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Central Sleep Apnea / Auto CPAP Trial without Study
#1
Central Sleep Apnea / Auto CPAP Trial without Study
Hey everyone,

This is my first post, so hello! Smile

I need your advice regarding my current situation. First of, I want to mention that I intend to do a sleep study. But I unfortunately haven't heard from my doctor in 4 weeks now and I'm sure it will take quite a while until I will be able to do the study and have an official machine. That is currently a problem for me since I am feeling extremely miserable and it's starting to hugely affect my work performance.

After having tried everything else to get better, I am convinced that central sleep apnea is probably my issue. Reason being that I'm being treated with strong opioids and have been for about the last 12 years (I'm 30 now) for a severe case of RLS. I am feeling more and more miserable, tired, can't concentrate, can't sleep and have a bunch of other symptoms. 

So, I'm thinking of buying a cheap auto cpap machine until I can finally do the official study and get something tailored exactly to my needs. I have read quite a few posts here of people doing the same but read some warnings that it could be more complicated in cases of central apnea for example. Since I'm highly suspecting that I do actually suffer from central apnea, I thought I would ask you guys for advice. Is there actually any huge risk involved with an auto CPAP machine or could I just try it out?

The device I'm looking to buy is a pretty cheap one from Germany (I don't wanna buy one of the expensive models since I want my insurance to dish out the cash for that). I intend to buy the following one in case anyone of you knows the model (unfortunately all in German): DME Link Removed. Instead search Pulox in Switzerland for Pulox Auto Cpap.

Anyways, thanks so much in advance for your advice!
MightyPotato





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#2
RE: Central Sleep Apnea / Auto CPAP Trial without Study
Hi and welcome to the board!

I'm pretty much in your shoes. Severe chronic pain, opioids (which no doubt aren't helping) plus severe central sleep apnea (having 80+ centrals/hour). In my case, the doctors have excluded the pain medication as the cause (though potentially could be exacerbating it) but I'm still fighting to get an ASV trial.

The first thing my sleep clinic did was put me onto CPAP. Just on the off-chance that it would help. And for me, personally, it does a little. 30-50AHI instead of 80+. And I did feel better because of no more headaches and migraines for most of the week. That said, I clearly wasn't managed. And if nothing else, it would give you some idea of what's going on.

The problem is, as you say, that CPAP/APAP can worsen the central events by improving your overall ventilation and blowing off too much carbon dioxide while you sleep. It takes your body time to adjust to that - sometimes days or weeks, sometimes not at all. And some people don't find it worsens anything for them.

The problem with that APAP is that I don't know how much data it records or displays. It might give you a basic idea but it's hard to tell.

Do you have a pulse ox that records overnight? That might be a better first step, it would at least tell you if your oxygen level is falling that might signify that you have some underlying disordered breathing.

The other option would be to look at buying an at-home sleep study, if those are available to you. At least then you'd have a better idea of what you're dealing with.
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#3
RE: Central Sleep Apnea / Auto CPAP Trial without Study
Pleasure to meet you and thanks so much for taking the time to answer! I'm sorry to hear that you're in similar shoes. On which opioid are you if I may ask? I'm taking Oxycodone. I'm thankful for the relief it provides me but I wish I didn't have to take it. I imagine you probably feel similar. 

Your advice was extremely valuable, thank you so much! You just cost me 100 Swiss Francs! Wink I bought one of these 24 hours pulsoximeters which will arrive this evening. I will try it out and maybe report back sometime tomorrow with my results. I guess it will be easier then to make a decision whether I will buy the device until I can get the study done or not. But from my understanding, these devices aren't able to differentiate between the type of apnea one suffers from, right? At home sleep studies aren't really much of a thing here unfortunately. 

Also, thank you for the explanation of how CPAP affects people with central apnea! I didn't know that and thought using CPAP for central apnea is generally contraindicated.
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#4
RE: Central Sleep Apnea / Auto CPAP Trial without Study
You're welcome! And yes, I very much would love not to need them, but you know... peritonitis and nerve damage hurts. I'm on morphine and fentanyl (which is particularly notorious for respiratory depression) but thankfully there doesn't seem to be any obvious relation between medication, dosages or times. Still, I try to avoid taking anything close to bedtime unless it's unavoidable, just in case.

It'll be definitely interesting to see what's going on with your sats. Hopefully it doesn't look anything like mine!

