other threads all dealing with the central apnea issues by lbl82. Keeping therapy threads together helps us to see a pattern of problems and know the history of settings and suggestions.

lbl82, you have central or complex sleep apnea that probably will require an adaptive servo ventilator (asv). You should contact your doctor about the high numbers of central apnea consistently appearing in your charts and request a titration study that evaluates CPAP and ASV if needed. Meanwhile, I would like to see what happens to your results if we significantly lower your CPAP pressure from 17 to about 11.0. This may increase the obstructive events, but the centrals are at an unacceptably high level with current high pressure settings. Your EPR settings have had no impact on your high level of CA events, and I don't think lower pressure will resolve things either, but it's something to try while you contact your doctor and try to arrange a clinical titration with ASV.

[lbl82]

I just got a prescription for BiPAP. It's the ResMed VAuto.  If it doesn't treat central apnea why did my MD prescribe it?

[sheepless]

"If it doesn't treat central apnea why did my MD prescribe it?"

that's the $64 question. it happens so often it must be by design, presumably driven by insurers. in addition, it's hard to avoid the thought that some of these sleep specialists simply don't understand the differences between machine modalities.

I had a previous dx of central apnea before having another sleep test that produced nearly equal numbers of obstructive & central events, and yet I was prescribed an apap which doesn't treat centrals. you can find hundreds of similar stories on this site.

unfortunately, it's up to us to press for the machine that provides the best therapy.

[Gideon]

You may not like this answer.

It is the next level up the CPAP chain.
You have failed CPAP, now you get to fail at BiLevel without Backup. In other words you are failing at the cheaper machines and you are expected to do so.

It would not be out of place to specifically ask that of your doctor. Why am I getting a machine that will almost certainly fail? Why not go directly to the machine designed to treat the Central Apnea?

I would like to see a 2-minute zoomed view of your Central Apnea, to actually see what is going on.

[Sleeprider]

First of all, the Vauto is a great bilevel machine, and the one I use. It is unsurpassed in the treatment of obstructive sleep apnea and upper airway restriction. Unfortunately, if you have central sleep apnea, it won't help you.

The problem lies with insurance requirements to use CPAP and failing that, a trial on Bilevel, and if that fails, you eventually reach ASV. I have never seen anyone with central apnea succeed with a bilevel, so good luck. We actually have a wiki on this subject http://www.apneaboard.com/wiki/index.php...+PAP&go=Go

It wouldn't hurt to call the doctor and ask him why he is not being forthcoming with his therapy strategy. We do know where this is going, so why not let you in on it? So much time and money could be saved if he would just schedule a bilevel titration that moves to ASV to determine your therapy needs. The question I have is, do you have significant copay or deductibles for this machine? If so, I would be more concered about the waste. Otherwise, you'll just have to play along. The Vauto is a spontaneously triggered bilevel, which means it requires your respiratory effort to trigger the higher inhale pressure. If you have central apnea, that won't happen, and the apnea will not be treated. The ASV uses smart programming to trigger the inhale pressure when it detects your breathing effort is falling short of normal. It can then add a little or a lot of pressure as needed to cause a breath.

[SarcasticDave94]

It would be great if Doc would tell you his secret plan to get the ASV after you waste time on another machine you will fail at. Maybe tell him you don't have the patience to fail this one too. Bean Counter insurance will probably not agree with you as they want hard evidence this is another bad device for you.