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[CPAP] Is My Central Apnea Hopeless?
#1
Is My Central Apnea Hopeless?
I'll try to keep this brief while providing all the relevant info.  Thank you in advance for any suggestions, advice, or links to helpful resources.

I recently did an at-home sleep test using the WatchPAT One, which led to the following diagnosis:

Obstructive Sleep Apnea (G47.33) - Severe based on pAHIo=79.7 and O2 nadir of 86%

Central Sleep Apnea (G47.31) - Mild based on pAHIc=12.5

This led me to purchase an AirCurve 10 Auto BiPAP machine, which started at PS 4.0 over 6.0-15.0.  The first full night of sleep, I had an AHI of 81, with 79 "clear pathway" (central) events per hour and only 1.6 obstructive events per hour.  I have talked with a respiratory therapist over the phone a few times since then to evaluate how things are going, and each time she decided to increase the pressure in the hopes that things will improve.  

After a few incremental increases, I am now at PS 4.0 over 14-22.  Last night I had an AHI of 54, with 52 clear pathway events per hour, 0 obstructive events per hour, and 2 hypopnea events per hour.  Consistently through each night of therapy, at least 95% of my events are clear pathway.  I have only been using the BiPAP machine for a week and a half, but my lowest AHI was 43, where almost all events were classified as clear pathway.  My current pressures are very uncomfortable, I feel less rested than before treatment, and I'm feeling discouraged that the BiPAP machine will do anything for me.

I have attached my latest sleep report from OSCAR. I have two questions:

(1)  Does it make any sense that my sleep test showed severe OSA and mild CSA, while my BiPAP consistently shows nearly nothing for obstructive events and severe levels of clear pathway events?  They seem to contradict each other.
(2)  Is there any hope that the BiPAP machine can still work for me, or should I start considering other treatments?


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#2
RE: Is My Central Apnea Hopeless?
The only ResMed machine is an aircurve AVS. With that being said some people (I am one) have lessen the centrals by changing the trigger setting to high or very high. It helped me BUT
my numbers was nowhere as many as you have. It is worth a try anyway.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Is My Central Apnea Hopeless?
Your test showed you have Obstructive and Central Apnea. Yes, they're at different levels, but both showed. In this case, you're needing the ResMed AirCurve 10 ASV. It's the only ResMed specifically able to treat Central Apnea. As you now see, your VAuto isn't capable of treating Centrals, the CA that's shown. In fact, the VAuto is making CA worse.

You need to get your detailed diagnosic report for your own records, and you should post a redacted version here. You need to list your symptoms and complaints about current treatment to your doctor, and request a titration that includes ASV in the pressure setting test. Then you'll request the doctor to recognize CA, which is clear airway to the machine, but medically are Central Apnea, as your real issue despite the diagnostic label of mild. You've proven the VAuto cannot treat or avoid CA, so your only answer is exchanging the VAuto for ASV.

Any machine other than ASV is 2 things to you, incorrect and incapable of treatment. Anything other than ASV would be setup to AVOID CA, while ASV is setup to treat CA. You need the machine that can treat, as the VAuto is proven incapable to avoid CA. Replace it with ASV.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Is My Central Apnea Hopeless?
Let's go back to you're 6-15 but with PS of 2
We may increase your obstructive events a bit but we need to reduce your CA events. Lowering PS should help that.

For now don't increase trigger, just 1 change at a time. We may further reduce PS as that can be a major driver for CA.

What we don't know is why you had the mild CA in your sleep test.

We likely will get to increasing trigger but not now.

I will not be surprised to see you with an ASV in your future. Let's see what we can do first.
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#5
RE: Is My Central Apnea Hopeless?
Thank you Stacey, Dave, and Gideon!  I was not aware that ASV could be a viable option if my current AirCurve 10 VAuto doesn't work out.  I was starting to lose faith, and I now have some hope that my apnea is treatable with a different device.

Per Dave's request, I have attached my initial diagnostic report to this post.  I'm pretty new to this, so all I got from it is that my apnea seems to be pretty extreme. 

