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Central sleep apnea periodic breathing
#11
Richb-

Your charts time and time again show CA's. The recent 10-minute chart, above, displays a very high accompanying AHI.

It's good that you are going to the sleep center in just a few days.

If I am not mistaken, you may be caught a bit in the trees and not the forest, no matter what one chooses to call it.

Others please chime in: Isn't there a commonly accepted solution with an ASV machine, whether one shows CA's or not in a diagnostic and/or titration setting?

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#12
(07-03-2015, 07:58 AM)swwalden1 Wrote: Met with my sleep doc (Pulmonologist/Internist) yesterday...

...He said they see it all the time in the sleep lab when they "over titrate" a patient. He was very clear that he thinks the the VPAP machine is causing this breathing pattern.

He sent me home to try lower max pressures and less pressure support--which, as you know, is consistent with a lot of the advice given on this board.

I hesitate to even mention this because 1) it's only one night of data and 2) I have a lot of night-to-night variation.

Having said that, I switched to CPAP mode, 10 cmH2O with EPR of 1 and my reported events were 7 OAs, 12 CAs, 12Hs over almost 7 hours of usage. Not great, but OK, and only one episodes of two back-to-back CAs.

Steve

Steve-

So your AHI went down to <5? Some improvement the other night!

Curious as to what your pulmo meant by using the terms 'all the time' 'over-titrate'. Did he elaborate?

It is subject to interpretation because there are Clinical Guidelines set up as to proper performance of a titration.
Was he implying they went beyond the Guidelines? The Guidelines are generally set too high, or?

I have my own reasons for these questions. However, this thread is not about me.

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#13

Steve-

So your AHI went down to <5? Some improvement the other night!

Curious as to what your pulmo meant by using the terms 'all the time' 'over-titrate'. Did he elaborate?

It is subject to interpretation because there are Clinical Guidelines set up as to proper performance of a titration.
Was he implying they went beyond the Guidelines? The Guidelines are generally set too high, or?

I have my own reasons for these questions. However, this thread is not about me.
[/quote]

He did not elaborate. My understanding was simply that it is not unusual to see in the sleep lab the kind of periodic breathing pattern I was inquiring about. I certainly did not infer "they went beyond the guidelines".

Steve
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#14
I think that the titration process is imprecise at best due to the stressful nature of sleep during the session. Once you are put on the machine you are asked to give it some time for the graphs to settle out. If things are not right a good sleep center will make adjustments to the settings. When I was titrated Centrals did not show up. They did the first night I was on the machine at home.
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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Organize your Sleepyhead Charts
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#15
(07-03-2015, 08:33 PM)richb Wrote: I think that the titration process is imprecise at best due to the stressful nature of sleep during the session. Once you are put on the machine you are asked to give it some time for the graphs to settle out. If things are not right a good sleep center will make adjustments to the settings. When I was titrated Centrals did not show up. They did the first night I was on the machine at home.


Don't have time right now to search through your numerous posts and I don't recall if you have low leaks or high leaks with the many CAs?

In my case, I had a terrible night on 3/18 showing more than 50 "Open Airway Apneas". It was nearly off the charts re high leaks for a period of over an hour. A high leak on my machine is >90 LPM- little doubt yours may differ.

I haven't had this issue to any extent before or since, but I do know it was attributable to using a Mirage FX pillow mask for the first time and I couldn't believe the results. Some of these OAA's were over 100 seconds. Quite certain it was the leaks:

[Image: 3-18-2015%20CPAP%20OAA%209-15CM_zpslilabvgw.png]


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#16
(07-03-2015, 07:58 AM)swwalden1 Wrote:
(06-24-2015, 06:28 PM)swwalden1 Wrote: I hope to get some insights into this next week during my follow up Dr. visit.

Steve

Met with my sleep doc (Pulmonologist/Internist) yesterday. He said this breathing pattern is not Cheyne-Stokes. He said they see it all the time in the sleep lab when they "over titrate" a patient. He was very clear that he thinks the the VPAP machine is causing this breathing pattern.

He sent me home to try lower max pressures and less pressure support--which, as you know, is consistent with a lot of the advice given on this board.

