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Difference between central and clear airway apnea
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Sleepster Offline
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Post: #41
RE: Difference between central and clear airway apnea
(05-18-2016 02:00 PM)PaytonA Wrote:  Chest effort Belts may be the gold standard but they do not measure the "real" symptom which is the brain not sending the signal to breathe per the definition of central apnea.

Researchers must go with the empirical evidence available.

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05-18-2016 06:06 PM
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eseedhouse Online

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Post: #42
RE: Difference between central and clear airway apnea
(05-18-2016 06:06 PM)Sleepster Wrote:  
(05-18-2016 02:00 PM)PaytonA Wrote:  Chest effort Belts may be the gold standard but they do not measure the "real" symptom which is the brain not sending the signal to breathe per the definition of central apnea.

Researchers must go with the empirical evidence available.

I did not have a Chest Effort Belt during my sleep study. I had electrodes all over my head and my chest, but no chest belt that I remember. I assumed they were reading my EEG and EKG. Why else would they stick electrodes on my scalp? Sadism?

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05-18-2016 09:36 PM
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palerider Offline

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Post: #43
RE: Difference between central and clear airway apnea
(05-18-2016 09:36 PM)eseedhouse Wrote:  
(05-18-2016 06:06 PM)Sleepster Wrote:  
(05-18-2016 02:00 PM)PaytonA Wrote:  Chest effort Belts may be the gold standard but they do not measure the "real" symptom which is the brain not sending the signal to breathe per the definition of central apnea.

Researchers must go with the empirical evidence available.

I did not have a Chest Effort Belt during my sleep study. I had electrodes all over my head and my chest, but no chest belt that I remember. I assumed they were reading my EEG and EKG.

as mentioned previously, the EEG is used to determine when you're asleep, and when breathing events cause arousals, that's all.

if you have a copy of your detailed sleep study, you'll be able to see if there were chest/abdomen belts, because there are traces for them on the detailed study. they're standard in lab studies.
05-18-2016 10:07 PM
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Luvmyzzz Offline

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Post: #44
RE: Difference between central and clear airway apnea
(05-18-2016 10:07 PM)palerider Wrote:  
(05-18-2016 09:36 PM)eseedhouse Wrote:  
(05-18-2016 06:06 PM)Sleepster Wrote:  Researchers must go with the empirical evidence available.

I did not have a Chest Effort Belt during my sleep study. I had electrodes all over my head and my chest, but no chest belt that I remember. I assumed they were reading my EEG and EKG.

as mentioned previously, the EEG is used to determine when you're asleep, and when breathing events cause arousals, that's all.

if you have a copy of your detailed sleep study, you'll be able to see if there were chest/abdomen belts, because there are traces for them on the detailed study. they're standard in lab studies.

I hope I'm not being rude by adding my thoughts to this thread, (BTW; Hello E-1Smile ) But as I read this section, I have vivid recall of my initial sleep study back in 2005, I had no idea what to expect, and no one offered support through this journey. But what scared me the most was finding out my brain wasn't sending the signal!! Does any one know what causes the brain to NOT send the signal??
e.g: heredity, aging, stress, poor occupation choices?? Just curious...if any one had ideas or info on the problem... thanks for having this blessed forum, it is a TRUE blessing for me!

I enjoy being with a group who like to share their "Hosehead" experiences, to remind me I am not alone.
(This post was last modified: 05-19-2016 02:45 AM by Luvmyzzz.)
05-19-2016 02:43 AM
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archangle Offline
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Post: #45
RE: Difference between central and clear airway apnea
(05-18-2016 09:36 PM)eseedhouse Wrote:  I did not have a Chest Effort Belt during my sleep study. I had electrodes all over my head and my chest, but no chest belt that I remember. I assumed they were reading my EEG and EKG. Why else would they stick electrodes on my scalp? Sadism?

I believe that some in-lab sleep studies don't actually check for central apnea, they just check for apnea. It seems strange, but I think it does happen. There is a big push for in-home sleep tests and other variations of testing methods such as watch-PAT. Some of the newer testing methods are frankly inferior in terms of data, but cheaper and/or easier for the patient. What actually gets tested is varying all the time.

