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Complex Sleep Apnea
#1
Hi,

I'm new to CPAP, but think i have had sleep apnea for years.

i have not had an overnight titration done, the just gave me the machine and have slowly increased the pressure trying to find a therapeutic level.

On 9.0 cmH2O for 15 nights averaged:
AHI: 35.5
Obstructive: 20.4
Central: 2.0
Hyponea: 12.9

On 12.0 cmH2O for 7 nights averaged:
AHI: 25.1
Obstructive: 13.8
Central: 2.2
Hypopnea: 7.2

On 14.0 cmH2O for 2 nights averaged:
AHI: 16.7
Obstructive: 9.8
Central: 1.5
Hypopnea: 5.3

On 15.0 cmH2O for 1 night:
AHI: 11.5
Obsructive: 4.3
Central: 1.7
Hypopnea: 5.4

On 16.0 cmH2O for 2 nights:
AHI: 11.3
Obstructive: 2.2
Central: 5.8
Hypopnea: 3.3

Is the rather sudden increase in central apneas at 16.0 cmH2O pointing towards Complex Apnea? Should I be asking for a titration on an ASV device?

Any feedback is appreciated.

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#2
Hi Sauron,
WELCOME! to the forum.!
Hang in there for answers to your questions and best of luck to you.
trish6hundred
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#3
Other more experienced members will give you better information, but in the meantime I do know that others have told me that higher pressures sometimes cause CAs. I wouldn't worry to much about it. It looks like your AHI is coming down so you are making progress. Maybe with some analysis of your data, you can get dialed in to cpap a little better.
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#4
First, I would stay at the pressure you are right now and see what happens for 2 or 3 weeks. Are you the one that is making the choice to change your pressure?

Secondly, depending on how long you have been using your machine, I would ask for an auto set. A sleep study titration is just for one night and they can find the pressure that is right for you THAT night. I just had a titration on a BIPAP because the CPAP and CPAP auto weren't working as well for me. I am waiting to see what my doc says and hoping he reads my study pretty quickly.

I have a few centrals here and there but usually it is when I am waking up; not sure if I had them other times as I would have to go back and look at my data.
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#5
(12-15-2013, 09:39 PM)me50 Wrote: First, I would stay at the pressure you are right now and see what happens for 2 or 3 weeks. Are you the one that is making the choice to change your pressure?

Secondly, depending on how long you have been using your machine, I would ask for an auto set. A sleep study titration is just for one night and they can find the pressure that is right for you THAT night. I just had a titration on a BIPAP because the CPAP and CPAP auto weren't working as well for me. I am waiting to see what my doc says and hoping he reads my study pretty quickly.

I have a few centrals here and there but usually it is when I am waking up; not sure if I had them other times as I would have to go back and look at my data.

I increased the pressure from 15 to 16 myself, I did it over the weekend after it seemed 15 was still leaving my AHI over 11. All previous increases were done via the specialist.

While the overall numbers are a little lower on 16, I actually feel more tired the following day than on 14 and 15 - I'm not sure what that's about. I left a message with the specialist and am hoping he might give me a call back today, and I have an appointment to see him on Wednesday. He's been surprised by how high we have had to put up the pressure to see any real results, as I'm not particularly overweight at 6'4" 220lbs.
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#6
Sauron, welcome, could you please supply some leakage data it should be below 24l, at 11 your AHI is still high and for some reason not really effective. Normally it will take time to come down as your body gets used to CPAP, but your not really giving it time to settle with the changes in pressures. I would have suggested you have a titration done in the first place and try to get the pressure as close to what it should have been. Doing it this way is a guessing game, if you had an auto at least it would self adjust, let us know how you go.
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#7
(12-15-2013, 08:41 PM)Sauron Wrote: Hi,

I'm new to CPAP, but think i have had sleep apnea for years.

i have not had an overnight titration done, the just gave me the machine and have slowly increased the pressure trying to find a therapeutic level.
Hi Sauron
Have you had sleep study in sleep lab? if so, whats the diagnoses
Normally titration done in sleep lab or sometimes at home with an autoPAP (not fixed pressure machine) for run-of-the-mill type apnea
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#8
Hello - others with more knowledge will reply in the next 24-36 hours, but a couple of points?

