on Autopap one month- central 90'% time

[sue60]

Hello,

I'm new here. Started my journey 4 months ago, had sleep then a titration study. Not sure what that was about as the doc mentioned bipap- but they never did that. The instructions were she wants you on your back most of the time- well I am a side sleeper but took an ambien to accomodate. Was never told I had CSA. Been on the airsense autopap? for over a month ranges 4 to 20, EPR 3 to reduce swallowing air. Using Sleepyhead to look at data last couple of weeks. It tells me I usually have CSA about 90% or greater most of the time. AHI is all over the place but not down below 5, usually 10-12. What I thought was my best night of sleep (heavy sleep)my AHI- was 50.79- numbers as follows

Date Sleep Wake Hours
1/26/2016 22:19:58 05:32:21 07:10:02
Clear Airway 48.55
Obstructive 1.26
RERA 0.28

Event Breakdown

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 9.73 4.00 9.62 12.62 13.18
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 6.04 0.00 5.38 10.62 21.75
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 11.81 0.00 12.20 18.20 44.60
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.02 0.00 0.00 0.11 0.52
Leak RateRate of detected mask leakage (L/min)
W-Avg: 1.70 0.00 0.00 8.40 120.00
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 0.34
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 2.58 0.20 2.24 5.18 10.06
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 1.93 0.06 2.08 3.06 4.34
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 480.06 0.00 440.00 840.00 1820.00

Total time in apnea 01:50:24

Most nights have not been that bad but being worried, this inspired me to order an oximeter and here's a couple of nights info imported into Sleepyhead

SpO2 Desaturations: 198 (20.86%)
Pulse Change events: 87 (2.38%)
SpO2 Baseline Used: 97.00%

another night


SpO2 Desaturations: 127 (35.50%)
Pulse Change events: 71 (1.91%)
SpO2 Baseline Used: 98.00%


My husband describes a Cheyne-Stokes breathing pattern for years that he thought was odd but he did not know what it was or how serious it was. It only became an issue when I was falling asleep watching tv much more. He forced me to go to a doctor. Fatigue does not cover it- foggy all the time- even in the shower- go in for a 5 min shower and come out 30 min later, asleep on couch every night then trouble going to sleep. I will be 60 soon and still work. I will see the doc in a week again but not sure what to ask or ask for- I am in uncharted territory right now. Thank you anyone/everyone for any comment , insight or advice. [/b]

[vsheline]

Hello,

I'm new here. Started my journey 4 months ago, had sleep then a titration study. Not sure what that was about as the doc mentioned bipap- but they never did that. The instructions were she wants you on your back most of the time- well I am a side sleeper but took an ambien to accomodate. Was never told I had CSA. Been on the airsense autopap? for over a month ranges 4 to 20, EPR 3 to reduce swallowing air. Using Sleepyhead to look at data last couple of weeks. It tells me I usually have CSA about 90% or greater most of the time. AHI is all over the place but not down below 5, usually 10-12. What I thought was my best night of sleep (heavy sleep)my AHI- was 50.79- numbers as follows

Date Sleep Wake Hours
1/26/2016 22:19:58 05:32:21 07:10:02
Clear Airway 48.55
Obstructive 1.26
RERA 0.28

Event Breakdown

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 9.73 4.00 9.62 12.62 13.18
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 6.04 0.00 5.38 10.62 21.75
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 11.81 0.00 12.20 18.20 44.60
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.02 0.00 0.00 0.11 0.52
Leak RateRate of detected mask leakage (L/min)
W-Avg: 1.70 0.00 0.00 8.40 120.00
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 0.34
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 2.58 0.20 2.24 5.18 10.06
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 1.93 0.06 2.08 3.06 4.34
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 480.06 0.00 440.00 840.00 1820.00

Total time in apnea 01:50:24

Most nights have not been that bad but being worried, this inspired me to order an oximeter and here's a couple of nights info imported into Sleepyhead

SpO2 Desaturations: 198 (20.86%)
Pulse Change events: 87 (2.38%)
SpO2 Baseline Used: 97.00%

another night


SpO2 Desaturations: 127 (35.50%)
Pulse Change events: 71 (1.91%)
SpO2 Baseline Used: 98.00%


My husband describes a Cheyne-Stokes breathing pattern for years that he thought was odd but he did not know what it was or how serious it was. It only became an issue when I was falling asleep watching tv much more. He forced me to go to a doctor. Fatigue does not cover it- foggy all the time- even in the shower- go in for a 5 min shower and come out 30 min later, asleep on couch every night then trouble going to sleep. I will be 60 soon and still work. I will see the doc in a week again but not sure what to ask or ask for- I am in uncharted territory right now. Thank you anyone/everyone for any comment , insight or advice. [/b]

Hi sue60, welcome to Apnea Board.

Obviously, treatment with standard APAP is inadequate in your case.

Please insist next on getting an "ASV Titration" rather than a standard bilevel titration.

Standard Bilevel PAP therapy tends to make central apneas more prevalent unless coupled with O2 therapy (supplemental Oxygen), and when compared to Bilevel + O2, the cost of an ASV bilevel CPAP machine is about the same and usually provides superior treatment/results and is quieter and more convenient. (O2 compressors are loud and heavy and expensive.)

