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+--- Thread: Treatment-Emergent Central Sleep Apnea (/Thread-Treatment-Emergent-Central-Sleep-Apnea)
Treatment-Emergent Central Sleep Apnea - GiantCat - 09-05-2019
About 10 months ago, I took an at-home sleep test after finally choosing to see someone about my snoring problem. I thought perhaps I just needed my abnormally long uvula trimmed down, but my ENT doc didn't want to do anything about it until I took a sleep test. I met with sleep doctor at a sleep clinic and got the at-home test. The at-home sleep test revealed that I had obstructive sleep apnea with an AHI of 19.0. AI was 5.0 and HI was 14.0.
My sleep doctor told me that I didn't have any mixed apneas, but now I'm looking at the test results right now and it says I had a few central apneas, but they took place separately from the obstructives. Central apnea was never discussed or diagnosed.
I started treatment with an APAP in December of 2018. At first it didn't help and my AHI was higher than 19.0. I eventually did a titration study in an overnight lab after a month of PAP therapy, where the pressures were settled at a better setting. After that things improved slightly, but it was noticed on follow up appointments that I had barely any obstructive apneas—around .8-2.0 per hour, but my central apneas had increased to between 10-15 per hour every night. It seemed I had traded obstructive apneas for central apneas. My doctor told me that some patients develop central sleep apnea after starting PAP treatment. Damn, this sucks. He didn't really have any solutions other than to continue and hope things improved or resolved. They didn't.
After some sleuthing online, I found these forums and the reddit sub on sleep apnea. I read that adjusting EPR down could help, so I did so. Wow! My centrals dropped down to below 5 almost every night with AHI around 1 or 2 per hour. My doctor never told me about this setting. When I followed up with him, he seemed to not know about this phenomenon. I dropped centrals from 15 to below 5 with this and he didn't know about the EPR settings having anything to do with helping someone in my situation. I now know that I have "Treatment-Emergent Central Sleep Apnea." I spent most of this summer with AHI totaling anywhere between 3.0 and 8.0
After this appointment, my sleep doc wanted to set up another titration study with a BPAP in an attempt to see if this could help. The study was a success! I had zero (0) central apneas and only 3 obstructives at a non-ideal pressure setting. I used a full face mask for the study, while I normally use just a nasal cushion at home. I was so happy. A follow up appt with my sleep doc had him ordering the Resmed AirCurve 10 VAuto. I was sure this was my cure.
I got the new BPAP machine (the AirCurve) one week ago. They did not approve the full face mask, so I'm still using my nasal cushion, which I like. They set up the pressure at 12 IPAP and 8 EPAP and recommended PS at 4, which were the recommendations from the sleep study. The results were garbage. My AHI was through the roof anywhere from 20 to 16. Centrals were taking up the bulk of these apneas. I then read about the "PS" settings on the BPAP machine and it seemed like they are similar to EPR, but I still don't quite know what PS does. Again, my doctors told me nothing about PS settings and had the machine set to PS level 3 when I got it despite the sleep study recommendation calling for PS level 4. I moved it down to 3 after a few nights and saw no improvement. Last night I moved it to 2 and saw modest improvement with AHI at 11.8, centrals at 10.9 and AI at 10.4.
So, here I am basically after 10 months of therapy and really no real, sustainable solution to my Sleep Apnea problem. I have adjusted the PS level down to 1 and hope tonight will be better. Maybe I need to give the BPAP time to adjust to my patterns. Maybe I need to push for a full face mask like I did in the successful sleep study. What about an ASV machine? Would this help? If none of this works, I may just give up on PAP therapy.
I am overweight, but have lost over 10 pounds in the last three weeks and am dieting and exercising again. I may just pursue this route and try to get skinny again like I used to be. Maybe work on developing my throat muscles with a didgeridoo. What about a jaw device? I guess there's that surgery option too. Might be time to get rid of the long uvula after all.
Any suggestions are open for me. This is my first post and this seems like a great community. Thanks in advance for all your help.
~GiantCat
RE: Treatment-Emergent Central Sleep Apnea - slowriter - 09-05-2019
I think (and the more experienced folks here can confirm): you need an ASV machine, which are designed to treat CAs. Not so with a standard bilevel.
I also predict people here will want to see some of your data.
RE: Treatment-Emergent Central Sleep Apnea - stanleydean - 09-05-2019
Hi Giant Cat and welcome to the forum. You will find answers and help here. You should probably go ahead and download Oscar so you can post some results, those here that can really provide some answers will want to see some charts.
