Does CPAP also treat central sleep apnea (csa)?

[LetMezz]

Hi all,

I was recently diagnosed with apnea after a sleep test. My AHI =21 (The obstructive AHI = 13  central =8)

For a few days now I'm on a CPAP, and getting events per hour of around 3. Hardly any OA and mainly from clear airway events.

It's unclear to me why my events per hour is alot lower with the CPAP than the central events measured by the sleep test

- Is the CPAP also treating (reducing) central sleep apnea?


Thanks,

LetMeZz

[SarcasticDave94]

Welcome to the Apnea Board,

I suppose for some just having CPAP can help with Centrals a bit. But Central Apnea has a trait members here call consistently inconsistent. The CA will be up or down randomly per night despite no therapy changes.

Best suggestion is get the free report tool OSCAR and keep track of your events in detail. Looking at the report on your PC, then you can post a screenshot after an F12 shot is taken.

If Central Apnea trend to be high and uncontrolled then you will need a specialized PAP called ASV. I recommend ResMed's AirCurve 10 ASV if it is needed.

Things you can do now to minimize CA is turn off Ramp and you may need to edit EPR. But again it's best to see OSCAR data before edit suggestions.

[Crimson Nape]

Hi LetMezz!  -  

The CAs you are experiencing could be treatment induced.  CAs can occur by having CO₂ washout.  If they are less than 20 seconds per event, then I would see if they diminish as your treatment continues over time.  

- Red

[Geer1]

Basic CPAP can treat central apnea depending on the case. It is the first line of treatment especially in cases like yours where there are also obstructive issues, if it fails more advanced treatments like ASV should be considered.

[Dormeo]

In both the sleep study and now, in your early days with CPAP, the CAs may just reflect choppy sleep.  What can happen is that you have a brief arousal, which washes out enough CO2 to reduce your drive to breathe, and then you pause your breathing until enough CO2 accumulates to trigger a breath.  You'll have a CA flagged if you pause for 10 seconds between breaths.  The negative here isn't really the CA itself; it's the arousal.

If you can use the Oscar software, you'll be able to look at your flow rate to see whether you're having that arousal/CA pattern.  It will look something like the attached, with some high-amplitude and disorganized breathing (arousal) followed by a CA.

With any luck at all, you'll sleep more soundly, with fewer arousals, once you get used to the new CPAP experience.

[Gideon]

To be clear on the OP's original question,

NO, CA cannot be "Treated" with a CPAP, APAP, BiLevel without backup.

We can potentially cause (Treatment-Emergent) or avoid Centrals by not doing actions (Increasing differential pressures or raising pressures) that can both cause central apneas and treat obstructive events..

[sheepless]

cpap, apap and bilevel are not designed to treat ca. the best we an do by design with cpap and apap is to tweak settings to try to avoid pressure induced ca. resmed bilevel has a setting that can help to a limited degree but it's an 'off-label' tweak that resmed doesn't acknowledge.

that said, I was diagnosed in 1987 with central apnea; no treatment available at the time. in 2016 my sleep test reported near equal numbers of events - something like 204 oa and 198 ca. as seems to be typical, I was prescribed apap despite almost 50% ca. here's the thing: apap brought my ahi down from 72.x to around 6, so clearly it had significant impact on both my oa and ca. noone has been able to explain this but there it is.

as it happens, it wasn't enough of an improvement to satisfy me so I moved on to other modalities without the sleep doctor. however, although the apap's reduction of my ca is unexplained, it's indisputable.

[Dormeo]

Just to emphasize what is probably already clear: there’s no reason to think you have central (or mixed) apnea and no reason to worry about how to treat it.

[sheepless]

8 ca in your sleep test aren't a lot but having them (and more ca than oa) before using cpap tells us the ca aren't treatment emergent or pressure induced and that you may be prone to them. not currently enough to worry about but they occur inconsistently so keep an eye on them and how you feel if/as they come and go.

[Geer1]

NO, CA cannot be "Treated" with a CPAP, APAP, BiLevel without backup.

Gotta disagree as I know of some studies that support it. Uptodate (a doctors resource) even has a potential mechanism of action that makes some sense. The theory is that it reduces pharyngeal narrowing that occurs during central apnea (aka keeps airway more open during the central apnea) which makes it easier and quicker to initiate the next breath reducing recovery breathing amplitude and ventilatory overshoot which as we know causes follow up CO2 driven centrals. In short it won't stop/treat all centrals but it can help avoid getting stuck with repeating central apnea.

I think we sometimes get swayed by primarily seeing members that are struggling to get adequate treatment and not seeing all the ones that are adequately treated by such machines. There is a reason it is the first recommended treatment and more invasive treatments like ASV are only preferred when necessary. I actually agree with this process especially considering the cost difference in machines, I just wish many doctors were more willing to use ASV when it is indicated.