Things Have Changed in the Last 10 Years...

[columbo]

I have not been on this board for over 10 years. I've had at least 4 sleep studies in the past, showing quite a bit of variation between them all. Mild to moderate. Then SEVERE! I think that one was skewed because of my disability case for toxic exposures. All of the previous tests were mild to moderate, with central apneas, hypopneas and mixed apneas. The SEVERE one said 40 OBSTRUCTIVE apneas/hr. NO central apneas!! Really??! Current girlfriend disagrees with those results.

Because I had a pending disability case, I decided to use my ResMed S9 every night...for a year while the case was being decided. Had to show "compliance." There was not ONE morning I felt any better for using that machine. I continued to use for a few more years anyway. I lived alone.

Back then, we could read our SD card data. Is that still true? There were still a few central apneas, buy I don't think they were for very long. I stopped using the machine about 10 years ago. I just sold the machine about 6 months ago.

NOW, my girlfriend has had a sleep study and was told she needed a CPAP. Things are different now. I rented mine for maybe $10-20/mo back then. Now she has to pay a few hundred dollars UP FRONT and around $45/mo for 9 months...I think. That's WITH good PPO insurance. DME prices varied A LOT when I had mine. Not sure now.

A mouth breather. Does not want a full face mask, only nasal pods. We'll see how she gets fitted.

Anyway, please advise on what's new, good and bad.

[clownbell]

You need input from an expert with many years experience, I am not that BUT my RT says things are much better than 10 years ago. Machines better. Mask technology much better and more choices. I also had a close friend (now gone) who was a RT and he felt the same way. Finally, I have a long term friend who has been on PAP for about 20 years. He was giddy when the new machines were released. He says today is much better than PAPland back in the day. Hopefully a bonafide expert will provide more info for you. Good luck.

[Ratchick]

Fellow Central sleep apnea person here. How was that last study done, the one that said obstructive apneas - was it a full sleep study in a hospital or was it done at home? If it was done at home, did you wear pressure sensor bands around your belly and chest? If they aren't measuring both airflow from the nose plus chest/belly movement to show respiratory effort, then it's entirely possible for them to mistake centrals for obstructives. That can also happen with the algorithm of the CPAPs too, because they don't measure chest movement, just the "echo" in your respiratory tract to estimate the level of obstruction... even if your airway is completely obstructed, though, if you're not making any effort to breathe, then its a central apnea... but the machine would probably read it as an obstructive.

CPAP is absolutely NOT designed to treat central apnea either. There's no point in splinting open your airway with CPAP if your brain isn't telling your body to take a breath, right? So you need therapy with either ASV (the gold star option) or maybe BiPAP with a backup rate to make you take a breath if you stop for too long. My docs are insistent that oxygen can help with central apnea too - and from my experience, sure, it can drop your AHI a little and boost your sats a little, but all it does for me is shove some of my centrals into the "almost apnea" category that OSCAR marks - so basically 8 or 9-second apneas that cause a significant drop in oxygen in my blood, but which aren't marked on the resultant reports. And although my AHI now is better with CPAP and oxygen than with just CPAP and CPAP alone is better than nothing, it's still averaging in the moderate range (15-16) and several times in the last couple of months since I got the oxygen, it's been in the 20s or even up to 33 one night. So if you're still feeling crappy, then you really need to find a doctor that understands HOW to properly treat Central sleep apnea. Like you, I spent 10 years untreated because "it wasn't important" with horrifically low oxygen levels and chronic respiratory failure because of the amount of carbon dioxide I was retaining (not that they even tested that until a couple of months ago).

For your girlfriend, yes, there are so many different products now and many people who breathe through their mouth can use a nasal or pillows mask. One part is dependent on the pressure - it's easier to keep a mouth seal with lower pressures than higher ones, and pillows can occasionally leak a lot if they not a really good fit, especially at higher pressures, but it's definitely doable. I can use pillows at a steady 15cmH20 and my friend does at a steady 16cmH20 with minimal unintended leaks. While my friend doesn't need to use any extra supports to keep her mouth shut, I do - I use a soft cervical collar (instead of a chin strap, just more comfy for me) to keep my jaw from dropping (with my full face mask too, to avoid leaks, pressure marks from having to overtighten, and limit dry mouth even with humidification) and I also tape my mouth - but for many people, they can simply train themselves to position their tongue to avoid leaks if necessary. It would, however, depend on why she is breathing through her mouth. Does she have a deviated septum or some other issue with narrow or congested nasal passages? I have horrible allergies, but I find the pressure of the air helps to clear my nostrils after a few minutes... but it can feel a bit rough if you're totally stuffed up. Thankfully, antihistamines help a lot for me.