It's possible they try to check for central apnea using other means, such as FOT or Respironics pressure pulses, or PAT (Peripheral Artery Tone.) I guess there might be some way to use electrodes instead of a belt to check for respiratory effort by detecting muscle efforts electrically. There might also be some sort of motion sensor they stick to your chest.

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05-19-2016 04:48 AM
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archangle Offline
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Post: #46
RE: Difference between central and clear airway apnea
(05-18-2016 05:06 AM)FrankNichols Wrote:  Based on the definition I have seen presented in this thread, I would think if I am laying in bed awake and I intentionally stop breathing for 10 seconds or longer, it should record a CA - since the airway is not obstructed, my brain is simply not sending the signal to breathe. On the other hand maybe if the brain decides not to breathe it also instructs other parts of the body to ensure that I do not breathe by closing off the airway. My point being, it is not JUST the brain doesn't say to breathe. There is more physiology going on during an actual CA.

I just tried it (twice) and both breathing interruptions were recorded as OAs.

When I consciously hold my breath, I find I automatically close off my airway. I've tried to stop breathing and not close off my airway and it's hard to do.

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05-19-2016 04:56 AM
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FrankNichols Offline

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Post: #47
RE: Difference between central and clear airway apnea
ResMed S+ is a step in the direction of non-contact monitoring. It uses a "radar" like system that is trained to detect various breathing patterns. I have been testing it for about 6 weeks, and it seems to be better than I expected and not perfect, but it is a first step. The idea is that bedclothes are transparent at the wavelength of RF used while your body is basically a sack full of water. It monitors the movement of that sack (expansion, contractions, etc.) and decides how you are breathing. I expect soon this will be expanded to other diagnosis. Non-contact is, IMHO, the future of sleep (and other disorder) monitoring.

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05-19-2016 05:02 AM
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archangle Offline
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Post: #48
RE: Difference between central and clear airway apnea
(05-19-2016 02:43 AM)Luvmyzzz Wrote:  I hope I'm not being rude by adding my thoughts to this thread, (BTW; Hello E-1Smile ) But as I read this section, I have vivid recall of my initial sleep study back in 2005, I had no idea what to expect, and no one offered support through this journey. But what scared me the most was finding out my brain wasn't sending the signal!! Does any one know what causes the brain to NOT send the signal??
e.g: heredity, aging, stress, poor occupation choices?? Just curious...if any one had ideas or info on the problem... thanks for having this blessed forum, it is a TRUE blessing for me!

Good point. We tend to discuss the "brain doesn't send the signal" part of the discussion a little too glibly. I imagine it's a pretty scary thing to someone who isn't familiar with the idea.

There's no need to panic. It's just a different form of sleep apnea, not necessarily worse.

You probably think "brain damage" when you hear the description of central apnea. While that's possible, it's not necessarily that bad.

Central apnea isn't necessarily worse than obstructive, it's just somewhat harder to treat, and has to be treated by different means than obstructive. Unless you have a large number per hour or the individual apnea lasts a long time, don't worry about central vs. obstructive.

You do need to be careful when increasing your CPAP pressure because you may increase your central apnea at the same time you're decreasing your obstructive. This is one of the biggest reasons all CPAPers should have a fully data capable machine and monitor their results.

As to the cause of central apnea, the scientists know a number of factors, but most of the time, it's a mystery.

For some people, CPAP pressure causes some central apnea. It's worse at higher pressures, so you sometimes have to try to find a compromise between central and obstructive apnea.

Some drugs, especially opioids, can make it worse.

Some heart problems can cause Cheyne-Stokes respiration, which can be a form of central apnea. Don't panic over this, because many people with perfectly healthy hearts get central apnea.

Mayo clinic has a page.

