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APAP Prescribed for Central Sleep Apnea?
#1
I was diagnosed with central sleep apnea in January, and have been using a ResMed Airsense 10 autoset since the 21st of January, per my VA sleep dr.  My AHI at diagnosis was 29.  My average is now 6.49 for the last 30 days, which is great.  The trouble is, I'm still SO tired, all the time.  I still have a hard time getting up in the morning, and struggle staying awake at work, especially in the afternoon.  I still nap every chance I possibly can get.  In searching for answers, I came across this wonderful forum, where I have consistently read that central apnea needs to be treated with ASV, not CPAP or APAP.  My prescription is 4-16 cmH2O, EPR 3 cmH2O, and I was told the machine will vary the amount of pressure as needed while I sleep.  My question is, is this adequate therapy for someone with central apnea?  Is my machine acting like an ASV? My AHI is much less, so something seems to be working.  Perhaps I need to give it more time to start to feel better, but I admit to being somewhat disappointed by how tired I still always am.  
Thanks for any words of wisdom.
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#2
For central apnea the ASV machine is the proper treatment, however for insurance purposes, most patients must fail or be unable to tolerate CPAP before bilevel and ultimate bilevel ASV will be reimbursed. This follows the Medicare guidelines for coverage. http://www.resmed.com/us/dam/documents/a...F_RADs.pdf The fact your AHI is still about 7 is remarkable, but not effective treatment. You need to contact your doctor in order to move to the next level, a E4071 device (bilevel with backup rate i.e. ASV). Be sure to emphasize how you feel, and the doctor should arrange an appointment and change you to the correct machine.

Be sure to leave a message at the doctor's office you are using CPAP but are not getting good results and cannot tolerate the continuing apnea and tiredness. This should trigger the next step. Keep in touch here, and we can try to help further, but I don't want to give you more effective settings as that may cause you to fall out of consideration for ASV. If you can't get help, then escalate the issue to the VA director.
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#3
Follow SR's advice.  I have Idiopathic Central Apnea and am now on an ASV machine with great results.  You will have to jump through some hoops to get the ASV machine as SR points out.  One thing that you will need to do is get an echo cardiogram to confirm that your heart output is sufficient to be able to use an ASV machine.  As you read about Central Apnea you will find that it is often associated with Congestive Heart Failure.  In my case the Central Apnea is most likely the result of a faulty feedback mechanism between my circulatory and nervous system.  I literally forget to breathe.  The ASV machine stimulates breathing when I forget to and gives me a very good nights sleep.  Stay in touch with us as you work your way through the system.  

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#4
Thank you Sleeprider and RichB.  I very much appreciate your advice and input.  I will certainly look into requesting the ASV machine from the VA.  I have indeed read a lot about central sleep apnea since my diagnosis, and was disturbed by the high connection with heart failure and atrial fibrillation.  I'm 42 and very healthy according to my last annual exam and bloodwork from last year...with less than .5 % probability of a heart attack in the next 10 years, according to my dr. I haven't had any tests to rule out an underlying pathology for my apnea. The VA isn't super pro-active about things, unfortunately.  I will definitely check back in with any other questions or findings.  I appreciate your support!
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#5
We really want you to get the best possible therapy, and for you that is ASV. You may or may not be screened for congestive heart failure to qualify for ASV, but the standard procedure is to issue CPAP and wait for the patient to fail before issuing the correct machine. Your return to the doctor will not be unexpected, and it is likely you will have an additional titration study on ASV before finally getting what you need.
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#6
Hi NeverRested,
WELCOME! to the forum.!
Good luck to you on your CPAP journey and hopefully, things go well for you as you go through the steps to get your ASV machine.
Keep in touch, hang in there for more responses to your post.
trish6hundred
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#7
Thank you all. I'm so glad I found this board, it has really helped me navigate this new part of life, I appreciate you all taking the time to help me. I'll be contacting my VA dr tomorrow to begin the process of convincing them to switch me to ASV. I'll let you know how it goes. Thank you again!
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#8
One more question...is Cheyne-Stokes always a bad sign? According to my SleepyHead readouts, I had a single night with over 8 continuous minutes of Cheyne-Stokes since starting therapy. Thoughts?
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#9
8 minutes?  Probably not...this is a problem (Congestive heart failure patient on auto CPAP with <45% LVEF and this goes on night after night.). The default label in Sleepyhead for periodic breathing is Cheyne Stokes. In most cases it is not CSR, and central apnea presents its own periodic breathing pattern. If you want to post an example, we can comment. Let's not let it look like this.

[Image: rYMdFhGh.png]
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#10
I should mention, this is from a day where I took off my mask while sleeping, which I did a lot at first, so the data for the night is incomplete. This also shows my settings before they were changed by my sleep dr from 6-16 to 4-16.

[Image: JgiVTzO.png]
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