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APAP and central apnea
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Ghandi Offline

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Post: #1
APAP and central apnea
There is a common beleif, at least from the ppl treating me, that auto-cpap doest treat central apnea as good. And that for complexe apnea it is better to use fixed pressure since it treats central apnea too.

Is there a consensius about this or its just my sleep doctor preferences?

I'm on fixed pressure and i have really few central apneas.
08-12-2014 09:18 AM
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justMongo Offline

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Post: #2
RE: APAP and central apnea
People who have many any/or long centrals are usually treated with an ASV machine.
(Auto Servo Ventilation)

Pressure can induce central apnea. I believe the mechanism is that one takes in a large air charge under higher pressures, then doesn't breath for a time afterward. There are some who feel auto pressure machines may induce more centrals. A pressure induced central is no more a problem that OSA. As long as they are rare and short; it's not an issue; and the benefits of an Auto machine in treating OSA generally outweigh fixed pressure. The medical community is somewhat slow to embrace Auto machines as it diminishes their sense of control over the patient.

The person who suffers from OSA is generally better served by an Auto as it adjusts for varying conditions that occur during the night and from day to day.

Today's machines are so smart that they do not increase pressure in response to a central; yet they aggressively increase pressure in response to flow limitation and snoring which are precursors to OSA. The ability to distinguish between a clear airway versus an obstructed airway during an apnea event is a marvel of technology. These machines advance aggressively and retreat slowly. (Like US Marines!) On average, the average pressure on an auto machine is lower than that required by a fixed pressure to achieve similar AHI.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 08-12-2014 10:24 AM by justMongo.)
08-12-2014 10:20 AM
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Ghandi Offline

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Machine: RemStar Pro with C-Flex+Philips Respironics System One
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Post: #3
RE: APAP and central apnea
Well it looks like i would have been better served with an auto-pap. But i just purcharsed my machine 2 months ago, so i'm going to be stuck with it for 5 years before i can try auto-pap. I could have paid a little higher to get the a-pap same model, but then the doctor will refuse to follow me if i change from fixed pressure to auto pap.

Hummm the joys of public health care. i bet in a private clinic the doc would have prescribe me whatever he needed to see me come back again.

thx again Marine Mongo!
08-12-2014 11:51 AM
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justMongo Offline

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Post: #4
RE: APAP and central apnea
(08-12-2014 11:51 AM)Ghandi Wrote:  thx again Marine Mongo!
Actually that's Airman Mongo (hence the A1E Skyraider) --- just a shout out to my Marine Brothers.

There are quite a few doctors who will dump a patient if they try to take control of their own therapy. Not just in county's with a National Health System.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
08-12-2014 11:56 AM
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Ghandi Offline

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Post: #5
RE: APAP and central apnea
roger that, Airman Mongo!!!
08-12-2014 12:02 PM
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archangle Offline
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Post: #6
RE: APAP and central apnea
(08-12-2014 09:18 AM)Ghandi Wrote:  There is a common beleif, at least from the ppl treating me, that auto-cpap doest treat central apnea as good. And that for complexe apnea it is better to use fixed pressure since it treats central apnea too.

Is there a consensius about this or its just my sleep doctor preferences?

I'm on fixed pressure and i have really few central apneas.

If they really think that, they're idiots.

Too high a pressure can induce central apnea in some patients. If you set an APAP machine with an unlimited maximum pressure, it may cause central apnea problems in some patients.

The answer is to limit the maximum pressure on the APAP if the patient has pressure induced central apnea.

If, for instance, your manual CPAP set at 14 cmH2O doesn't cause central apnea, an APAP set at 8-14 cmH2O probably won't cause you any problem with central apnea, but you'll still have the advantage of lower air pressure if you don't need it for part of the night.

A lot of doctors still think that "APAP" means "set the machine at 4-20 cm pressure and ignore the data collected." That's simply wrong. An APAP machine can and should be set to a more restricted pressure range that works better for the patient.

A lot of DME's downplay APAP's because manual CPAP is more profitable for them.

Auto CPAP is not the best treatment for everyone, but every APAP machine out there can be set for a narrower range of pressure or even set to run in manual CPAP mode.