Generally yes, CPAP isn't the right therapy for centrals, for all the reasons I explained about how it can worsen them. The urge to breathe (in all but the sickest of people with COPD etc) doesn't actually come from oxygen being low, but from carbon dioxide being too high. Low oxygen DOES trigger a breathing reflex eventually, but it's much lower than at the point when CO2 normally does, and it's very very close to the point at which the hypoxia would cause you to faint. And your body is very sensitive to changes in carbon dioxide normally, for obvious reasons. The problem comes at night, when you're breathing more effectively on CPAP, you're removing the gas more effectively that triggers you to take a breath and that can cause periodic breathing (where the depth of breaths waxes and wanes) and eventually, triggers you to pause so long between breaths that you have an apnea - the only difference between a central apnea and a long gap between breaths at that stage is basically time - hold your breath for ten seconds, you just experienced what would be marked as a central apnea. The proper, and best, therapy is ASV, though some people do well on BiPAP if they have complex needs, other co-existing respiratory disorders etc. And some people do manage to balance things enough on CPAP to feel better. It just depends.

As to whether a CPAP can determine the nature of an event... kind of? Some can't, of course, especially the cheaper models, but something like the Resmed machines, they use a method a little like "air echolocation" to make an educated guess. It pulses air when it notices you haven't breathed in about 4 seconds, and by measuring the signal that bounces back, it decides if your airway is obstructed or clear. It can't say for certain - because there's no measurement of breathing effort, which is the ultimate decider on if it's a central event or not. It tends to underestimate centrals, in my experience. A small percentage of mine regularly get listed as "undetermined" because the algorithm can't tell for sure. And the other issue is that, even if the airway is obstructed, that doesn't automatically mean that it's the obstruction causing the apnea. If you don't even attempt to breathe, then it's a central apnea.

Reliability really depends on how well the person reading your chart is educated. And that, unfortunately, can be a bit of a crap shot. I don't even pretend to be good at it, and I can only recognise some basic things myself, but there are, at least, a lot of folks on here who will also have more info in the future when and if you end up with a compatible xPAP device. Smile
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#5
RE: Central Sleep Apnea / Auto CPAP Trial without Study
Welcome to the Apnea Board,

I know you don't have official Central Apnea confirmation, or other data yet. A CPAP/APAP may be OK for some that suffer from CA, others not so good like me.

Definitely avoid any BPAP without breath backup rate, this is any regular BPAP that's not a specialized higher class machine. CA will very likely skyrocket into a trainwreck. On CPAP you can use the "avoid plan" to miss some CA. Avoiding CA plan is to set your PAP so that it doesn't add too much more CA, but it may not reduce or treat them.

To avoid CA on CPAP, no Ramp and likely no EPR on a ResMed. You will have to play around with pressures a bit, likely with a fairly narrow range or even static for some.

Failing the avoid CA plan, ASV is your best friend and the CA worst enemy. ASV is built specifically to combat Centrals, and it does a great job at Obstructive events too. ASV is a BPAP with breath backup rate.

Best bet eventually is to get a diagnosic sleep test that includes a chest effort belt (used to flag Central events). You get your detailed report and post here. We help decipher the info, such as did you have CA and how many. This bit of info helps tell us if you have CA and how bad.

Oxycodone? Yep I had it before for back pain. Worthless, it was like Pez candy. I had all the so called pain killers, and none cut it, except in the hospital ER on morphine. So I had a spinal cord stimulator implanted to block back pain, fully paid for by insurance.

Keep us updated here.

Coffee
Dave

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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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#6
RE: Central Sleep Apnea / Auto CPAP Trial without Study
The main value in a CPAP trial will be that you can eliminate the possibility that CPAP will be useful as a first therapy option. I am not familiar with the Pulox, but you need a machine that can report data and preferably distinguish between obstructive and central apnea. This machine seems to have a micro-SD card and uses Resview software which I have never seen. In my opinion, this is a poor choice for obtaining the data needed to validate or invalidate the CPAP trial.

The therapy indicated for central sleep apnea is adaptive servo ventilation (ASV), which is capable of treating both obstructive and central sleep apnea using pressure support on a breath by breath basis to ensure the respiratory rate and volume are maintained. In your price-range there are three Resmed S9 VPAP Adapt BIPAP #36007 for sale on DotMed, a marketplace site for respiratory and medical equipment. The prices are from $400 (14,500 hours of use) to $550 (8698 hours of use), or the Resmed AirCurve 10 ASV Bipap #37043 (7788 hours use) for $1100 USD. Most of the sellers will ship internationally, but you may be responsible for import fees and VAT. These ASV machines can operate in both ASV and CPAP mode and will treat central apnea. If you want something that will definitely work until you can get proper medical attention, these are your best options.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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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#7
RE: Central Sleep Apnea / Auto CPAP Trial without Study
(01-04-2022, 08:16 AM)Ratchick Wrote: You're welcome! And yes, I very much would love not to need them, but you know... peritonitis and nerve damage hurts. I'm on morphine and fentanyl (which is particularly notorious for respiratory depression) but thankfully there doesn't seem to be any obvious relation between medication, dosages or times. Still, I try to avoid taking anything close to bedtime unless it's unavoidable, just in case.