I hesitate to even mention this because 1) it's only one night of data and 2) I have a lot of night-to-night variation.

Having said that, I switched to CPAP mode, 10 cmH2O with EPR of 1 and my reported events were 7 OAs, 12 CAs, 12Hs over almost 7 hours of usage. Not great, but OK, and only one episodes of two back-to-back CAs.

Steve

Please keep us updated -- your question about CA events is of high interest to me.

I've been on an APAP for 3 weeks, and my results are erratic, with occasional AHIs under 5 but most in the 7-9 range. Pressure 7-11 and recently 8-13. In every case the vast majority of my AHIs are CA events. I've tried nasal masks (which seem to work the best when lip leaks/mouth droops are relatively few), nasal pillows (not terrible, but also lip leak/mouth droop issues) and full face mask (no leaks, but poorest numbers, oddly). I've wondered about the relationship of CAs to pressure and mask type -- so far not enough samples to come to any conclusions.

Good luck to you,
Andy
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#17
swwalden1 Wrote:Met with my sleep doc (Pulmonologist/Internist) yesterday...

...He said they see it all the time in the sleep lab when they "over titrate" a patient. He was very clear that he thinks the the VPAP machine is causing this breathing pattern.

(07-03-2015, 12:01 PM)tedburnsIII Wrote: Curious as to what your pulmo meant by using the terms 'all the time' 'over-titrate'. Did he elaborate?

(07-03-2015, 02:45 PM)swwalden1 Wrote: He did not elaborate. My understanding was simply that it is not unusual to see in the sleep lab the kind of periodic breathing pattern I was inquiring about.

Hi tedburnsIII,

I think the doctor was saying it is common for central events to be caused by CPAP therapy (this is sometimes called Complex Sleep Apnea Syndrome), especially when the titrated pressure is high. I think this happens to a minority (perhaps 15%) of patients, but a doctor who specializes in this area may have seen a lot of patients with this problem.

I think most of the Complex Sleep Apnea Syndrome patients who initially have significant numbers of central apneas (more than 5 per hour) find that within a few weeks or months they have adapted to CPAP therapy and their CompSAS disappears (meaning the number of Clear Airway events decreases to less than 5 per hour). I think this is why some sleep centers are not very concerned by moderate amounts of central events during a titration, knowing that in most cases the number of central events will decrease given time.

Sometimes, lowering the prescribed CPAP pressure will lower the number of central apnea events caused by CPAP therapy without increasing too much the number of obstructive events.

Also, bilevel therapy sometimes (in a minority of cases) causes Complex Sleep Apnea, and lowering the difference between IPAP and EPAP will often lower the number of central events caused by CPAP therapy. Therefore, lowering EPR or Pressure Support may lower the number of central events.

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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#18
vsheline-

With all the variables re settings CPAP vs. APAP vs. BPAP vs. ASV, it can be confusing, especially where one is reporting CA events as with richb. He is on Auto but I don't know what his titration study recommended as his optimal pressure.

In any event, one may choose to fall back on the titration study. If optimal pressure is 15 or higher, BPAP is the recommended therapy.

I look at BPAP as 'more finely tuned' CPAP/APAP, for those who need higher pressures.

Comments?

If one is seeing treatment-related CA's might it be easier to reduce or eliminate CA's using BPAP than APAP or CPAP?

Please excuse my naivete. I am a relative newbie, 4.5 months in now.
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#19
I was originally set for BPAP 9 epap 13 ipap. Then reset to epap 9 and ps 6 with a max of 16. The machine has been self adjusting for an average pressure of between 12 and 13. With these settings I am getting AHIs between a high of 38 and a low of 18 virtually all of them CAs. Dr appt on Tuesday.
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#20
(07-04-2015, 01:33 PM)richb Wrote: I was originally set for BPAP 9 epap 13 ipap. Then reset to epap 9 and ps 6 with a max of 16. The machine has been self adjusting for an average pressure of between 12 and 13. With these settings I am getting AHIs between a high of 38 and a low of 18 virtually all of them CAs. Dr appt on Tuesday.

Lowering PS to 3 or lower (at least temporarily, while your system adapts to the therapy) may reduce number of CA dramatically.
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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