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Breathing Stops When First Falling Asleep
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Sleepster Offline
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Post: #21
RE: Breathing Stops When First Falling Asleep
(08-16-2012 05:24 PM)Tommy C Wrote:  Interesting reading below. The central apnea study below, by the Mayo Clinic, has certainly given me more hope about using an ASV machine. (servo-ventilation or VPAP by ResMed)

These are two different categories of machines here:

1. A bilevel machine, also known as a BPAP, provides two levels of pressure. One higher level when inhaling, one lower level when exhaling. Respironics brand is called BiPAP. ResMed brand is called VPAP.

2. Auto servo ventilator (ASV) machine. I know less about these. They are more expensive and harder to adjust. They actually breathe for the patient, as I understand it.

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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.
08-16-2012 08:49 PM
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Tommy C Offline

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Post: #22
RE: Breathing Stops When First Falling Asleep
(08-16-2012 08:49 PM)Sleepster Wrote:  2. Auto servo ventilator (ASV) machine. I know less about these. They are more expensive and harder to adjust. They actually breathe for the patient, as I understand it.

I've been doing a lot of reading on them. This is quite surprising:

From what I read the ASV has two impellors, one inhale and the other exhale. This way, they can attain almost instantaneous air flow reversals. Used together, they can adjust the CPAP pressure for OSA, and control the support to add or subtract the CA breathing requirements.

The ASV CPU maps the person's breathing pattern and then tries to make it continue by pressure enhancements. (in-phase, out of phase air) It also has a "back up" routine to keep breathing rythmic according to it's algoritm. It anticipates apneas and tries to keep the breathing within 90% of the person's optimal.

And get this: The way it gets the brain to restart during the BEGINNING of a CA event is by letting a carefully measured amount of CO2, that is always present in the hose, flow in with the air to trigger the lung's breathing response. I read this from an engineer, but did not see it actually printed on the Resmed site. He thought this was quite revolutionary back in 2006. Of course, CO2 can be a dangerous game to play with - especially if we are amateurs.

For central apnea, the ASV system is a step up from the standard APAP or Bi-PAP system without servo-ventilation features.

If someones has only OSA, then by far, a standard S9 auto is more than adequate. But since CA and complex apneas are more rare, there is not a large market for these ASV machines, thus many have been discontinued or they are going for big $$ new.

After looking over my S9 SleepyHead data results again, I see no correlation between pressure, CA and OSA. I see CA when the pressure is at 4 or at 16. I see OSA when the pressure is 4 or 16. Then, get this, I see a full hour of perfect sleep (no events) with the pressure at 4 the whole time. Bottom line is I don't know if the higher pressure is causing CA events or the lower pressure makes any difference at all to increase OSA. I may not even run the S9 tonight and wait for the ASV. Reason being is the CA events seem much higher with the APAP than what showed up on the sleep study. I don't want to risk a serious problem with these LONG CA events showing up if there is a hope of getting them handled with the ASV machine... [sigh]

What a trip.

T
08-16-2012 09:59 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #23
RE: Breathing Stops When First Falling Asleep
(08-16-2012 09:59 PM)Tommy C Wrote:  If someones has only OSA, then by far, a standard S9 auto is more than adequate.

Unless the CPAP therapy itself induces the central apnea!

I thought that you were diagnosed with pure OSA.

Sleepster
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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.
08-16-2012 10:09 PM
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Tommy C Offline

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Post: #24
RE: Breathing Stops When First Falling Asleep
(08-16-2012 10:09 PM)Sleepster Wrote:  I thought that you were diagnosed with pure OSA.

That's what the tech told me over the phone and it stuck in my head, but was incorrect. When the actual report arrived it said:

58% OSA

41% CA

What concerns me is last night SleppyHead showed the reverse - about 65% CA, 30% OSA and about 5% other.

I'm thinking that the pressure (6-16 cm) is causing more CA and the OSA has dropped down. Thus, my AHI was 39 on the sleep study and ~ 18-24 last night, depending on the session time.