It'll be definitely interesting to see what's going on with your sats. Hopefully it doesn't look anything like mine!

Generally yes, CPAP isn't the right therapy for centrals, for all the reasons I explained about how it can worsen them. The urge to breathe (in all but the sickest of people with COPD etc) doesn't actually come from oxygen being low, but from carbon dioxide being too high. Low oxygen DOES trigger a breathing reflex eventually, but it's much lower than at the point when CO2 normally does, and it's very very close to the point at which the hypoxia would cause you to faint. And your body is very sensitive to changes in carbon dioxide normally, for obvious reasons. The problem comes at night, when you're breathing more effectively on CPAP, you're removing the gas more effectively that triggers you to take a breath and that can cause periodic breathing (where the depth of breaths waxes and wanes) and eventually, triggers you to pause so long between breaths that you have an apnea - the only difference between a central apnea and a long gap between breaths at that stage is basically time - hold your breath for ten seconds, you just experienced what would be marked as a central apnea. The proper, and best, therapy is ASV, though some people do well on BiPAP if they have complex needs, other co-existing respiratory disorders etc. And some people do manage to balance things enough on CPAP to feel better. It just depends.

As to whether a CPAP can determine the nature of an event... kind of? Some can't, of course, especially the cheaper models, but something like the Resmed machines, they use a method a little like "air echolocation" to make an educated guess. It pulses air when it notices you haven't breathed in about 4 seconds, and by measuring the signal that bounces back, it decides if your airway is obstructed or clear. It can't say for certain - because there's no measurement of breathing effort, which is the ultimate decider on if it's a central event or not. It tends to underestimate centrals, in my experience. A small percentage of mine regularly get listed as "undetermined" because the algorithm can't tell for sure. And the other issue is that, even if the airway is obstructed, that doesn't automatically mean that it's the obstruction causing the apnea. If you don't even attempt to breathe, then it's a central apnea.

Reliability really depends on how well the person reading your chart is educated. And that, unfortunately, can be a bit of a crap shot. I don't even pretend to be good at it, and I can only recognise some basic things myself, but there are, at least, a lot of folks on here who will also have more info in the future when and if you end up with a compatible xPAP device. Smile

(01-04-2022, 10:09 AM)SarcasticDave94 Wrote: Welcome to the Apnea Board,

I know you don't have official Central Apnea confirmation, or other data yet. A CPAP/APAP may be OK for some that suffer from CA, others not so good like me.

Definitely avoid any BPAP without breath backup rate, this is any regular BPAP that's not a specialized higher class machine. CA will very likely skyrocket into a trainwreck. On CPAP you can use the "avoid plan" to miss some CA. Avoiding CA plan is to set your PAP so that it doesn't add too much more CA, but it may not reduce or treat them.

To avoid CA on CPAP, no Ramp and likely no EPR on a ResMed. You will have to play around with pressures a bit, likely with a fairly narrow range or even static for some.

Failing the avoid CA plan, ASV is your best friend and the CA worst enemy. ASV is built specifically to combat Centrals, and it does a great job at Obstructive events too. ASV is a BPAP with breath backup rate.

Best bet eventually is to get a diagnosic sleep test that includes a chest effort belt (used to flag Central events). You get your detailed report and post here. We help decipher the info, such as did you have CA and how many. This bit of info helps tell us if you have CA and how bad.

Oxycodone? Yep I had it before for back pain. Worthless, it was like Pez candy. I had all the so called pain killers, and none cut it, except in the hospital ER on morphine. So I had a spinal cord stimulator implanted to block back pain, fully paid for by insurance.

Keep us updated here.

Coffee

(01-04-2022, 11:02 AM)Sleeprider Wrote: The main value in a CPAP trial will be that you can eliminate the possibility that CPAP will be useful as a first therapy option.  I am not familiar with the Pulox, but you need a machine that can report data and preferably distinguish between obstructive and central apnea.  This machine seems to have a micro-SD card and uses Resview software which I have never seen.  In my opinion, this is a poor choice for obtaining the data needed to validate or invalidate the CPAP trial.  

The therapy indicated for central sleep apnea is adaptive servo ventilation (ASV), which is capable of treating both obstructive and central sleep apnea using pressure support on a breath by breath basis to ensure the respiratory rate and volume are maintained.  In your price-range there are three Resmed S9 VPAP Adapt BIPAP #36007 for sale on DotMed, a marketplace site for respiratory and medical equipment. The prices are from $400 (14,500 hours of use) to $550 (8698 hours of use), or the Resmed AirCurve 10 ASV Bipap #37043 (7788 hours use) for $1100 USD.  Most of the sellers will ship internationally, but you may be responsible for import fees and VAT.  These ASV machines can operate in both ASV and CPAP mode and will treat central apnea.  If you want something that will definitely work until you can get proper medical attention, these are your best options.

