Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

How Long Before Centrals Subside
#21
It's been over 3 months now on CPAP with auto-set pressure from 5 to 11. The pressure usually runs around 10. My average AHI is just under 5. I'll have 3 or 4 nights that average about 3, then I'll jump to a night or two of 10 or 11. These nights include periods of very regular Cheyne-Stokes with the centrals averaging about 15 seconds. During the night I'll have 2 to 3 episodes of about 30 minutes or so of periodic breathing before they settle out to regular breathing. It all seems pretty random except that if I've been on a treadmill working hard, such as for a stress echo, etc. the AHI that night is quite low. The last two weeks I have been really, really tired. Up to that point it had seemed that the CPAP was helping. But the last couple of weeks it's been like it was before CPAP. Looking forward to seeing my sleep doctor in a couple of weeks, where I will talk about a different machine. However, with such erratic results from night to night, I don't know how another titration for a different machine would be anything more than hit or miss.

A note on the extra level of fatigue - in part it may have been from some extra work. I may put in a half day of extra activity and it takes several days to recover to feeling somewhat normal. Overall, I'm guessing I need to bite the bullet and exercise more rigorously (with common sense) and whatever happens, happens. It's almost impossible to find any good material on Cheyne-Stokes breathing that doesn't talk about congestive heart failure, which we have ruled out as a problem. In any event, that's where I'm at with my original question concerning how long central events last before subsiding.
Post Reply Post Reply
#22
Heart failure is possible with normal LVEF, but it sounds like you have had a complete workup. I can't explain the CSR that happens intermittently with you, other than it is something that needs to be discussed with a professional along with some statistics of its frequency. This is going to be difficult to replicate in any sleep study. On good nights, you are considered well-treated, but when these events occur, you certainly qualify for SV treatment. The advantage of ASV is, it works when you need it, and is essentially a BPAP at other times.

How do you feel about buying a gray-market machine? They generally run $900 to $1400 and are new stock, usually acquired by third parties during DME auctions (going out of business).
Post Reply Post Reply
#23
(04-11-2017, 08:35 AM)hartikka Wrote: .... However, with such erratic results from night to night, I don't know how another titration for a different machine would be anything more than hit or miss.

I suggest using ResScan to print out reports to show your doctor (including waveforms of the High Rate Pressure, the Flow and the Leak, zoomed in to show 10 or 20 minutes of CSR-like breathing pattern) for several nights which had long CSR breathing. And simply ask your doctor to prescribe an ASV machine. Go from there.

If it later turns out that insurance or Medicare or whatever will not cover the ASV Titration or the machine, then you could consider picking up an ASV on the secondary market.

Quote:In any event, that's where I'm at with my original question concerning how long central events last before subsiding.

I think they should subside within the initial several weeks or months. If you have been using the machine every night (and whenever napping) for three months, I think the central apneas are not likely to go away on their own.

Things which may lower how often you get centrals:
Turn off or reduce EPR.
Check into whether alcohol or prescription meds may be causing the Centrals.
Some have reported that Vitamin C helps (I use Ester-C at bedtime) helps
Some have reported that a teaspoon or two of Coconut Oil in the evening helps.

Take care and good luck.
--- Vaughn
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.
Post Reply Post Reply


#24
(01-17-2017, 01:56 PM)hartikka Wrote: 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.
  i have had centrals for decades before the machine 
nothing they can do about them 

can the machine cause more
possibly
can they adjust it to do less
that is unclear
an ASV might help
or it might not

my echo was good
all labs are good
lungs good
i just have central apneas
will they kill me
maybe
but at 76 i have not seen that happen yet
Post Reply Post Reply
#25
Hi xxyzx and harttika.

You guys have correctly identified that in some cases Central Apnea and Hypopneas are are the Primary reason that we are seeking help because we stop or greatly reduce our breathing during sleep.  By Central Apnea I mean Central Apnea NOT related to Congestive Heart Failure.  One of the key factors in the Central Apnea diagnosis is that in a Sleep Study the Central Apnea will often present as Hypopneas.  This alone is a problem because many Sleep Drs and Clinicians can't or won't differentiate between Obstructive and Central Hypopneas.  The next problem is that the standard treatment for Sleep Apnea is CPAP or APAP.  A third problem is CPAP and APAP can cause or bring out Central Apnea symptoms which we are told will resolve with time and or tweaks to our settings.   Researchers suggest that those who have Central Apnea/Hypopnea have a faulty feedback loop in the blood-nervous system loop centered in the Carotid Body.  There can be aggravating factors that cause additional CO2 washout and Hyperventilation. This feedback loop measures the pH of the blood and signals for more respiration as the blood becomes more acidic.  (Dissolved CO2 forms Carbonic Acid)  In my case, CPAP and BiPAP washed out enough CO2 to convert an AHI of 44 (all hypopneas) to what looks exactly like Cheyne Stokes Respiration.  I had frequent desaturations during my Sleep Study.  I can only imagine the desats when I spent 1 in 8 hours in some form of Apnea.  I like most people had an occasional 1 or 2 Obstructive events per night.  It took me a total of 5 Sleep Studies and a search for a new Sleep Doc familiar with Central Apnea to get my ASV machine.  On the ASV machine my usual night shows an AHI close to 0.0 even though the machine is working hard all night. There are quite a number of Apnea Board Members using ASV machines with mostly excellent results.  My point is that when Central Apnea seems to be Primary ASV machines are the gold standard for treatment.  