Dave, it looks like you don't believe my current machine will lead to successful treatment, so would you suggest getting a "real" sleep study in a doctor's office so that I can get a proper ASV titration?  I'm not going through insurance and my supplier has a 60-day return policy that would allow me to apply my Vauto's cost as a store credit towards an AirCurve ASV, so I hope that I could make that switch without too much trouble.  I only don't know if my current prescription would allow it.

Tonight I will follow Gideon's suggestion to try 6-15 with a PS of 2, and I'll post my relevant OSCAR screenshot in the morning.

Again, thank you for sharing your experiences and suggestions.  This board and its contributors are truly a lighthouse in the storm.

- Scott


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#6
RE: Is My Central Apnea Hopeless?
Gideon's suggestion got me my lowest AHI since starting therapy, but I suppose I still have a ways to go at 37.74.  Again my obstructive apnea events seem to not be a problem at 2.17 events per hour.  It is still almost all central, at 35 events per hour.

I've attached my OSCAR report and I look forward to any further suggestions you might have.

- Scott


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#7
RE: Is My Central Apnea Hopeless?
Ok, let's now take PS=0
Still hold off on trigger modification though that is next

No other changes.

Keep copies of this and the previous to show your doc.

See if your doc will schedule a test of your LVEF, left ventricle ejection. Factor. Passing this should be no problem but a previous study has made it mandatory for ASV.

Before this week is out you should be asking your doc for an Rx for an ASV

Tonight: PS=0
Tomorrow: trigger=high
The next night: trigger = Very high if needed.
That's it. Tweaking for comfort
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#8
RE: Is My Central Apnea Hopeless?
Thank you for your suggestions.  I will follow them and post results each day.  I won't be able to get into my doctor until next week, but I'll post the results of that as well.

I'm still pretty concerned about what is actually causing the central apnea, since it seems like we're treating the symptom instead of the disease.  The internet suggests heart failure, stroke, brain cancer, and a host of other terrifying options, but I'll try to stay hopeful that it's not something so immediately life threatening.
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#9
RE: Is My Central Apnea Hopeless?
My layman view is that your CA are similar to mine, but in a lower event count than mine. Your sleep study report was and is valuable in that it states the events and counts of these, and this gives data a format the doctor accepts.

A lab diagnostic should not be needed. A lab titration, yes this is possibly needed, but as you're not involving insurance then no it's not. Stipulation is if doc will change the script to ASV, at any pressure set he wants.

We'll coach you on changing it here on the fly. It isn't difficult, no more than the VAuto you have now.

Echocardiogram for testing LVEF% is a good idea to assure doc you're OK to use ASV. My 2x of this test yielded 55% in '17 to get my ASV, then up to 63 or so in 2020 for full cardio workup.

The echocardiogram is typically done at the hospital's imaging department. It's audio/visual samples of the heart, taken via ultrasound. You lie on exam table, no shirt, tech uses a cold wand with cold lubricating gel, moves wand about the left chest over the heart. Image and sounds data passed on to cardiac doc to review and sign off results. You're given these results in about a week. The info highlighted as necessary for ASV is LVEF%, Left Ventricle Ejection Fraction, passing is 45% or higher. You'd know if you can't pass, as your heart health would drag you down to poor overall health.

Not to offend, but don't overwhelm yourself with why you've got CA, just focus on acting on obtaining ASV.

Like Gideon mentions, bug your doc about needing to get ASV script ASAP, you're up against a clock with your DME supplier it seems. Contact them as well, get the switch request at least on record.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Is My Central Apnea Hopeless?
The problem with PS 0 is it doesn't leave any room for high trigger sensitivity to work. This is pretty severe therapy onset central apnea and I think the ultimate outcome will be a need for the Resmed Aircurve 10 ASV, which will resolve nearly 100% of events. The best CPAP therapy for individuals with this problem is fixed pressure, without EPR or pressure support, and I'm sure this will significantly reduce your event rate from what we saw with 6-15 PS 4. I agree with the approach being taken by Gideon, but would just fix pressure at 7.0 or 8.0. higher pressure is not going to accomplish anything but airway instability. This is classic idiopathic central apnea, and will eventually end up needing a bilevel with backup rate to maintain breathing rate. With regard to the title of this thread, it is anything but hopeless. We have many members using adaptive servo ventilation with great success and some of the lowest event rates imaginable.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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.
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