Thanks to all of you for you answers. I will try to adress all of you in my answer here.

@Ratchick: That sounds very painful. I'm sorry you have the misfortune of dealing with it! Thank you for the very detailed central/obstructive clarification. Seems like I have a lot to learn... Wink I definitely don't think that the machine I posted above is capable of that. I thought buying a cheap one until I can get a more expensive one would be the better deal but I just found a European Supplier that sells these machines quite cheaply. So if the oximeter test tonight is indicating that something is wrong, I will probably get this one: search for BMC G3 A20 Auto CPAP with Smart Humidifier from CPAPstore Europe

It states that it's capable of differentiating between central and obstructive and even though 300 francs more is a lot, what the hell. And in terms of being able to differentiate: I actually meant the pulse thingy. Wink But I guess at this point I know that it's not capable of doing that from what I learned from your comments. 

@SarcasticDave: Thank you for taking the time to give an answer! To be honest, I don't understand most of the things you're talking about but I guess I will once I have a machine and start fiddling with it. Thank you! Regarding the Oxy: I think it's a very individual thing. For me, Oxycodone also does not present with any traditional painkilling features. I probably wouldn't want it for back injuries or something like that. At least not long-term. But for my type of neurological "discomfort", it's still working wonders even after all this time. Glad that you were able to find something that helps you out!! 

Sleeprider: Thank you for taking a look at the machine and the software! I really appreciate it! It definitely seems that it's not really a good model. I think I will bite the bullet, pay a bit more and get this one: search for BMC G3 A20 Auto CPAP with Smart Humidifier from CPAPstore Europe


Costs me almost double but in this case without a sleep study, I rather pay a bit more with a higher chance of success. First I will have a look at the oximeter tonight. Thank you so much, I really appreciate it!

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Moderator Action: DME Link Removed: CPAP Store Europe BMC G3

To maintain our status as an educational organization, links to DME-owned or DME-operated websites and links to pages that sell prescription-required items are prohibited in forum posts.  This is stated in the Apnea Board Rules.

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#8
RE: Central Sleep Apnea / Auto CPAP Trial without Study
Don't commit to an off brand cpap machine until we can confirm it has data capability with Oscar. Without data we/you will be flying blind. I don't know the capabilities of this machine so will wait for someone that does.

If you want to commit to something Resmed brand, autoset, vauto, st or asv would be best. Only the st and asv have backup rate necessary to treat centrals though and asv >>> st.

You are better buying a machine we know is good and have experience with even if you have to do so used to get reasonable price.

Central apnea as I believe others have commented on can be worsened by a basic cpap machine so buying something incapable of treating central apnea can give you information to help with diagnosis but that is all it might provide. A recording oximeter (I believe already mentioned) is also somewhat capable of diagnosing (but we won't be able to easily tell if obstructive or central).
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#9
RE: Central Sleep Apnea / Auto CPAP Trial without Study
The BMC G3 A20 Auto CPAP with Smart Humidifier is a Chinese manufactured machine and is not capable of determining central from obstructive. Please review the used machines I suggested earlier which can be a much more permanent solution. I understand you want to save money, but buying a machine that won't likely work, and won't give you useful data is not the answer. In addition to the relatively inexpensive machines on DotMed, Supplier #2 sells machines with very few hours or new, but for $3000 to $4000 USD. The prices have gone up significantly in the past year.

Please note you have received a couple warnings for posting links to equipment sold by CPAP suppliers. You can use the name of the equipment, but our rules prohibit any URL links or parts of links to these sellers.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#10
RE: Central Sleep Apnea / Auto CPAP Trial without Study
(01-04-2022, 01:12 PM)Sleeprider Wrote: The BMC G3 A20 Auto CPAP with Smart Humidifier is a Chinese manufactured machine and is not capable of determining central from obstructive.  Please review the used machines I suggested earlier which can be a much more permanent solution.  I understand you want to save money, but buying a machine that won't likely work, and won't give you useful data is not the answer.   In addition to the relatively inexpensive machines on DotMed, Supplier #2 sells machines with very few hours or new, but for $3000 to $4000 USD.  The prices have gone up significantly in the past year.

Please note you have received a couple warnings for posting links to equipment sold by CPAP suppliers.  You can use the name of the equipment, but our rules prohibit any URL links or parts of links to these sellers.

Sorry for the links. 

Hm, seems I got confused by the following statement from the manufacturer: "When an apnea occurs, the device emits oscillating waves, and determines the type of apnea based on changes in airflow and pressure". After reading your comment again, I see now how that is different from what you said the other machine does. 

I will first see what I learn from the oximeter and then decide what I wanna do. Thank you for all the valuable advice.
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