One of the CA's lasted 95 seconds!! last night. The longest in the sleep study was 60 seconds with most less. Those long CA events scare me more than the OSA, thus my hesitation to continue until I get the ASV system or at least have the doc look at my initial S9 data.

What do you think?

T
(This post was last modified: 08-16-2012 10:33 PM by Tommy C.)
08-16-2012 10:26 PM
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PaulaO2 Offline
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Post: #25
RE: Breathing Stops When First Falling Asleep
Of course the obstructive events were lower, you were being treated for it.

It is also possible that the pressure from the CPAP caused the central event. It happens to a lot of us.

Here's the notes I kept: (March '04)
CPAP level 5 resulted in 97% O2 saturation, breathing stopped 13 times an hour (all obstructive)
CPAP level 7 resulted in 90% O2 saturation, breathing stopped 36 times an hour (all central)

The doc started me at 8 (I thought that was odd) and several months later, raised it to 10. And in '08 (gosh, that's been 4 yrs??) it was raised to 12. Both when I first started and with each increase, my sleep quality dropped like a rock. Since I've never had a data capable machine, I had no proof as to why but I'm betting each increase caused more central events until my body got used to it. If I had a sleep study now, I'd probably be diagnosed with mixed sleep apnea.

How long have you been using CPAP?

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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.
08-16-2012 11:06 PM
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Tommy C Offline

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Post: #26
RE: Breathing Stops When First Falling Asleep
(08-16-2012 11:06 PM)PaulaO2 Wrote:  Here's the notes I kept: (March '04)
CPAP level 5 resulted in 97% O2 saturation, breathing stopped 13 times an hour (all obstructive)
CPAP level 7 resulted in 90% O2 saturation, breathing stopped 36 times an hour (all central)

How long have you been using CPAP?

Interesting your the CA blew thru the roof with just a 2 cm/H2O increase. You sure know the sweet spot.

I haven't used CPAP long at all. The first machine was a leaf blower and didn't use it. This S9 APAP is really the first attempt.

I decided tonight to run an experiment tonight. I will set the min and max at 4 cm/H20 constant and see how my CA events do. They were terrible last night running at 6-20. I'm just curious to see just how much the high pressure is affecting the CA before proceeding.

We'll post tmw.

T
(This post was last modified: 08-17-2012 12:14 AM by Tommy C.)
08-17-2012 12:11 AM
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PaulaO2 Offline
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Post: #27
RE: Breathing Stops When First Falling Asleep
Okay, here's a problem. You keep messing with stuff. Pick a setting and leave it for two weeks. Unless you are absolutely miserable, don't change anything.

If on the off-chance your CA is being caused by the pressure, if you are constantly changing that pressure, you're not giving your body a chance to adjust. And if you are wanting data to show to your doc, the changes aren't helping.

One night or even five nights is not going to show a trend and not provide enough data to really matter. Yes, they do sleep studies in one night but that's with all the other equipment collecting data, too.

There's nothing wrong with experimenting as long as we realize the data is not accurate if we go by just a night or two.

Also, start a sleep diary. Write down each night how you feel before going to bed and then in the morning, how you feel after sleeping. In the diary, keep notes on what changes you did along with dates. This helps to remember what and when things happened.

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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.
08-17-2012 08:57 AM
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Post: #28
RE: Breathing Stops When First Falling Asleep
I agree with Paula - when it comes to this kind of stuff, and especially when we're trying to get solid data on which to base a decision, we have to be looking at longer-term trend data, not one or two night's worth of data.

One or two or even three nights of data does not a trend make. I personally don't make any additional changes to my pressures or settings until I've lived with my last change for at least a week. This establishes a much better data set to use for analysis-- one that can't be easily skewed by one night that perhaps was way out of the norm [in other words, data that's been "poisoned" by unwanted criteria that has nothing to do with the pressure changes (ie- a change in diet, exercise, drugs, weather, etc.)]

