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Central Apneas & ASV Users
I am a new member to the Board. I currently have a ResMed Aircurve, S-10 vAuto machine. I use it in the VAuto mode. It is truly a great machine insofar as ease of breath and exhale. My problem is that I am having about 18+ events per hour. They are central apneas, as the machine takes care of all my obstructive apneas. I am going to try and persuade my doctor to give me an Rx for an ASV machine, as I would like to get my number below 5 events per hour. At my last visit, my doctor seemed to think that central apneas were no problem, only obstructive apneas mattered. I have looked into that question and can find no support for the position that central apneas don't matter and I should be unconcerned with such events.

I am wondering if any of you have had your doctor dismiss central apneas as of no significance? Also, if you use an ASV machine, did it take care of the central apneas?
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G'day Jerrydaw, welcome to Apnea Board.

Last question first - ASV machines are the gold standard for treating central apnea and (in my experience) they are very effective indeed.

It's probably true that central apneas are less stressful on the body than obstructive, but they are still a cessation of breathing and will lower your blood oxygen and cause consequential damage to other organs in your body. I don't understand how doctors who should know better just dismiss them.

You might like to see if there's any literature specifically on the damage caused by centrals (Google Scholar is a good place to start) and also get hold of a recording oximeter to see how your blood oxygen holds up (or not) during central apnea events.

Good luck!
Apnea Board Moderator


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You could have complex apnea - that's when the pressure needed to clear obstructive apneas causes central apneas. That's why I was put on an ASV. An ASV will require an overnight titration so make sure your insurance will cover it.
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Hi jerrydaw. Welcome to the Apnea Board. You seem to be on the right track thinking about getting an ASV machine. From my experience some Drs. don't or can't treat Central Apnea. Start gathering data (the recording O2 monitor) and begin your quest.

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

Download Sleepyhead
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(07-22-2016, 10:48 AM)jerrydaw Wrote: I am a new member to the Board.


I am wondering if any of you have had your doctor dismiss central apneas as of no significance? Also, if you use an ASV machine, did it take care of the central apneas?

Another welcome to the board - this is a great source of support and information.

I also have central apnea. My cardiologist referred me for a sleep study because she could not find anything in my history that satisfied her as being the reason for my atrial fibrillation. I thought she was both desperate and nuts - I >KNEW< I didn't have apnea. Of course I had never heard of central apnea, only the obstructive version. Now I think she's both well informed and actually cares about her patients. I also believe that there are a lot of central apnea sufferers who have no idea that they could and should be helped.

As I understand it, apnea often leads to both cardiac disease and memory trouble due to oxygen deprivation. As my cardiologist explained it to me, because my apnea deprived my body of oxygen, my heart started working harder and harder to improve my blood O2 levels. This led to enlargement of my heart, and along the way my upper chambers got out of control and now beat wildly and too often. Fortunately, the lower two chambers are still well-regulated.

I believe most cardiologists would accept these statements as generally true. It does not matter >why< your blood O2 levels falls (obstruction, or simply failing to initiate a breath) but how much it falls and for how long. Yes, another user posted a link to a YouTube video of some expert at a conference explaining how obstructive and central apnea differ and she said she was not sure central apnea should be treated. I very strongly feel she did not really understand what central apnea is, but who am I, etc.

I also use an AirCurve 10 vAuto, which happens to work well for me, although my results are quite variable from night to night. My average AHI is around 3, but last night it was 0.4. I started my treatment at the end of May and my AHI got down below 5 pretty quickly (although it fluctuates and is above 5 about once a week). I have heard different things about ASV, but for the moment I'm going to ride this out.

Is there another doctor you might consult for a second opinion? Hang in there, it's worth it.
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Hi jerrydaw,

Around a third (I think) of new users initially get an excessive amount of central apneas when first starting CPAP therapy, and about half the time within the first weeks and months of treatment the number of centrals eventually drops below 5 per hr, as the body becomes adapted to treatment.

If after a couple months of use, if the rate of centrals is still above 5 per hr and you are still feeling excessive daytime sleepiness, I think it is likely that an ASV titration and a switch to an ASV machine would be covered by most insurance companies.

I think ASV typically eliminates all central apneas and central hypopneas, and also will treat obstructive events similar to how your AirCurve Auto treats obstructive events.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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Many thanks for all replies. I, probably like most of you, have suffered from sleep apnea for years but did not know it. My wife would tell me the next morning about how I held my breath through out the night. I thought it was nothing, just an occasional event. I was wrong!! I had a sleep test last December and found I was having about 50 events per hour. I got a ResMed S-10 AirSense machine in January. That was replaced by an AirCurve VAuto about 2 months ago. Through out this time, I have been bothered by Mixed apneas, mostly central. Whether machine created, or otherwise, they have persisted at essentially the same high level.

I have no problem taking another sleep test, I just want to address the problem and get my events down to an acceptable level. I vary from between 6 and 36 events per hour. Most are in the 20's and 30's. As I related, my doctor, a board certified sleep specialist, thinks I should be unconcerned about my centrals. I have tried researching this topic and have found no evidence that centrals are something to be dismissed as trivial. As a result, I am still pushing the issue with him. Hopefully, I can talk him into giving me an Rx for an ASV machine. Have an appointment in the next week or two.

Thank all of so much for your comments. I really needed someone to bounce my thoughts off on.
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Some people take a while to get used to this therapy and I would guess that this is what your Doctor is thinking. This does not mean that this is going on with you-push away. Let your Doctor that you are watching your treatment and taking it personally. They tend to react better to
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I wanted to jump in and clarify some of the questions concerning ASV and treating central apnea.

First - Many who have atrial fibrillation or congestive heart failure or kidney insufficiency ALSO have central apnea. IN fact one of the most common causes of atrial fibrillation or congestive heart failure IS sleep apnea.

Concerning the comments about ASV for central apnea - In 2015 a study was publish showing neg. results (higher over all mortality rates) in SEVERE congestive heart failure (ejection fraction less than 35%) who were on ASV compared to those NOT on ASV.

Until this was published ASV was the treatment of choice for such patients. Some cardiologists (trying to reason this through since ASV does IMPROVE the AHI and ejection fraction in such patients) feel that the pressure/hemodynamic changes with ASV caused the struggling heart to work even harder and MAYBE the central apnea is a natural means of compensation for a severely compromised heart.

So - ASV is no longer prescribed for pts with severe CHF and central apnea in the US. At present there is a vacuum in their treatment except to treat the heart failure and any other cause including obstructive apnea, arrhythmia, kidney insufficiency etc.

Hope this answers some of the questions.
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My sleep lab doctor took my centrals very seriously; after my study, and I was put on an Aircurve 10, ASV, immediately. I've been using it now for over a year, and my numbers are, in her words, "exceptional." My only problem is that my FFM has left permanent marks and indentations on my face; even using a gel liner, so I'm likely going to have to have filler shots.
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