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How Long Before Centrals Subside
#1
Question 
Began CPAP 3 weeks ago after sleep lap and diagnosis of 48 AHI which includes 10 central apneas/hr. First week was tough, ie sleepy and struggled a bit. 2nd week felt REALLY good for 6 days. Third week - circling the drain with fatigue. Pressure is 10 constant. ERA set to 3. Ramp from 6 to 10 in 5 minutes with Resmed Air Sense Auto Set. I got used to the mask easily. I sleep well for 8 hours, waking once or so.

My average central is still 10/hr and hypopneas very near zero. No obstructive events - well maybe one a night. My low has been 5/hr and high has been 24/hr a couple of nights. Clearly this is too much long term. I've been told that centrals usually decrease after a month or two. Mine are always associated with Cheyne-Stokes breathing. This usually happens between about 2 a.m. and 5 a.m. and for up to an hour at a time. Central apneas last an average of 20 seconds, Cheyne-Stokes in between apneas last about 30 seconds. This cycle will happen 2 or 3 times a night and last for an average of a half hour.

I'm wondering about this type of central apneas as being fairly common, something that's expected to lessen, or is this something that needs attention soon. It's a confidence question, ie is this the way I should be going?

I've had this for over 10 years before diagnosis. My heart's been checked numerous times - recently stress echo, which was completely normal. I'm having lung function testing and looking for disease - none so far, ie pulmonary hypertension, COPD, etc. Only positive so far is a D-Dimer. Followup with ct scan showed no clots in the lungs. I still have some shortness of breath, palpitations and chest distress, but I'm told this is also possible with sleep apnea.

I guess I'm looking for average experience with others, etc. that indicates I'm on the right track. Is it too soon to start experimenting with the machine's settings? I think the sleep doctor is gone to some distant desert island, and the sleep technicians are sleeping on the job.

Thanks - if nothing else, this post will let others know what someone else's experience is.
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#2
AFAIK: elevated d-dimer is only meaningful when other tests and symptoms present. They did a ct to rule out blood clots in the lungs.

I'd ask my cardio to stick a ZIO patch on me for 10 days to look at rhythm -- since you have palps.

I'd also look at meds -- beta blockers are known to zap energy from some people. Have your doc do a med review with you.
Make sure all medical professions who treat you have a copy of a master list of meds you take at each visit.
I keep my own list on my computer and print out a copy before any doc visit.

If CAs remain above 5 at about 20 seconds duration, there may be an ASV machine in your future.
I wouldn't mess with pressure settings at this time.
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#3
Hi harttikka, welcome to the forum. Since you have primarily central apnea, your immediate goal is going to be to reduce pressure and eliminate the variations of EPR. Ultimately, it may turn out you need a machine capable of treating central apnea, but for now, we can probably reduce the CA signifiantly. You have an Airsense 10 Autoset set to CPAP mode. I would like to get you to change to Autoset Mode (soft) if available, and set the minimum pressure at 6.0 and the maximum pressure at 10.0, with EPR off.

Eventually we will need to see some of the data results. I recommend you add SleepyHead to your data review (free and easy to use), and the links in my signature describe how to best organize those charts for interpretation and how to post them by hosting on Imgur.

Your experience is not unusual for individuals diagnosed with central or mixed apnea. EPR can actually make the centrals and periodic breathing worse in some people, so it would be good to eliminate that variable right off the tip. In addition, the recommendation for lower pressure is aimed at reducing CA events. The only reason, I'm suggesting Autoset mode with a maximum at 10 is for a contingency that the lower pressure allows OA to occur, however for individuals like you, a more constant pressure is usually more helpful than auto mode. If you want to remain in CPAP mode with EPR off, then a pressure of 7.0 may be another option to consider. The correct treatement for central and mixed apnea is an Adaptive Servo Ventilator (ASV) which can increase pressure on a breath by breath basis to induce breathing during a central apnea, and to increase volume in hypopnea. The problem is that insurance companies will not allow reimbursement for ASV until the patient fails CPAP and Bilevel therapy and establishes a medical need for the higher level of machine. Needless to say, that can take some time. Our object is to give you the tools needed to optimize treatment, in spite of the fact CPAP is not ideal. I would say that the forum is generally about 50% successful in helping complex apnea member to overcome CA and H with CPAP, and we can help you on your journey towards ASV if that is what is needed.
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#4
Thanks jM,
No meds, and had a Holter for a couple days, but I didn't think that was long enough. 10 sounds good.

I had a suspicion that an ASV might be in order right after my sleep study. It looks like a journey to get into it if needed.

Too bad my doctor didn't suggest a sleep study years ago. I think it's done some damage.

Have a good one!
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#5
Hi hartikka,
WELCOME! to the forum.!
Good luck to you on your CPAP journey, hang in there for more responses to your post.
trish6hundred
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#6
Smile 
Thanks SR!

I turned off the EPR and dialed down to 7 for a short nap. Things felt good, so I'll try it over night. I've done a LOT of research, as that's my thing anyway, but this apnea 'thing' seems like it has a long ways to go in the medical field.

I'll let you know what happens in a couple days, and also check out the Sleepyhead link. Thanks again.

T Hartikka
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#7
Let's see how it goes, but with a sleep study of primarily centrals, I'd cut to the chase sooner than later and have a heart to heart with the prescribing doctor. We all know the right equipment to deal with this is ASV. I don't want to get too far ahead of the game, but I did just see a zero hour ASV selling for $995, shipped free CONUS. Depending on your copay and deductible situation, it might be attractive to cut to the chase and get on the right therapy without all the run-around.
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#8
Hi SR,

My sleep study was 48 total, or 48 AHI including 10 centrals. With CPAP I went to very little OSA, like .1/hr but still with 10 centrals. So the doctor diagnosed me with severe obstructive. The actual report was 104 hypopneas/hr and 10 centrals for a score of 48 AHI.

The night before last my centrals were 12/hr and 18/hr the night before that. Last night I tried your suggestion of 7 with the EPR off. I only had 2.5 centrals/hr and 2.4 hypopneas/hr. I feel much better so far this morning. The hypopneas went up as i suspected they might, but the trade off seems worth it for sure.

I videotaped my night as well last night and noted that I had 3 times where I started up with a few centrals (they were also less in length at about 13sec each). Each time the centrals started I had moved to the supine. Each time I moved to my side the centrals stopped. Hmm?

The sleep lab had said centrals tend to back off after a couple of months, but the way I've felt the last week was absolutely terrible - worse than no CPAP. It's only one night, but last night was great. Thanks!

I'll keep my eye on that ASV unit and also get set up with Sleepyhead. I'm sure we'll need a good week to see if this change is effective. (Although sleep laps titrate over hours at best.)

Have a good one!
T Hartikka
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#9
Obviously that is a remarkable improvement last night, and I hope it continues to improve. I think you have mixed central and obstructive issues, i.e. complex apnea. I'm wondering if you should consider finding a doctor that knows about 2-cents worth about central and complex apnea. I'm not too confident in your guy from your description. If we can find settings that provide reasonable treatment, and better rest, that will be great, but it would be worth looking around for a doctor that recognizes apnea comes in more than one form, and requires more than just pressure to treat. You might want to start by checking for AASM Accreditation. http://www.aasmnet.org/accreditation.aspx

Glad to hear last night went well. Keep in touch on this.
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#10
Give it time. Transitional or random centrals can possibly go away over a couple of months.

However, cheyne stokes breathing pattern wont.
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