I need some advice about Central Apnea

[Ed Overstreetq]

several months ago I went through a sleep study. The sum total, I was having 59 AHI. I averaged not breathing 32 seconds an episode with the longest period of not breathing, 1.36.

Nine days ago I spent my first night with the ResMed S9 VPAP S using a Quattro mask. I have been following my progress using SleepyHead software (awesome).

Here is my data so far which will lead to my need for advice and guidance.

I now have a average 9 day history of:

7.2 hours of sleep
15.18 AHI which breaks down to Apnea = 0, OA 2.22, Hypoapnea .28 and finally Clear Air or Central Apnea = 12.68. The last two days....I have slept on either one side or the other and my OA has gone to less than one and Clear Air to 9 for a total of 10 AHI plus a fraction.

It appears that my apnea is coming from brain to breathing communication. I have been reading - googling - cause and cure if any and, of course, there isn't any...so far.

For those of you who also have clear air Apne (Central Apnea) do you have any advice. It is apparent the ResMed S9 VPAP S has helped a lot....from 59 to 10 and the times are averaging 15 to 20 seconds. I plan to talk with my physican about the Resmed machine that forces a burst of air when one does have these episodes. I also found out Medicare is not going to approve it's use without a fight, audit, and denial and more fight. The cost is 6,000 and if need be I would boy one. Back to my advice - knowing my limited info.....what would you advice, especially those of you who have a similar apnea issue.

May GOD bless these boards they have been soooo helpful!!

[PaulaO2]

I updated your subject line so you get the answers you need from those who know.

Now, I don't know much since I don't have CA but the machine you have the VPAP S, is a bilevel machine and not for treatment of central apnea events. However, if the CA events you were having during the sleep study were caused by high pressures, then that is why they are trying you on a bilevel first.

[justMongo]

I updated your subject line so you get the answers you need from those who know.

Now, I don't know much since I don't have CA but the machine you have the VPAP S, is a bilevel machine and not for treatment of central apnea events. However, if the CA events you were having during the sleep study were caused by high pressures, then that is why they are trying you on a bilevel first.

Hi CPAP pressures can cause CA?

[PaulaO2]

It can in some people. Usually just for a short period of time before the body and brain adjust. This is evident in sleep titration studies where a pressure stops most Obstructive Events but the Central events increase. This is from my sleep study:

CPAP level 5 resulted in 97% O2 saturation, breathing stopped 13 times an hour
CPAP level 7 resulted in 90% O2 saturation, breathing stopped 36 times an hour

It is one of the main reasons we advocate increasing pressure in small increments.

[archangle]

I updated your subject line so you get the answers you need from those who know.

Now, I don't know much since I don't have CA but the machine you have the VPAP S, is a bilevel machine and not for treatment of central apnea events. However, if the CA events you were having during the sleep study were caused by high pressures, then that is why they are trying you on a bilevel first.

An "ASV" machine is the "heavy artillery" for central apnea. It's tough to get used to for many people. However, it does do a lot more to eliminate central apnea.

However, it's not that clear that a bilevel machine isn't for treatment of central apnea. It may help some central apnea sufferers. It may be worth a try because it may work for some with less cost and discomfort.

Also, insurance may artificially require "failing" CPAP and bilevel before going to ASV.

However, anyone with central apnea using bilevel should be monitored closely to evaluate whether they need adjustments to bilevel or switching to an ASV machine.

There are also "ST mode" bilevel machines that are an intermediate step between "S" mode bilevel and ASV.

[alby_c]

I am no expert on Centrals, but I know when I reduced my top setting by 2 in my APAP my centrals dropped from 5 per hour to 0.5

Of course, it also could have just been my system adjusting to the therapy.
Just my 2 cents worth.

[justMongo]

I'm no expert on this. I believe ST mode machines have a Timed mode, a Spontaneous mode; and a combined ST mode. Timed mode would be a backup for a central apnea event would it not?

[PsychoMike]

Mongo, that's my understanding. The timed is so that if you have central events that typically span a length of time, like eoverstreet's 30+ seconds, you could set it so if you don't breathe for say 15s or 20s, it'll kick in the ventilation and get you breathing, rather than waiting for your SPO2 to drop so far you wake up enough for the brain to remember to breathe.

[archangle]

I'm no expert on this. I believe ST mode machines have a Timed mode, a Spontaneous mode; and a combined ST mode. Timed mode would be a backup for a central apnea event would it not?

Yes and no. ST or T mode switches to the "inhale" (IPAP) pressure for the bilevel settings even if you don't inhale on your own.

In some cases, this might be enough to knock you out of a central apnea.

An ASV machine will hit you with an even higher pressure, if needed, to get you out of a central apnea. It may an uncomfortably high pressure, but it only hits you with it when you're having an apnea. The ST/T mode bilevel will hit you with the input pressure you're getting on every breath.

You may find that if you turn the IPAP high enough to "kick" you out of a central apnea, the IPAP pressure is too high for you to stand it on every breath.

That's probably a bit oversimplified, but hopefully it gets the idea across.

I suspect most central apneacs need ASV rather than T/ST mode bilevel.

[Sleepster]

When they switched me from a CPAP machine to a bilevel machine my OA index went way up. They lowered the pressure to fix the problem. Since then I've been gradually raising it back up with great success.

I make small changes once per month.