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Central Apneas and ASV?
#1
This is my first post after reading the boards for awhile. Apologies in advance because my health situation is quite complex. I'll try to keep it simple, however, I have a suspicion that my doctor is over complicating my sleep issues.

I've had stage IV cancer for several years and last year spent a couple of months in the hospital following complications from a brain tumor and surgery. Leading up to that, I gained a lot of weight as a result of treatment. During my hospital stay I was prescribed opioids for pain relief. They also noticed that my SpO2 would briefly drop below 95% a few times per night, so out of precaution, I slept with a nasal cannula for O2 most nights, with the recommendation that I have a sleep study once I was home. Before all of that, my weight has fluctuated over the years, and while I tend to snore at heavier weights, I never felt like I had excessive fatigue during the day.

After being home for a few months, I lost the weight, but continue on the lowest dose of opioid pain medication. I had the sleep study and was diagnosed with mild sleep apnea with an AHI of 11. I've now been using an APAP for almost a year and I check my overall AHI daily and periodically look at the underlying data using ResScan and SleepyHead. My treated AHI has averaged 1.3 with a CAI of 0.9 and the rest split evenly between apneas and hypopneas. The highest month, my overall AHI was 1.6 with a CAI of 1.2 and the lowest month, my AHI was 0.6 with a CAI of 0.4. On the worst single night, my AHI was 4.7 and CAI was 3.1, but I've only had maybe three nights close to that. Also note that my centrals are almost all at or barely above the 10 second range to count as an event. I haven't noticed any difference in sleep quality before or after starting treatment.

From what I've read here, I almost feel dumb even asking about this, because it seems like my numbers are pretty good, even though the majority (about 2/3) of my low number of apneas are central. I assumed my recent follow up with my doctor would be uneventful. But when I saw him, he suggested I consider moving to a Respironics Trilogy machine based on "my situation". He said that when I read about it, it would be described as a ventilator, but not to worry about that, it's "really not".

I got home, did some reading here and elsewhere, including about the Trilogy. I understand that central apneas are better treated by an ASV system, and that the Trilogy can operate as a CPAP, APAP, BiPAP, ASV, or ventilator, but it just seems like overkill (especially given the cost difference between this and my CPAP). He didn't even mention an ASV. From what I've read here, it also sounds like APAP can also contribute to CA events, but I could be misunderstanding that. I pulled out my titration study results and during the four hours of sleep that night, there were no CA events. Finally, to add to all this, during the appointment, I noticed he was looking at a report from the first month of my treatment. When I pointed it out, they tried to get an updated report from the card, but said they couldn't get any data from it and I should get the card replaced. I was able to read the card fine later. My numbers haven't really changed from then until now anyway, but it just makes me question the basis of all this.

tl;dr, I've been using an APAP for almost a year with a treated AHI of 1.3 and CAI of 0.9, both of which seem good. I take low dose opioids for pain, which I think is the likely source of the CA events. Doctor said to consider a Trilogy ventilator, I assume to be used in ASV mode. I'm already dealing with a lot, and this just doesn't seem necessary. Am I missing something?

Thanks,
Tim
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#2
Quote: I've been using an APAP for almost a year with a treated AHI of 1.3 and CAI of 0.9, both of which seem good. I take low dose opioids for pain, which I think is the likely source of the CA events. Doctor said to consider a Trilogy ventilator, I assume to be used in ASV mode. I'm already dealing with a lot, and this just doesn't seem necessary. Am I missing something?

I would consider this to be well treated - my opinion is not a medical opinion, but I think I would seek a 2nd medical opinion. Smile
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#3
Thanks for the reply and your presence on the board. I'm not completely sure how to interpret your reply, though. I have more doctor appointments and tests than I know what to do with already. Is this the time for a second opinion or simply changing doctors at my next follow-up?
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#4
There's a lot of history there that makes you not the "normal" sleep apnea patient.
Given all that's going on; and what more there may be in your history (and future) I would salute the doctor and say, "Yes Sir!"
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#5
How long do the CA's last and when in your sleep session do they occur? As you go to sleep and as you wake up your breathing pattern will be erratic causing the CPAP to record a CA event.
______________________
Useful Links -or- When All Else Fails:
Posting SleepyHead Charts in 5 Easy Steps
Robysue's Beginner's Guide to Sleepyhead
Apnea Helpful Tips
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#6
Hi SleepyTim75,
WELCOME! to the forum.!
Wow, you have been through a lot.
I wish you much success with your CPAP therapy.
Hang in there for more responses to your post.
trish6hundred
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#7
If the Central Events are staying below 5, then why on earth are they wanting you to get another machine? Unless the CI goes above 5, you don't have the diagnosis. And your numbers are excellent, by the way. For someone who has had brain surgery, takes opiods, and has multiple health issues, you're AHI is freakin' awesome.

Your insurance is not going to pay for another machine (and that one sounds expensive) without doing another sleep study to verify it. And that sleep study is going to say just what your data is saying now: everything is fine, don't rock the boat.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#8
G'day Tim, welcome to Apnea Board.

Just on the basis of the AHI and other indices you've given us I wouldn't think you need anything more than your current machine. However, as Mongo said, there are likely to be other factors at play here which your doctor is aware of and we aren't. The use of opioids is known to cause central apneas for some patients, and APAP therapy can also do that, especially at higher pressures. If you're only experiencing a low number of short-duration centrals and your AHI is generally well under 5 then I don't think it's cause for concern.

I looked up the Trilogy on the Philips site - that is one monster of a machine! With an IPAP up to 50 you will definitely know that you're being ventilated! I notice it also doesn't seem to have a humidifier, so you might need an external unit. This is not a machine for "normal" sleep apnea. In my non-medical opinion, you would only want a Trilogy if there are other issues that require a heavy duty ventilator.

In your position I'd have another talk to your doc and find out what he's thinking and why he's recommending this machine.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#9
I agree with most all of the above, all combined. opioids can indeed interfere with breathing, most people here don't use them so little experience and no "canned" responses. You do have other issues involved that most here also do not have.

If there is a progression in what's going on or an increase in the opioid dose becomes necessary then indeed a ventilator may be useful in the future. If this becomes the case it may make sense to just get it now and already have it on hand. More expensive, yes but cheaper than both down the road.

If you like your Doctor and trust them, I would just get the Trilogy and have it at the ready. The way you describe your interaction with your Doctor, everything sounds reasonable. A little on the more protective side is better than the other way around.

Would I be concerned with your level of events, no not really-at this point in time. It would be nice that if in the future you started have a breathing issue, that you could just flip a switch and be fine again. Personally I wish I had a Trilogy just have it all at hand even though I, like you have no reason to have one now.
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