[Equipment] CSA #'s that require BPAP or BPAP-SV?

[Sleepster]

Therefore, turning it off would make the bloating (from air) worse.

That's right.

I do stay in bed, but don't go into anything that I would describe as a comfortable deep sleep.

I have the same problem. Sleep well for a few hours, then find myself awake and unable to go back into a prolonged sleep.

After over two years of CPAP therapy and some improvement in these symptoms, I went to my first sleep doc. She basically said I can either put up with it or take drugs. She hinted at some type of behavioral therapy but said it involved getting only four hours of sleep a night, which would of course be no fun.

I took the drugs.

[WakeUpTime]

Thanks Sleepster. There are a few things I've learned about CPAP lately:
(1) How much we all have in common, and
(2) How popular it is. I believe it's much more common than the 2% number that gets quoted. I swear, every time I bring up CPAP to someone, they tell me their on a CPAP machine....
- mentioned to a neighbor a few doors down, "yah, I use a machine"
- guy who worked next door came by, saw the PR Sys One picture, said "got one too"
It's not the kind of thing that you talk about all the time, but every time it comes up in the conversation, it seems the person's using one, or their spouse, or brother, etc.

That leads me to a few more questions:
(1) What they heck would have happened to us humans 30-100 years ago with severe sleep apnea? Did people just die a few years later of something of the heart/brain/lungs and the "root cause" was never really known?
(2) What the heck is really causing all of this? Maybe I've seen too many conspiracy shows, but is it filling in our teeth from 40 years ago that have been "leaking" for 30-40 years? Is it radiation in the air floating around from Japan or wherever? We know it's not a local issue because it seems to be a global issue. Of all the Sleep Apnea articles, none of them really looked into that. Is it something in our human diet that's changed in the past 30-50 years? Is it going from a meat/fruit/veg diet to a massive carb diet going it? The sleep clinics, distributors and manufacturers will surely never want to investigate that subject! Their business has mushroomed in the last 5-10 years.

I can't believe the impact on memory, and perhaps "reasoning", as a result of the (possibly) years of sleep apnea. It's starting to explain a whole lot of things. Sadly, it makes me wonder what things would have been like for the past 20-30 years (for all of us) if it was diagnosed properly at that time. The future is surely brighter for humanity's future generations as a result of the diagnostic and treatments being perfected.

[WakeUpTime]

March 14th was apparently "World Sleep Day" (google). They now say 25% of the population has sleep apnea. That number makes more sense. I'll bet that it's even higher than that, at some stage in someone's life.

[Peter_C]

The downside is that as more and more people with OSA get treated, the problem will slowly grow instead of dying out. Natural selection at work would have me dying and unable to pass on my genetic issues to offspring. While I am of course glad to be living, this is the downside of better medicine in general.

50 odd years ago, people with severe OSA would simply die at an early age, usually of heart related issues. My wife is a diabetic because her mother was one - without insulin, my mother in-law would have died prior to having my wife - so, on one hand we've sorta broken 'natural selection' - but on the other hand I for one would not be here without that medical knowledge.

[vsheline]

I thought there might be some general rule or formula of when someone might require a BPAP or BPAP-SV, when CPAP is insufficient as a result of continuing central apnea events.

In the USA some insurance companies follow Medicare guidelines, which are that an ASV class machine can be covered if the number of central events (apneas and hypopneas) is at least 5 per hour during sleep and these make up the majority of the Apnea Hypopnea Index (AHI), symptoms of excessive sleepiness are present, and an overnight titration has shown that the patient benefits from ASV therapy.

http://www.healthcare.philips.com/pwc_hc...lpHint.pdf

I've also heard, though, that some insurance companies in USA require the number of central events (apneas and hypopneas) be at least 15.

In my own case, I emailed PDF copies of a couple ResScan reports showing my CAI was (a little) above 5 and these made up the majority of my AHI. The reports included a zoomed-in view each night of my longest period of Cheyne-Stokes Respiration during the night (10 minutes one night, 30 minutes the other). My doctor provided me a prescription for an ASV titration, and upon my request my insurance company pre-authorized the ASV titration.