Stan
RE: Treatment-Emergent Central Sleep Apnea - sheepless - 09-05-2019
asv is the only machine I've heard of that is designed to treat ca. you didn't have ca in your test and you mentioned treatment emergent / pressure induced ca. it's pretty common in new cpap users and they say it dissipates in 30-90 days. the trick is to find a pressure that reduces obstructives without significantly increasing the centrals.
losing weight, playing the didgeridoo, trying a mandible advancement device are all good things to do. from what I've read here on AB forum, it's wise to be very cautious before ent surgery.
the folks here can almost assuredly help you reduce your ahi as much as possible. it's isn't necessarily you, it's the lack of support from the 'system' that leaves you un- or under-treated.
post some oscar charts and you're on your way.
RE: Treatment-Emergent Central Sleep Apnea - SarcasticDave94 - 09-05-2019
Besides OSCAR and posting some daily chart info, I'd suggest getting a physical copy of the sleep study, redacting personal info and posting it here in full. The multi-paged detailed sleep study is what I'm referring to, not the summary. Reasons? 1) you need to keep a copy of your sleep report on file in case this doc's office closed up 2) it helps us see if CA existed before CPAP treatment or only after. Suggestions on settings depend on the info based on section 2 above and OSCAR data.
PS is Pressure Support. It's similar to EPR but can be set higher than 3. BPAP machines use this added to EPAP (expiration pressure used to air splint your throat) to get an IPAP (overall inspiry pressure). See above suggestion before ASV is discussed. The time CA existed matters in determining if it's needed. If CA existed upon entering the sleep study, that could indicate they're not treatment emergent.
RE: Treatment-Emergent Central Sleep Apnea - GiantCat - 09-05-2019
Thanks. I can't download Oscar because my Mac says it's unauthorized.
RE: Treatment-Emergent Central Sleep Apnea - GiantCat - 09-05-2019
Okay, got a workaround on the Oscar download. Working on getting it set up. Thanks to all!
RE: Treatment-Emergent Central Sleep Apnea - SarcasticDave94 - 09-05-2019
(09-05-2019, 03:21 PM)GiantCat Wrote: Thanks. I can't download Oscar because my Mac says it's unauthorized.
I don't know Mac devices as good as I'd like, but isn't this where you can opt to install regardless? It's possibly a security warning to caution the user.
good to hear you got it going
RE: Treatment-Emergent Central Sleep Apnea - GiantCat - 09-05-2019
I have successfully downloaded Oscar and uploaded my data from the BPAP into Oscar. I have also downloaded my sleep studies. I am in the process of redacting those for posting and looking into how to how to post my Oscar data here. I have a call out to my sleep doctor to confirm if I indeed did or or did not have Central Apneas on my initial, at-home sleep study. I also have questions about mask type and possibility of ASV PAP. After I have confirmation on that I will post again. I'm very impressed at this community and the responsiveness. Thanks so much.
RE: Treatment-Emergent Central Sleep Apnea - Gideon - 09-05-2019
Based on the above you have a few possibilities.
1. You don't have any form of Central Apnea (I don't really believe this one)
2. You have Treatment Emergement Central Apnea.
3. You have Idiopathic (unknown cause) Central Apnea.
Note that by Central I mean in any of it's forms.
I see one of several outcomes. I'm not fussy, but I want what is right for you.
The path we go is really your choice.
Assuming the data confirms significant central apnea.
Path 1, We work with you to optimize your treatment with the machine you have, either a bi-level or an APAP or CPAP. This means lowering pressure and minimizing pressure variance from and all of EPR/Flex/PS, and minimizing pressure ending in typically very close to a CPAP fixed pressure. Seriously we can get you fairly comfortable with this, but it is by avoiding the Central Apnea, not by treating it. This IS a valid option.
Path 2, we work at justifying an ASV. This means very poor treatment, uncomfortable treatment because we will fail at CPAP, fail at Bi-Level without backup, then succeed at ASV (we may have to fail at B-Level with backup (T or timed mode).
Note: BiLevel T mode can "technically" treat Centrals but it is a constant timed presentation of very high PS on every breath and is really targeted at COPD type on patients not Central Apnea.
Read this WIKI article http://www.apneaboard.com/wiki/index.php?title=Justifying_Advanced_PAP_Machines
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