Take care,
--- Vaughn

[richb]

Hello,

I'm new here. Started my journey 4 months ago, had sleep then a titration study. Not sure what that was about as the doc mentioned bipap- but they never did that. The instructions were she wants you on your back most of the time- well I am a side sleeper but took an ambien to accomodate. Was never told I had CSA. Been on the airsense autopap? for over a month ranges 4 to 20, EPR 3 to reduce swallowing air. Using Sleepyhead to look at data last couple of weeks. It tells me I usually have CSA about 90% or greater most of the time. AHI is all over the place but not down below 5, usually 10-12.
[/b]
My husband describes a Cheyne-Stokes breathing pattern for years that he thought was odd but he did not know what it was or how serious it was. It only became an issue when I was falling asleep watching tv much more. He forced me to go to a doctor. Fatigue does not cover it- foggy all the time- even in the shower- go in for a 5 min shower and come out 30 min later, asleep on couch every night then trouble going to sleep. I will be 60 soon and still work. I will see the doc in a week again but not sure what to ask or ask for- I am in uncharted territory right now. Thank you anyone/everyone for any comment , insight or advice. [/b]

Hi sue60, welcome to Apnea Board.

Obviously, treatment with standard APAP is inadequate in your case.

Please insist next on getting an "ASV Titration" rather than a standard bilevel titration.

Standard Bilevel PAP therapy tends to make central apneas more prevalent unless coupled with O2 therapy (supplemental Oxygen), and when compared to Bilevel + O2, the cost of an ASV bilevel CPAP machine is about the same and usually provides superior treatment/results and is quieter and more convenient. (O2 compressors are loud and heavy and expensive.)

Take care,
--- Vaughn

I 2nd this recommendation. Depending on your insurance you might need a dual titration. One to show that your current machine is not working and another (same night) to titrate you on an ASV machine. Some insurance including Medicare only accept data obtained during a PSG (sleep study). I don't believe that your current machine can be adjusted to relieve the Centrals and Periodic breathing you are experiencing. A new titration will tell.

Rich B

[Sleeprider]

Sue, you appear to have CPAP induced complex apnea. Without CPAP you have obstructive apnea. Once enough pressure is applied to prevent airway collapse, you develop central apnea. I suspect you did not get a clinical CPAP titration, or this condition would have been found. It affects about 15% of CPAP patients.

As suggested above, complex apnea requires an adaptive servo ventilator (ASV) to prevent the periodic breathing, central apnea and hypopnea. Since your "treated" AHI is 50, you clearly do not tolerate CPAP and should schedule a discussion with your doctor as soon as possible. Many doctors and insurance will first trial you on CPAP. When you fail CPAP, they upgrade to bilevel. If you fail bilevel they then move to ASV. You need to shortcut that ridiculous process and be sure you receive a titration study that can evaluate bilevel and titration in the same night. You do need treatment, and I encourage you to put some pressure on your doctor to make it happen sooner than later. Your good health really depends on it, and the machine you are now using will not work.

[vsheline]

Once enough pressure is applied to prevent airway collapse, you develop central apnea. I suspect you did not get a clinical CPAP titration, or this condition would have been found. It affects about 15% of CPAP patients.

Sometimes doctors discount central apneas observed during an initial titration because, for about half the patients, treatment-induced centrals tend to gradually decrease to acceptable levels during the first month or so of 'PAP therapy as our system becomes accustomed to sleeping with 'PAP.

Clearly, in Sue's case the centrals have not abated, and I think the need for ASV therapy is obvious.

[sue60]

Thanks Richb, vhseline and Sleeprider, Can I possibly do a split night- half the night on auto bipap and second half on asv? Can't pressure adjustments be figured out on data at home for a week or 2 also? Do not auto machines give an idea on pressure needs vs titration studies? Ultimately will do whats needed. Starting to think its a money trap though. Thanks again all!

[DariaVader]

Thanks Richb, vhseline and Sleeprider, Can I possibly do a split night- half the night on auto bipap and second half on asv? Can't pressure adjustments be figured out on data at home for a week or 2 also? Do not auto machines give an idea on pressure needs vs titration studies? Ultimately will do whats needed. Starting to think its a money trap though. Thanks again all!

that is definitely a possibility. My son just had that study, even tho asv is not indicated in his case, but bilevel is. The titration proved this to be the case, and that is good.

[vsheline]

Thanks Richb, vhseline and Sleeprider, Can I possibly do a split night- half the night on auto bipap and second half on asv? Can't pressure adjustments be figured out on data at home for a week or 2 also? Do not auto machines give an idea on pressure needs vs titration studies? Ultimately will do whats needed. Starting to think its a money trap though. Thanks again all!

I suggest best to ask for only straightforward ASV titration. If they say no, then push for pre-agreement to continue on to ASV titration if the required bilevel titration is not succeeding. Doctor should agree (or change doctors), so it may depend on the sleep lab policies, and an exemption from standard policy might be forthcoming as soon as you cancel the titration and explain you will be finding a sleep lab which is more accommodating.

In any case, I think insurance will want to have the titration demonstrate that standard bilevel therapy or ASV bilevel therapy will result in acceptable therapeutic results before authorizing coverage for a new machine.

[richb]

Thanks Richb, vhseline and Sleeprider, Can I possibly do a split night- half the night on auto bipap and second half on asv? Can't pressure adjustments be figured out on data at home for a week or 2 also? Do not auto machines give an idea on pressure needs vs titration studies? Ultimately will do whats needed. Starting to think its a money trap though. Thanks again all!

I recently did a split night study to get an ASV machine. And, you are right about the money trap. One problem is that Medicare and some insurance providers want a sleep study and titration for approval.

Rich B.

[Sleeprider]

Just know that in sleep labs, the same machine has all these capabilities. It's not like they have to swap out machines, they just change modes. Insist on it as a matter of conserving money.