Periodic breathing while semi-sleeping

[jaredihnen]

What a fantastic resource this is!!!  It was reassuring to see so many people out there that are having the same pattern of periodic breathing as myself.  I was diagnosed with CSA and just started therapy 2 weeks ago.  Pressure of 6. A good portion of the time when I am in the periodic breathing episodes, I am half awake and aware it is happening.  I can consciously control it, but as soon as my mind wanders, it slips right back into the pattern. I for the most part just lie there and let it happen.  Is this a common phenomenon?  I couldn't find any threads addressing this aspect of periodic breathing. It is super weird. Maybe it's a subconscious sleep apnea Munchauser's?        

[Sleeprider]

The problem is you're on CPAP and should be using ASV. ASV is a bilevel machine that detects when breathing is too shallow or not present, and uses pressure support to stimulate (remind you to take) a spontaneous breath or can deliver a breath as needed, then it stands back and acts as a CPAP. Almost everyone with a CSA diagnosis is required to try, and potentially fail CPAP. If these clusters of central apnea and periodic breathing continue more than 30 days, you need to follow-up with your doctor to get the right therapy. That may require a titration test to evaluate bilevel and ASV to demonstrate efficacy for ASV. We can help you through the process, and it looks to me like that's the way it's going to go. Read our wiki on Justifying Advanced PAP machines https://www.apneaboard.com/wiki/index.ph...P_Machines

Remember that a CPAP or bilevel without a backup rate are strictly to treat obstructive sleep apnea. Central sleep apnea is treated by use of the ASV, although some people are improperly prescribed a bilevel ST. To read about the different types of machines and how they work, you can review the Resmed Titration Guide and look at how CPAP, bilevel, ASV and ST work and the conditions they are intended to treat.

[jaredihnen]

I figured ASV was where this was going to end up after going through a lot of the other threads on this site.  Out of curiosity, do you know about what the percentage of CSA cases have satisfactory results with CPAP only?  It's got to be a significant number to justify all the insurance hoops you need to jump through to get an ASV machine, right?

I am interested in other's first hand experiences with being awake and aware of apneas as they are happening.  I've looked extensively online and haven't found anything other than fact sheets that say that with CSA you can have apneas while awake.  You would think you could find someone at least blogging about it somewhere.

Thank you for your insight!!

[Sleeprider]

Probably as many as half the cases of diagnosed CSA end up with CPAP. Maybe half of those are treated adequately with CPAP and the rest either give up or feel chronically tired. The system is designed to make you go away. There is a significant portion of members that end up acquiring a used ASV out-of-pocket, and proving to their doctor that the therapy works. Most people that succeed with CPAP had therapy onset centrals that eventually abated. Success with CPAP outcome for those diagnosed with central/complex from a sleep study is quite a bit lower. In truth I have not got any statistics, but I've been around a while. I do recall at least one instance where a new member had a lot of CSA and did great on CPAP. Really surprised me.

[jaredihnen]

Interesting.  They say that when treatment emergent apnea resolves it can take 30 to 90 days.  In your experience, do they piddle out slowly over that entire time frame, or would they be consistent in severity for like 30 days, and then piddle out over a shorter span?  My question is essentially if the nightly frequency of the apneas has zero improvement at all over the first 30 days, do sleep doc's typically see that as time to move on?  Or would they be more likely to tell me "let's give it another month or two"?

[Sleeprider]

I think it is simply adaptation to increased ventilation of CPAP. It gradually diminishes, and if you don't see fairly significant improvement in 30 days, I wouldn't expect a lot more in 60. CPAP pressure can change the balance of CO2 in the bloodstream, and some people are more sensitive than others and will have central apnea. The doctor is going to look at a threshold of 5 AHI with predominately central apnea if it also accompanied by fatigue or other symptoms, and will tolerate 15 AHI. If you're happy the doc won't argue. Improvement is very hard to predict. I have seen 30 to 40 AHI resolve to satisfactory results, and lower AHI simply not budge. Something you'll hear me say is that central sleep apnea is consistently inconsistent. It is difficult to test for, and poses a major challenge in titration tests because you don't know if the patient is responding to pressure or is just not experiencing apnea. I look for a linear relationship of events to pressure for most obstructive apnea, and CSA doesn't work that way. I do see a lot of members respond positively to the Resmed Aircurve 10 Vatuo which does not have a backup rate, but does have trigger sensitivity settings. It seems if you give them just a nudge of PS they will breathe spontaneously.

[paulag1955]

I was diagnosed with severe complex sleep apnea, with more central than obstructive events. I feel like I get satisfactory treatment with CPAP at a fixed pressure of 8, with my AHI typically around 2.5. I do experience high flow limits and am working on some way to figure that into my treatment results so that I can get a more complete look at how my treatment is going.

On average, I have 6.5 central events, 1.7 obstructive events, 3.6 hypopneas, and 0.5 RERA events per night. But, again, there are the high flow limits, so it's a balancing act for me. Since I don't experience any apnea-related symptoms, I can only go by the numbers, which is why I'm fixated on the data I can download into Excel.

[jaredihnen]

Good to know.  BIG THANK YOU for all the knowledge you and your compatriots impart on this board!  The amount of anxiety you all are able to relieve within the sleep apnea community is immeasurable.  Thank you for the board on ASV acquisition tips as well.  Super helpful to know what you are getting yourself into before you paint yourself into a corner and are stuck with a therapy that doesn't work.