Rich
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


Post Reply Post Reply
#26
(04-17-2017, 04:05 PM)richb Wrote: Hi xxyzx and harttika.

You guys have correctly identified that in some cases Central Apnea and Hypopneas are are the Primary reason that we are seeking help because we stop or greatly reduce our breathing during sleep.  By Central Apnea I mean Central Apnea NOT related to Congestive Heart Failure.
...
  My point is that when Central Apnea seems to be Primary ASV machines are the gold standard for treatment.  

Rich

I have a question about this as a total noob with just a basic, but growing, understanding of all things related to sleep apnea.

Since starting therapy about 3 weeks ago centrals are usually 50% or more of my events each night.  However, my AHI is running between 2 and 3 most nights.  It sounds like an ASV machine would do a better job for me, but with my AHI so low I would be unlikely to ever get insurance to cover a new machine at this point.  

I'm not really thinking of switching as I can live with an AHI of 2 or 3.  I feel so much better these days.  Just trying to understand a bit more.
Post Reply Post Reply


#27
(04-17-2017, 06:10 PM)KCFLY Wrote:
(04-17-2017, 04:05 PM)richb Wrote: Hi xxyzx and harttika.

You guys have correctly identified that in some cases Central Apnea and Hypopneas are are the Primary reason that we are seeking help because we stop or greatly reduce our breathing during sleep.  By Central Apnea I mean Central Apnea NOT related to Congestive Heart Failure.
...
  My point is that when Central Apnea seems to be Primary ASV machines are the gold standard for treatment.  

Rich

I have a question about this as a total noob with just a basic, but growing, understanding of all things related to sleep apnea.

Since starting therapy about 3 weeks ago centrals are usually 50% or more of my events each night.  However, my AHI is running between 2 and 3 most nights.  It sounds like an ASV machine would do a better job for me, but with my AHI so low I would be unlikely to ever get insurance to cover a new machine at this point.  

I'm not really thinking of switching as I can live with an AHI of 2 or 3.  I feel so much better these days.  Just trying to understand a bit more.

Hi KCFLY. A few Centrals are not really an issue that would require treatment with an ASV machine. As I mentioned, your machine settings could be causing the Centrals and some tweaks to your settings might be all that is necessary to reduce their numbers. You would be best served to start a new thread asking how a new CPAP user can reduce Centrals. You will be asked right away to post some Sleepyhead data showing your settings and your flow data. Several members have shown considerable expertise in looking at your settings and flow data and making really good recommendations to reduce Centrals. Give it a try.

Rich
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


Post Reply Post Reply
#28
It is awesome to see richb here showing the end of the rainbow.  I remember us in the early months of 2015 puzzling and sweating about rich and the crappy stuff he was going thru.  It is amazing the transformation that occurred - BY BRUTE FORCE.  Though they don't believe us, we still state as clearly as possible I NEED HELP, and this first block of steel is not doing it for me.  We have gotten enough sleep now to recognize this is not the BOX we were looking for.

The forum has been great.  The contributors, and wise moderators have been wonderful.

The DETERMINATION of the apnea sufferer is the final building block.  Rich did that.  YOU can do that, armed with data.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
Post Reply Post Reply
#29
Thanks QAL

Rich
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


Post Reply Post Reply




Possibly Related Threads...
Thread Author Replies Views Last Post
  Centrals and Leak Rate Allessio77 3 120 12-10-2017, 04:40 PM
Last Post: CB91710
  First Nights of APAP...All Centrals! Allessio77 31 808 12-04-2017, 11:21 AM
Last Post: Dawnstar
  [Pressure] Centrals increasing; new to BiPap cdbeardie 39 996 11-28-2017, 04:05 PM
Last Post: SarcasticDave94
  Another long over due newbie dsmith14469 6 205 11-09-2017, 09:54 PM
Last Post: dracus
Question New user, are centrals normal in the beginning? and other Q's FunkOdyssey 10 325 11-08-2017, 05:17 PM
Last Post: trish6hundred
  Long time user, new machine - need help LabDog66 2 219 10-28-2017, 03:40 PM
Last Post: LabDog66
  home study for centrals jerry1967 21 1,022 10-09-2017, 07:27 PM
Last Post: Sleeprider

Forum Jump:

New Posts   Today's Posts




About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.

For any more information, please use our contact form.