Even "normal" people may get some "central apnea," as well as obstructive apnea. It only becomes important if it's bad enough.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
05-19-2016 06:10 AM
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FrankNichols Offline

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Post: #49
RE: Difference between central and clear airway apnea
Central Apnea can also occur not because of anything unusual about the brain activity, but because you have a surplus of oxygen and a lack of carbon dioxide. CO2 is a trigger to cause breathing, if for some reason (you are hyperventilating) you can have a lack of CO2 and so, do not trigger a breath.

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05-19-2016 07:15 AM
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richb Offline

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Post: #50
RE: Difference between central and clear airway apnea
(05-19-2016 06:10 AM)archangle Wrote:  
(05-19-2016 02:43 AM)Luvmyzzz Wrote:  I hope I'm not being rude by adding my thoughts to this thread, (BTW; Hello E-1Smile ) But as I read this section, I have vivid recall of my initial sleep study back in 2005, I had no idea what to expect, and no one offered support through this journey. But what scared me the most was finding out my brain wasn't sending the signal!! Does any one know what causes the brain to NOT send the signal??
e.g: heredity, aging, stress, poor occupation choices?? Just curious...if any one had ideas or info on the problem... thanks for having this blessed forum, it is a TRUE blessing for me!

Good point. We tend to discuss the "brain doesn't send the signal" part of the discussion a little too glibly. I imagine it's a pretty scary thing to someone who isn't familiar with the idea.

There's no need to panic. It's just a different form of sleep apnea, not necessarily worse.

You probably think "brain damage" when you hear the description of central apnea. While that's possible, it's not necessarily that bad.

Central apnea isn't necessarily worse than obstructive, it's just somewhat harder to treat, and has to be treated by different means than obstructive. Unless you have a large number per hour or the individual apnea lasts a long time, don't worry about central vs. obstructive.

You do need to be careful when increasing your CPAP pressure because you may increase your central apnea at the same time you're decreasing your obstructive. This is one of the biggest reasons all CPAPers should have a fully data capable machine and monitor their results.

As to the cause of central apnea, the scientists know a number of factors, but most of the time, it's a mystery.

For some people, CPAP pressure causes some central apnea. It's worse at higher pressures, so you sometimes have to try to find a compromise between central and obstructive apnea.

Some drugs, especially opioids, can make it worse.

Some heart problems can cause Cheyne-Stokes respiration, which can be a form of central apnea. Don't panic over this, because many people with perfectly healthy hearts get central apnea.

Mayo clinic has a page.

Even "normal" people may get some "central apnea," as well as obstructive apnea. It only becomes important if it's bad enough.

A malfunction of the Carotid Body(s) is believed to be the cause of Central Apnea / Periodic Breathing not associated with another disease process such as Congestive Heart Failure. The Carotid Body actually measures blood pH and responds to a lowered pH with a nerve message to the brain where there are other nerve centers which also help regulate respiration. In many cases of Periodic Breathing the symptom is a high frequency of Hypopneas with a few Centrals during sleep. Traditional CPAP therapy converts the Hypopneas to Centrals probably because of additional CO2 washout. The problem is that Sleep Techs have a lot of trouble determining whether Hypopneas are Central or Obstructive in Nature. The AAST suggests the following criteria (on their blog) for determining the difference: It is an Obstructive Hypopnea if ANY of the following are present:
"Snoring during the event
An increase in the flatting of the nasal pressure flow or PAP flow signal
Paradoxical breathing
You can only call the event a Central Hypopnea if NONE of the above is present."

We discussed the flattening of the nasal pressure flow in this thread. It seems to be pretty straight forward. In my case the Sleep Techs failed to recognize that my Hypopneas (AHI 44 desat to 86%) during my sleep study were Central in nature. This was probably a cultural issue since my then Sleep Doc did not treat Central Apnea. Even if he did I still needed to fail using traditional CPAP to qualify for the proper treatment (ASV). My point is that our high tech xPAP machines are the standard, for insurance purposes, to diagnose and prescribe proper treatment of Central Apnea/ Periodic Breathing.

Rich

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
05-19-2016 07:25 AM
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