I chose a place to have the overnight titration done (one in my insurance company's medical network), after emphasizing that this must be an ASV titration and verifying that my desired brand of equipment (I wanted ResMed, others may prefer Respironics) would be used.

[robysue]

That leads me to a few more questions:
(1) What they heck would have happened to us humans 30-100 years ago with severe sleep apnea? Did people just die a few years later of something of the heart/brain/lungs and the "root cause" was never really known?

The really severe cases where it seemed as though someone was truly at risk of dying in their sleep? Prior to CPAP, they were given tracheotomies. Serious---holes were cut into their throats so they could breath at night. The less serious cases? They were ignored. "It's just part of aging" or "It's normal for you" or "There's nothing much we can do for you" or "try sleeping with a ball sewn in your shirt to see if that keeps you off your back". Heck, it wasn't even really tested for prior to CPAP because there really wasn't much they could do to treat it.

As for dying? Yes, people with untreated OSA 30-100 years (or more) ago, simply died younger. They had strokes or congestive heart failure. Or they died "peacefully in their sleep" without anybody looking into what actually caused the person to die "peacefully in their sleep" at age 50 or 60 instead of living to 75 or 80.

(2) What the heck is really causing all of this? Maybe I've seen too many conspiracy shows, but is it filling in our teeth from 40 years ago that have been "leaking" for 30-40 years? Is it radiation in the air floating around from Japan or wherever? We know it's not a local issue because it seems to be a global issue. Of all the Sleep Apnea articles, none of them really looked into that. Is it something in our human diet that's changed in the past 30-50 years? Is it going from a meat/fruit/veg diet to a massive carb diet going it? The sleep clinics, distributors and manufacturers will surely never want to investigate that subject! Their business has mushroomed in the last 5-10 years.

A lot of it is just more awareness. And some of it is the fact that as PAP has become more comfortable, docs have been willing to test more people who are "borderline" in terms of symptoms. Thirty years or so ago, during the dawning of the CPAP age, only the people with the most serious OSA were put on PAP because the machines were large, clumbersome, noisy, and very uncomfortable. The risk/benefit analysis for folks with mild to moderate OSA went more like this: The cost of treatment probably outweighed the benefits since being on CPAP back then really did make things like traveling much more difficult and the masks really were much harder to adjust to.

Another factor is that for a variety of reasons, modern Americans are simply fatter than they used to be. And for a large number of OSA sufferers, the weight really is a factor. They may have been borderline or moderate OSA before the weight gain, but with the weight, the OSA went from borderline to moderate or from moderate to severe.

And another factor has been an increasing understanding that for people who sucessfully adapt to PAP, there's a real increase in quality of life as well as some potential health benefits. For people with moderate or mild apnea, the quality of life issues are actually a better reason for PAPing than prevention of health complications---or at least that's what some long term studies indicate according to my sleep doc.

I can't believe the impact on memory, and perhaps "reasoning", as a result of the (possibly) years of sleep apnea. It's starting to explain a whole lot of things. Sadly, it makes me wonder what things would have been like for the past 20-30 years (for all of us) if it was diagnosed properly at that time. The future is surely brighter for humanity's future generations as a result of the diagnostic and treatments being perfected.

What would have happened with a diagnosis of OSA 20-30 years ago would have been determined by the severity---both in terms of AHI and the depths of the O2 desats. If your OSA is in the mild or moderate range, you probably would NOT have been put on PAP 20-30 years ago because PAP was seen as a unnecessary, but difficult therapy to adjust to if there were not real clear identifiable health risks. And at the time, moderate and mild OSA were not seen as "life threatening". If your OSA was severe, you'd probably be given a choice about whether you wanted to try a PAP machine, but unless your O2 levels were seriously low, you probably would not be pushed into doing PAP therapy the way docs push you into therapy now.