[Sleeprider]

It sounds like your girl friend is being charged a lot of money for a CPAP, so she better be getting a good one. The Resmed Airsense 10 or 11 Autoset is the best on the market by far. Do not accept one of the Chinese made pretenders like Ressmart,or BMC Luna, or that deductible will represent the full retail cost. Just because you got a quote from a DME does not mean you should not compare costs with another one. Find out what suppliers are in-network for her insurance and contact several to find out your out-of-pocket costs. There are suppliers that will tack on extra charges and extend rentals longer than required. The best option is to own the machine after demonstrating compliance. Some insurance requires renting for up to 13 months, but you should call your insurance provider to know what their policy is on buying or renting.

You did not find satisfying sleep with your machine, but had you come here to ask, we might have been able to help. Your S9 had features like exhale pressure relief and other optimization that may have made a difference with some coaching. If you were affected by complex or central apnea syndrome, we could have helped direct you to a more appropriate device. You can download the free OSCAR software and see details of therapy and learn how to make it better. You should help your GF hook up with this software, and avoid discouraging her with your past experience. I hope she has great success and hopefully, by calling around to insurance and other in-network providers, you can determine if these costs can be reduced and she can end up with a Resmed Autoset machine.

[SarcasticDave94]

Welcome to the Apnea Board funny farm of all things that go QUACK.

This is an if situation on the Central Apnea. If you have Centrals, the only choice is a ResMed AirCurve 10 ASV, a 9 series will be fine if you need to buy your own. Philips Respironics makes an SV Auto that combats CA as well, but they're in a battle over unsafe foam inside their machines, so can't recommend it.

I myself have used the ResMed's 10 ASV, it's easy to setup yourself and will treat all Apnea, not just CA.

Now, the best thing to do now I suppose it's talk with your primary doc and ask about either a good home Apnea diagnostic test that includes the respiratory effort belt or a lab diagnosic. When you do this, you'll know where you are currently. Then you request your DETAILED report, post a redacted version here in your thread. Members come in to view and comment, giving you actions to take.

Alternatively, if you had your old reports, get your doc to script a PAP and mask, etc.

Back to CA, if you have them that is not treatment emergent, a CPAP is better than BPAP without backup breath rate, while ASV is the best answer for Centrals. BPAP with backup rate is why ASV works, along with its specific algorithm.

[columbo]

All of my sleep studies were done in a sleep lab with full hookups.

The last one was done in 2010 at Stanford Hospital and Clinics. RDI 46.5 (being called obstructive hypopnea), lowest o2 89%, stage N2 53%, stage 4 0%, stage REM 12.6%. NO central apneas.

Previous study in 2003 at a different lab. Stage 2 53%, Stage3/4 7.4%, Stage REM 17%, AHI 13.4. ZERO obstructive apneas. ZERO central apneas. I simply stayed in stage 1-2 too long and not long enough 4 and REM.

back in 2010, The SD card on my S9 showed central and obstructive apneas during the night. Ventilation Average L/min was 5L or less. Lowest 2.5L up to 12.15L. AHI was less than 2 most of the time.

Another study in 2016: stage 1 11.2%, stage 2 56.4%, stage 3 11.6%, REM 20.8%. EEG AROUSALS 68 (16.6/hr) AHI 6.4/hr. MIN 02 91%. Baseline o2 94%. "Unexpectedly, his REM sleep apnea was less frequent (AHI=2.4) than in Non-REM sleep (AHI=7.4.)" "He does not qualify to use Nasal CPAP." (Interesting comment!)

Sooooo... after using my S9 for over 7,000 hours without feeling any benefit, ever, I stopped using it.

I would really like to have "restorative sleep." Perhaps there is something else going on since I have had chronic exposures to neurotoxic chemicals and have multiple abnormal brain scans. I have seen over 40 different doctors in 7 different specialties and NONE of them are willing to "connect the dots."

[Ratchick]

It sounds like you were mostly having Hypops or RERAs then? There is a condition called UARS that usually presents with few, if any, apneas, but a lot of RERAs In that case, an S10 with EPR on three might prove more helpful... I honestly don't know if the S9 has the same kind of EPR setting. Was that something that you tried turning on full time in the past? If not, there's a possibility that it might help with those RERAs. And at least it would give us a couple of charts to look at on OSCAR.

It's possible that you have something else going on though, and it might be a central issue (not necessary CSA though) but that's not necessarily something we can see on the data.