Severe Central with mild Obstructive

[dlevens]

I have pretty much given up on using my machine, I was a consistent nightly user since Dec 2011 till around April of this year. Since then I use the machine rarely because I am not noticing much if any improvement in restfulness and energy.

I have always had a high number of central events and very low obstructive. Looking at my ResScan:

Jan to April 2014 I was:
AHI: 46.2
Central: 42.2
Obstructive: 4.4

From May to August 2014 I was:
AHI: 51.7
Central: 47.8
Obstructive: 3.9

I use a ResMed S9 VPAP Auto with heated humidifier tray
I use a ResMed slimline hose and ResMed Quattro FX Full Face Mask

My settings on the ResMed are still the same as they set them after my sleep study back in 2011. They are

Min EPAP: 5.0
Max IPAP: 14.0
Pressure Support: 8.0

I am 5' 9" and 157 pounds

The place I did the sleep study had me in there for 3 different nights. 1 night to determine I had apnea and 2 nights testing with a CPAP machine.They had me using a standard CPAP machine which I could not stay asleep with and was blowing me up like a balloon.

When they tested me the first night with no machine my RDI was 28.1 with non REM RDI at 33.4 and REM RDI at 4.2 but I spent only 18% of my time in REM and 73% in N2 sleep. But my sleep efficiency was 86.4%

When they tested me the 2nd time they could not find a setting that worked and suggested I be treated with AUTO CPAP 7-15cmH2O, my sleep efficiency was 77.9%

When they tested me the 3rd time my sleep efficiency was 69.7% and I spent ZERO time in REM even though I was sleeping for 275 minutes. They claim the best controlled events were at BPAP S/T at a setting of 15/10cmH2O with back up rate 10BPM.

From all 3 tests I never got a better night sleep than with no machine or mask. I left 2 of those nights with back pain from over bloating.

My machine was ordered and somehow during a conversation with the doctor he mentioned a VPAP Auto machine that would avoid having to breathe out against pressure and was able to auto adjust pressure, so they swapped my machine and I have been with this ResMed S9 VPAP Auto ever since.

The reason for my post is I am only finding my central events staying high 40s to low 50s and my obstructive around 3 to 4 events.

I am not sure I am even in the right machine. I am hoping there might be others out there with similar issues who may have found that lowering the pressure support is worth trying or if my numbers look about right for someone with severe centrals and mild obstructive events.

[trish6hundred]

Hi dlevens,
WELCOME! to the forum.!
Usually, to treat Central Sleep Apnea, (CSA,) they use an ASV (Adapt Sirbo Ventelator,) machine.
Hang in there for more responses, (& a better explanation than I gave,) to your post
and best of luck to you.

[PaytonA]

The servo ventilators are what are normally used to treat centrals and I do believe that the doctor was wrong in stating that with a VPAP ST machine you would be exhaling against full pressure. The VPAP or BPAP is a bilevel machine that gives you lower exhalation pressure.

[Buckeyedog]

I also have central apnea and from being on here for a few months now, I believe you have the wrong machine. The above posters are correct in that you need an ASV machine.

[robysue]

dlevens,

You need to get in touch with the sleep doc's office IMMEDIATELY. And you need to insist that you get a call back from the sleep doc. And you need to report that the long term Central Apnea Index is way, way, way too high----as in well above 30. And that your diagnostic AHI was less than what your machine is reporting as the CAI.

The VPAP ST is simply NOT working with the current settings. And it's been long enough where if the problem with central apneas was going to resolve itself, it would have.

You may very well need an ASV machine. The difference between a VPAP ST and a VPAP AdaptSV is that the ST only monitors the respiratory rate: It triggers inhalations if your RR drops below the back up rate of 10 breaths per minute. The ASV machines, however, monitor minute ventilation and/or tidal volume in addition to the respiratory rate. And if the minute ventilation or tidal volume drops below the target values, the machine steps in and starts triggering inhalations---even if the respiratory rate has not dropped below the back up rate.

[PaytonA]

It looks like the OP is currently on a VPAP Auto not a VPAP ST.

[dlevens]

Wow, thank you for the replies...I was not getting them, even though I am subscribed to the thread, so glad I decided to check.

My machine is a VPAP Auto, not a VPAP ST and I do not believe I have a backup rate. I was hoping I could tweak my settings to try and lower my centrals but it appears no machine is better than this machine as with no machine my centrals were much much lower. I know there is debate about centrals and I am confused still if they really matter unless they are for long duration. I am not sure how to tell from my machine or reports how long each central is lasting.

I won't be going back to the sleep doctor who put me into this machine as it seems pretty clear that even my early reports show it was not the right machine for me.

My current heathcare plan is a Aetna PPO with HSA account, which means I am on the hook for all costs until my $3800 is met and so far our family has used around $800 which means I still have $3000 I would have to cover.

If I could trade my machine in, that would be much easier to handle the cost of an ASV machine but not sure that is possible.

Dennis