It's rather like high blood pressure as a health issue: Prior to the 70s, doctors just assumed that blood pressure would naturally rise with age and hence the blood pressure needed to diagnose HBP in a 50 year old was substantially higher than it was to diagnose HBP in a 30 year old. Large numbers of 40 adn 50 year olds were walking around with untreated or under treated HBP in the 50's and 60's and some of them were dying of all kinds of things that we now know are associated with HBP.

[robysue]

Check Robysue profile, she have blog titled "adventure in hose land" which include chapter about insomnia among other useful stuff

You're right. Robysue is an amazing resource with great help. I'll follow some of these ideas.
(If she offered a course, I'D TAKE IT!)

Thank you for your kind words!

I hope that some of my ideas really do help you get over your hump.

Insomnia is an interesting subject. For me, it's hard to just get up and do something else. Why? The brain is wide awake (the heart too sometimes) but the rest of the body is in a near-paralyzed tired state. My eyes are burning, etc. To do something else is sometimes even harder. I have to experiment with an audio book sometime to see how that might work out.

I've found that if I can just pull myself out of bed to go to the bathroom for a few minutes, sometimes that's all it takes to get the brain to simply shut up and let the rest of the body go back to sleep ...

Seriously: I keep a book in the bathroom and if I wake up and can't get back to sleep, I'll just go to the bathroom--- even though I have no sense of "needing to go". If I'm still not sleepy, I'll start reading and usually within a few pages, the brain is as happy as the rest of the body is to return to bed and go back to sleep.

Somehow "getting up to go to the bathroom" seems less intimidating than "getting up to go to the living room and wait to get sleepy again" when you're lying in bed awake while wishing you were asleep.

[nasnas]

Looks like you are on the cusp of an abnormal amount of central events which is usually accepted as 5 central events an hour when asleep and not in wake/sleep transition when central events are regarded as normal. You may well end up needing an ASV machine to completely stabilise your breathing. However I would recommend trying switching off the CFLEX/AFLEX if it is not too uncomfortable or at least substantially lowering the level. This has been shown to reduce central events in certain individuals (such as myself with full Complex sleep apnea). In my opinion it is certainly worth a try.
Ian

You understand my situation very well. I'll try exactly that. (Much appreciated.) It's either a transitional thing (only 2 mo. of CPAP) or the "Complex" part of CSA (CSA during CPAP). [No significant CSA was detected during the sleep study; only with CPAP.]

I'm just curious how much time to give it before being convinced it's CSA. Perhaps somewhere in a 6-12 month window I suppose. I really seem to be stuck on that 5 CA events/hour number. I don't know if that's the cause of the ongoing crummy sleepless nights on CPAP. (It's not a tolerating thing.) The OSA is down to a low 2, but sleeplessness continues (awake every 1.5 hours last night).

The machine's set at a constant 12 at the moment rather than variable, which seems to be the number that almost ends the OSA. The pressure doesn't really bother me, but my stomach each morning is sure ballooned/bloated/cramped.

Hi wakeuptime
i`am as just as you
i tried autoCpap for months and dident help at all
AHI was below 2 and CSA was about 5 and my sleepiness and HUGE MEMORY LOSS!! continued....
1month ago I bought RESMED ASV and my AHI is under 1 ,but that too, dosent work for me much
I almost wake better than before but after some minutes!! sleepiness and HUGE loss of concentration!! comes back
I`m really frustrated,very very very depressed
what other things I supposed to do?
HELLP!!

[me50]

Maybe it is time to see an internal med doc or someone that can look at other medical conditions. Have you been checked for narcolepsy? There are a lot of other medical conditions that can cause sleepiness (and some meds can cause this too) and poor concentration.

[nasnas]

Maybe it is time to see an internal med doc or someone that can look at other medical conditions. Have you been checked for narcolepsy? There are a lot of other medical conditions that can cause sleepiness (and some meds can cause this too) and poor concentration.

thank you
but Im sure the problem is my sleep
in PSG my AHI was about 96 mixed apnea
after about 5 surgeries it dropped to 23
and then CPAP and ASV ....
am I supposed to wait more to adapt to device or something else?
damn apnea ruined my life
excuse me, why do you use VPAP? do you have centrals or?