Centrals tend to go up at higher pressures, usually only for a week or so, then they usually will taper off.

Without a complete med list and data to look at, we are mostly just making guesses. If you are not on any type of meds that can affect breathing, sleeping, etc - I would suggest two things at this point. Due to the spike in centrals, I would leave it at '16' for 2-5 more nights and watch the numbers - including leak rate (very important).

Centrals came be a few different things - one clue that could help here is to also get and use a data capable Oximeter like the 'CMS50F' - which is what I use, it is a wrist mount with a probe that is good for sleeping with, and comes with software that will monitor both O2 stats and heartrate. By watching your O2 stats, pressure graph, leak graph, and events graph (AHI, etc) you (or others) may be able to tell exactly what is going on.

While I've been on XPAP for 12+ years, my OSA is complicated by all the meds I am currently on, including pain meds which affect (can) my breathing, and has increased the number of centrals, periodic breathing, etc...

I'll PM a member that I believe may be a great help and make him aware of your thread.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#9
First, that's just two nights of data. Not enough to form any opinion other than "well, that's different".

Second, complex apnea diagnosis would be if the central events had been high to begin with and had changed at all with treatment. They stayed relatively low the entire time until you hit 16. This is common. And I can tell you why it happened.

Look at the time you spent at each pressure.

15 nights
7 nights
2 nights
1 night
2 nights

Those last three were too many changes over too small a time frame. The first two were fine. Lots of time to gather data, look for trends and averages. You can't go by one or two nights and call it done. Too many things go into it. Add in that all you have to go by is a CPAP machine and you are really shooting in the dark. At least the single night of sleep study includes other factors such as oximetry, chest belt, limb movement, etc.

You say you made the move from 15 to 16 so I am assuming the others were made by the doc. They may have looked at your data and saw a pattern we can't see. So when you didn't drop low enough in those two days (which is really too short a time span) they raised it a single digit. But then you raised it one more. Your body and brain went all "hey, wait a minute" and the central events increased. This happens to a lot of us. What they may do is if they decide that 16 is your treatment pressure, is they may lower it back to 14 for a few weeks then raise it to 15 for a few weeks then go to 16 for a few weeks and monitor your data. Or they could give you an autoPAP and avoid all this mess.

Really, an autoPAP would have done what they've done here in much less time anyway. But I'm sure they had their reasons.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#10
My comment:

1) Has a doctor seen any of your data? If so, what's the doc say about it?

2) As others have pointed out, you need to have more than one or two days worth of data before declaring something is a trend. In other words, if you give yourself more time at 16cm, those CA numbers may come down or they may not.

3) It's very premature to be talking about an ASV titration in my opinion. The first step is to see if your body adjusts and the CAs disappear on their own after a week or two of using 16cm. If the centrals remain about 5 at 16cm of pressure for a week or more and if the OAs and Hs are well controlled at 16cm, the next step (which is usually required by an insurance company) would be to see if an APAP or an ordinary bi-level (a Resmed VPAP or a PR BiPAP) might allow the OSA to be controlled without triggering the excessive number of centrals. An APAP would only increase the pressure when there is a need for additional pressure to control the OSA stuff, and since the pressure would not need to be as high as 16cm all the time, there may be far less of a tendency for the CAs to emerge. The advantage of the the bi-level over either a CPAP or APAP is that the overall pressure needs are reduced (even further) since there is one pressure for exhale (EPAP) and one pressure for inhale (IPAP). And the difference between them can be set to be farther than 3cm apart if need be. If the OSA is controlled by a bi-level and the centrals go away, then there's no need for the even more expensive ASV machine. If the centrals remain in clinically significant numbers after a switch to a bi-level machine, that's when the docs usually start thinking about doing an ASV titration.
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