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[Diagnosis] Questioning CPAP when experiencing proportion CA events
#11
RE: ??? CPAP when experiencing proportion CA events
Another point to raise is how do you feel after therapy? Better or worse off how? Assess and note it needs told to doc. If you feel worse off, maybe points towards ASV. BPAP may make you worse off.
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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#12
RE: ??? CPAP when experiencing proportion CA events
I'm not knowledgeable enough to make recommendations, especially with so little information. after 1.5 years of apap I bought an asv on my own. it much improved my ahi and slowly improved my fragmented sleep to a large degree (but not sufficiently by any stretch of the imagination), and after 1.5 years of asv I still felt sleep deprived.

my last sleep study untreated ahi was over 72, almost equally ca and oa, and for reasons no one has been able to explain, my central apnea came down as much as my obstructive apnea with apap. even though vauto doesn't treat ca, trigger and Ti min can help reduce it. I'm just saying it can be complicated and I, at least, don't see enough info for you to go on. you may need to get a few months machine time and data first.

my recommendation was to check in with your doctor and ask how s/he plans to address your central apnea. if the answer isn't satisfactory, then decide what to do on your own, particularly after logging more machine time.
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#13
RE: ??? CPAP when experiencing proportion CA events
The BiLevel will not be worse than a CPAP (AutoSet) but neither will treat Centrals. That was a Diagnostic test and I assume that both documents were from the same test. IMHO the diagnosis should me mixed or complex Apnea which means both OSA and CA. Since this is a diagnostic test the centrals are not treatment-emergent and thus are less likely to be based on the CO2 balance. You now know first hand why we want to see all of the test documentation.

IF (that's a big if) the centrals are emergent and CO2 based they may be able to be treated with a APAP or BiLevel and a mask modified to rebreathe a little extra CO2.
"treatment" with CPAP/BiLevel is by avoidance. Be aware this is complicated because this is exactly the opposite of what is needed to manage OSA.

If you are self pay and are getting a CPAP consider a BiLevel instead, it is a better more flexible machine.

The most likely machine that will treat your apnea is the ASV. Many here prefer the ResMed.

Looking at causes for your centrals, do you have any of the following.

Heart or cardiac conditions
History of seizures
Stroke
Drug use, either Prescription or Recreational
Altitude (usually greater than 5000 ft)
Any other breathing disorders Asthma, COPD, etc.
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#14
RE: ??? CPAP when experiencing proportion CA events
Hi Leonie

It's really hard to read the charts you've posted - if you can get a better in focus scan that would be great.

As far as the American escalation is concerned, that doesn't apply here. You can buy whatever machine you like, no prescription required, and no need to "fail" at one machine before you try another. Health insurance typically only covers a tiny percentage of the machine, regardless of which type you get. Of course an ASV is a heck of a lot more expensive than a regular cpap so you need to be sure that's what you need.

It's an unfortunate fact that many sleep doctors and therapists only think of sleep apnea as obstructive. Central apnea doesn't come into their thinking at all. It's nothing to do with insurance, it's just a mindset they have all got into. My diagnosis was OSA even though I had 50% centrals. I asked the doc what's the story and he didn't seem to know how to answer.

My recommendation at this stage would be to talk to your doc and explain that you're concerned about the centrals and ask for a proper in-hospital study. It should be possible to have the study bulk-billed and the facility fee covered by your health fund, so you end up very little out of pocket (if any). I had my study by Cardio Vascular Sleep at Hollywood Hospital, and it wasn't too bad an experience at all. Even got breakfast in bed(!) But I still got misdiagnosed. Luckily I had a great therapist who got me sorted with an ASV, which is what I required.

I think the most important thing for you is to take things slowly and make sure you get the right diagnosis and the right treatment. Don't get rushed into buying a machine which may not be the right one.
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#15
RE: ??? CPAP when experiencing proportion CA events
Quote:Thank you Fred,

I appreciate your in depth answer.

As for the source of my C A's....
I don't suffer from any of the conditions you have listed nor do I use any opioids or other drugs of choice,  I am a type 2 diabetic and take insulin and metformin daily. 
I am yet to see the doctor who may be able to assist with exposing thar CAs .

Many thanks agsin
Leonie 
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#16
RE: ??? CPAP when experiencing proportion CA events
You have heard pretty good advise so far. The proper machine for central or complex (mixed) apnea is ASV (adaptive servo ventilator). The ASV works like any other bilevel with automatic increasing exhale pressure to treat OSA and pressure support for comfort, hypopnea, snores etc. The ASV also has a breath by breath 'adaptive" pressure support that can cause a person having a central apnea to take a breath, even when they don't make the spontaneous effort. The ASV targets your minute ventilation rate to keep you breathing at the same rate and volume through the night. Deepbreathing who replied earlier has the older Resmed S9 VPAP Adapt (ASV), and the current model is the Resmed Aircurve 10 ASV.