They should always dispense an APAP machine and then set it to CPAP mode if they can't find a good setting in APAP mode. If they just dumbly dispense a manual CPAP, they can't change it to APAP later.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
08-12-2014 10:20 PM
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Ghandi Offline

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Posts: 137
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Machine: RemStar Pro with C-Flex+Philips Respironics System One
Mask Type: Nasal pillows
Mask Make & Model: airfit p10(resmed)
Humidifier: systeme one humidifier with humidity set at 3 and heat set at 1
CPAP Pressure: 8
CPAP Software: SleepyHead

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Post: #7
RE: APAP and central apnea
Oh god, i regret not paying that extra 150$ for the apap option. That way i could have asked to try apap at some point. Now it's too late Sad. At least for the next 5 years.
08-13-2014 08:09 AM
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PaytonA Offline
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Post: #8
RE: APAP and central apnea
Don't feel bad Ghandi. I received my S8 VPAP Auto I think just before the S9s came out some 4 years ago and now I finally got my S9 Auto within weeks of the advent of the S10s in the U.S. I really do not feel too bad, since from what I have read so far, I may prefer to stay with the S9. The S9, however, had some significant (to me) improvements over the S8. I was prescribed the bilevel mode and that is how my S8 came set up. I tried the auto mode and my results showed a definite worsening trend, so I have been back on bilevel ever since. All of this to say that it may not be so bad.

Best Regards,

PaytonA
08-13-2014 11:58 AM
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archangle Offline
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Machine: ResMed S9 AutoSet
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Post: #9
RE: APAP and central apnea
(08-13-2014 08:09 AM)Ghandi Wrote:  Oh god, i regret not paying that extra 150$ for the apap option. That way i could have asked to try apap at some point. Now it's too late Sad. At least for the next 5 years.

If you're in the US, with most insurance, you don't pay more for APAP if your doctor is on the ball and prescribes APAP.

However, you did get the PRS1 Pro model, which is data capable. You're lucky you didn't get screwed by getting the PRS1 Plus model.

With the Pro, you don't have the advantage of your machine fine tuning it for you continuously. It won't adjust up and down as your needs change due to REM or other sleep stages, or as you needs change over time. You don't get the comfort of lower pressure for part of the night when you don't need the higher pressure.

However, if you occasionally check the data your Pro machine records every night, you can probably adjust your manual CPAP pressure to make it work well for you.

Unfortunately, if your doctor is bad enough to think APAP is a bad idea, he's probably bad enough to not really look at the data your CPAP collects and adjust your pressure. He'll probably let the DME check the data, see that you're using it 4 hours a night like insurance requires, ring the cash register, and assume you're doing fine.

Like many of us, you will probably have to figure out how to monitor your own progress to be sure it's really working right.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
08-13-2014 12:07 PM
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Ghandi Offline

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Machine: RemStar Pro with C-Flex+Philips Respironics System One
Mask Type: Nasal pillows
Mask Make & Model: airfit p10(resmed)
Humidifier: systeme one humidifier with humidity set at 3 and heat set at 1
CPAP Pressure: 8
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Post: #10
RE: APAP and central apnea
PaytonA Thx for your encouragements Smile Maybe i can find out if apap is treating me better when they put the machine back in titration mode which is auto pap for like 15 days per year.

archangle well i had 80% of any machine payed by the insurance so i should have though about it. It was more a matter of my doctor probably wont allow me to use apap so i should have the possibility to do it in case they dont want to follow me anymore and i cant use pap.

I check the data everyday Smile For the moment i mainly focus on sleep position. But eventually pressure ajustements will come if those non treated long OAs continue.

My doctor is not so bad, he listens to me and seems open minded. PLus it's public health care so he makes the same money out of me whatever the outcome is. But the freaking DME. Wow they really dont give a damn about me. They have a cassette playing "Well your ahi is under five so you therapy is ok, there is no need to change. We dont want to overcorrect your apnea". They should't but so dismissive of concerns i have. They are clearly there for the $ and since the machine is sold and configured dont will not get extra money improving the therapy.
08-13-2014 02:43 PM
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