Generally, the longer you can gather data, the more accurate your trend analysis is going to be.

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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.

08-17-2012 12:14 PM
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Tommy C Offline

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Post: #29
RE: Breathing Stops When First Falling Asleep
Yes, I realize the test time is short, but I am worried about the LONG 90 second CA events being generated that were not there before starting the higher pressures.. I'm trying to play it safe.


Last night's experiment has shed some new info...

AHI = 7.4, best so far - using a constant 4 cm/ H2O!

I was worried about the serious, long CA events possibly caused by the higher pressures, so tried an experiment to see how pressure affected CA. I set the min and max pressure to a constant 4 cm/H2O and used a dental guard and tried to sleep on my side to reduce OSA events. I hoped to filter out the OSA events and see mainly CA events as a result. It worked.

Today's results show the OSA events were way down, below 10%, however, the CA events still dominated - but now to over 90%, but were not anywhere as severe as the night before when the pressure was high.

The length of all CA events seemed to average in the 30 second area. This was an excellent night’s sleep compared to the previous night, though the CA seems to continue way above normal and at unacceptable levels. At times, CA will average over AHI 24 for 30 minute periods, then go away again. I consider this test a close approximation to sleeping without the mask due to the low 4cm level.

I sent this info and data SD card to the doctor to see what adjustments, if any, he suggests.

As I mentioned, using the prescribed 4-20 cm/H2O pressure is causing up to 90 second long CA events, which is life threatening, thus my caution and wanting to consult the doctor with this data before proceeding.

I personally believe that an ASV machine will lick these CA events and perhaps the OSA too, by a combination of techniques.

Tom
(This post was last modified: 08-17-2012 12:48 PM by Tommy C.)
08-17-2012 12:25 PM
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SuperSleeper Offline

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Post: #30
RE: Breathing Stops When First Falling Asleep
(08-17-2012 12:25 PM)Tommy C Wrote:  As I mentioned, using the prescribed 4-20 cm/H2O pressure is causing up to 90 second long CA events, which is life threatening, thus my caution and wanting to consult the doctor with this data before proceeding.
Tom

Glad you're checking with the doc on this. That's a good thing to do.

I admit I haven't read through all the replies on this thread, but allow me to interject here that no home CPAP machine is able to give a completely accurate and fool-proof record of whether these events are true Central Sleep Apnea events or simply an event that appears to be non-obstructive in nature. This is why they are sometimes more accurately reported as "clear airway events" rather than central sleep apnea events.

A true Central event is a neurological event and your CPAP machine has no way to positively determine such an animal. This is not to say that all your Clear Airway events are not centrals; (but rather that you just can't assume that they are without the proper lab equipment).

This is why we've had the ongoing discussion here many times over whether pressure increases are actually responsible for true central events or not. Anecdotal evidence based upon a patient's home CPAP data doesn't prove or disprove anything, especially since these home CPAP machines have no way to determine true central events. And, in some cases, the increased pressures caused more mask leaks, which some machines may falsely record as an "open airway event", (when in fact the "open airway" event was due to the increase in mask leaks that was caused by increased pressure).

To date, there is no credible, large scale clinical study that has proven increasing a patient's CPAP pressure can cause true central events. One would think that if it's true, there would be a study somewhere, by someone that can demonstrate beyond a reasonable doubt that such is the case. But, since the beginning of CPAP therapy in the 1980's, no study has been able to prove such a thing (not yet, at least).

All the hype coming from folks who claim that Central events are much more dangerous than Obstructive events is a bit misplaced, I think. Both OSA and CSA events are detrimental to one's health and both have very similar end-results. But, they are different animals that generally aren't caused by the same things. If you suspect that you are having true central events, it's best to get yourself into a sleep lab and have them test you using proper equipment. The home CPAP or APAP machine is not the proper equipment to use in determining true CSA events.

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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.

08-17-2012 01:04 PM
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