The problem with ASV is that the machine costs about 3-times what you would pay for a good CPAP and twice what a regular bilevel would cost. A good source for our Aussie friends is Supplier #2 who provides good prices on new and used machines and ships overseas. Current prices from Seondwind CPAP are $1749 USD for gently used and $2149 USD for new.

If there is a way for you to trial CPAP before making a purchase, that would be ideal. With a data recording CPAP like the Resmed Airsense 10 Autoset, we would know almost immediately if you need to upgrade to ASV or not. See if your doctor can provide a loaner or rental. If it is going to work it will work right away, but if it will ultimately fail, we will know that too. Based on your sleep study you have severe sleep apnea, and it appears to be a complex apnea that may not respond to CPAP. I urge you to do what it takes to get these answers as soon as possible as your oxygen desaturation is serious (over 23 minutes) and reaches very low levels. You need therapy, and the best way to find out what you need is a brief CPAP trial before you buy. Beg, borrow, rent, but get the answer you need soon.
Sleeprider
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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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#17
RE: ??? CPAP when experiencing proportion CA events
The experts on data analysis have already spoken, but I'll throw in my thoughts. As already noted, this is just a diagnostic. Without a titration, it is just a guess as to what therapy will work. My original sleep study, AHI 79, showed 70% OAs and 30% (mostly mixed and centrals). During the titration both the OAs and Mixed/CAs went to zero with straight CPAP.

I did have a 10 year dark period of no data as the technology wasn't even there at first. When I got a Resmed S9 Elite CPAP machine, my mix was about 2/3 CAs and 1/3 OAs & Hypopneas. But some of the CAs looked like sleep/wake junk and mixed (Rescan software). I managed things quite well with CPAP and APAP for over 15 years, and always felt pretty good to great (the reality is that life, not SA, causes us to have some tough nights sleeping). A little more than a year ago, the centrals started to take off. Now I was experiencing real (in my mind) CAs that would spike into double figures. It was sometimes hit or miss over a few weeks, but when it started there was nothing I could do with the therapy I had. More importantly, I was feeling worse. A couple of months ago I got an Aircurve ASV and things have been really good since then.

I don't know if my original CAs and Mixed were accurately diagnosed years ago. If they were there, they were not treatment emergent. And here was no treatment for CAs back then. But you really need to get a titration and have a good doctor. Depending on those results, I would make a decision. Good luck with your journey. Be positive, it can be a really good experience.

John
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#18
RE: ??? CPAP when experiencing proportion CA events
Thank you all so very much.
Your in depth knowledge and willingness to help is amazing and is vey much appreciated.  Thanks

I am meeting with the sleep tech on Thursday to be fitted and kitted up for a 4 week trial with  CPAP.
It's my understanding that they'll initially offer me the resmed airsense autoset10 to trial. 
Of course i will post the results as soon as i get some consistency in my sleep patterns. 

 ( just getting used to the idea of cpap has been challenging... let's see how i go wearing all gear and then try to sleep!)

Hopefully the data will help sort out if the CA issue is real and not an aberration.

Thank you again for your individual and collective advice.

I'm looking forward to feeling as if I'm human again

Sleep-well
Leonie
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#19
RE: ??? CPAP when experiencing proportion CA events
Download OSCAR and make sure you have an SD card in the machine. Then we can help you along the way. That SD card will contain the data that will help you understand what is going on.
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#20
RE: ??? CPAP when experiencing proportion CA events
Aussie Lee Wrote:I am meeting with the sleep tech on Thursday to be fitted and kitted up for a 4 week trial with CPAP.
It's my understanding that they'll initially offer me the resmed airsense autoset10 to trial.

Ask your therapist about the strategy they will be following. Many will start with an AutoSet wide open (ie min pressure = 4, max = 20) then narrow down the pressure range until they arrive at "your pressure", a single fixed pressure which is supposed to cover you for all eventualities going forward. Although the method is far superior than a single night titration study, the end point is probably not what you need. We strongly recommend automatic machines in preference to fixed pressure for a whole lot of reasons.

In your particular case you have the complication of the central apneas. Make sure the tech is aware of these and ask what is the strategy for eliminating them. It's often the case that with careful pressure and EPR adjustments the centrals will appear to go away, but they will always come back, and in an inconsistent manner.

At your session with the therapist ask to be provided with more than one type of mask for trial. The mask is really the hardest part of this exercise - every face is a different shape, and getting the right mask that fits your face, is comfortable and doesn't leak can be a whole exercise in itself. Try nasal pillows (eg Resmed P10), a nasal mask and a full face mask. See which you are most comfortable with. There is a detailed discussion of mask types here: http://www.apneaboard.com/wiki/index.php/Mask_Primer
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