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 does a CPAP machine identify CA events ?
#11
RE: How does a CPAP machine identify CA events ?
David, were you ever obliged to wear a Holter Monitor for 24 hours?  I developed paroxysmal atrial fibrillation near the end of a 10 km run three summers ago. I was out of breath, and felt 'funny' in the chest.  All the energy left me, and I had to sit on the curb for a while.  I was given every diagnostic possible, MIBI, even echo cardiogram and Doppler ultrasound of the carotid arteries.  Everything checked out very well, even for a younger man.  As a last resort, my cardio ordered a sleep lab, and that's where I was diagnosed as 'severe'. I knew I snored some, but apnea?!?  Severe?!?  Heart arrhythmias and OSA go together far too often to be mere coincidence.

Heart arrhythmias can cause anxiety, but so can all sorts of things, and they do tend to be cumulative.  They affect sleep, which, in turn, can cause heart problems...it is a most vicious cycle.  Nothing showed up for me in the tests, except that I presented to emerg twice with fibrillation.  Only the polysomnography showed the cause.
Post Reply Post Reply



Donate to Apnea Board  
#12
RE: How does a CPAP machine identify CA events ?
daviddm Wrote:I don't feel inclined to push my luck further by requesting charts and tables showing my sleep-study results .

Your call, of course but I like to have a hard copy of all my medical results. As you went through the public system your sleep report is probably on MyHealth unless you have opted out. Even for your own interest I'd encourage you to download it and have a good look at the results. Sleep studies have a bad reputation around here for missing a lot of important stuff, which is why we said above to get hold of the charts and tables, not just the summary.

Quote:Meanwhile my gut feeling tells me : like the count of ectopics, AHI is just another number.

Well, yes. But if your AHI is high that number indicates your body is being put under unnecessary stress. The ectopics can be directly caused by apnea events and the more events you have, the higher the stress on your heart. I used to have ectopics which were really distressing at times - I can remember the sensation of wondering if my heart was going to beat again. Once I got AHI under control my heart problems evaporated.

I read your brief history above as well as your thoughts on how you believe your central apnea could be an extension of your daytime slow and shallow breathing. I don't think it really works that way. Holding the breath while awake is something we all do, especially when concentrating on the job at hand. I've been doing it while typing this message. It's not a problem as sooner or later the CO2 level in your blood will rise sufficiently to trigger a breath. In pre-existing central sleep apnea, the brain doesn't respond to the raised CO2 for an inordinately long time. In treatment-emergent central apnea, the CO2 levels are thrown out of balance by the additional pressure in our lungs, tricking the brain into thinking you don't need to breath for a while longer. (This is a very rough description but sufficient for the basic idea).

Central sleep apnea doesn't respond to the same treatments we use for obstructive apnea. In the more intractable cases we have to use a different type of machine (ASV) to get on top of the central apnea. We see many, many people who have been diagnosed with OSA but actually have central. The basic CPAP and APAP machines used to treat OSA don't work well for central, and can in fact make it worse. That's why we asked to see your sleep study charts and why we've mentioned Oscar charts. These are tools to allow you to monitor your therapy and improve it. And it allows us to help, if that is what you want.

We're here to help, and of course the amount of help you want is entirely your call. If you decide you're doing OK and don't want to bother with charts and such, no problem. We'll still be here if you need us.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
Post Reply Post Reply
#13
RE: How does a CPAP machine identify CA events ?
This isn't meant to be arm twisting but to highlight the info sleep studies have and how it can be helpful. And I'm aware it's your call on actions to or not to take.

Just an example of what happens if sleep study info is posted: soon after joining here, I posted my BPAP sleep study, I was on my Respironics DreamStation Auto BiPAP then. Results were incredibly bad. Why? Central Apnea. Upon posting my sleep study, Sleeprider points out 2 major things to me, CA at 124, OA at 24, and one CA was about 90 seconds. I made an appointment with the pulmonary team to discuss why I was not on ASV. I had taken my copy of that PSG just in case. That appointment was with a nurse practitioner; her answer to my ASV question was something like "I don't know why you're not on ASV. Let's correct that. I'll be right back, I've got to show this and confirm with the doctor on call". ASV process started then. Currently, I'm on ASV where CA are essentially eliminated with mask on.

We'll help you however possible. Best to ya.

For what it's worth, here's my thread. http://www.apneaboard.com/forums/Thread-...guru-input
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice.


Wiki Info for Beginners
OSCAR Chart Organization
Mask Primer
Post Reply Post Reply
#14
Smile 
RE: How does a CPAP machine identify CA events ?
I'm quite touched by the generosity and willingness of the board members to help struggling CPAP-users like me . My thanks, in particular, to DeepBreathing and S-Dave for waking me up from my slumber regarding the relevancy of sleep-study charts and tables . It's not that I doubt their usefulness, but more  the case where I feel my OSA knowledge is not yet at the point to properly digest and make use of them  . In fact, I'm kind of overwhelmed, saturated with information being offered in this forum . At this stage I'm grateful to gain enough clues just to walk with my CPAP machine without falling over . It's my good fortune to know that there are many here who can run and fly with it , and also willing to show me how.

I guess my difficulties are not just physical, but also emotional and psychological . Being easily agitated, getting unnecessarily anxious over things, I often have to remind myself repeatedly : "Don't sweat too much. Go sleep on it !"  .    Well, that strategy won't be of much use for OSA problems, will it  .  Smile
Post Reply Post Reply



Donate to Apnea Board  
#15
RE: How does a CPAP machine identify CA events ?
(11-08-2019, 12:32 AM)mesenteria Wrote: David, were you ever obliged to wear a Holter Monitor for 24 hours?  I developed paroxysmal atrial fibrillation near the end of a 10 km run three summers ago. I was out of breath, and felt 'funny' in the chest.  All the energy left me, and I had to sit on the curb for a while.  I was given every diagnostic possible, MIBI, even echo cardiogram and Doppler ultrasound of the carotid arteries.  Everything checked out very well, even for a younger man.  As a last resort, my cardio ordered a sleep lab, and that's where I was diagnosed as 'severe'. I knew I snored some, but apnea?!?  Severe?!?  Heart arrhythmias and OSA go together far too often to be mere coincidence.

Heart arrhythmias can cause anxiety, but so can all sorts of things, and they do tend to be cumulative.  They affect sleep, which, in turn, can cause heart problems...it is a most vicious cycle.  Nothing showed up for me in the tests, except that I presented to emerg twice with fibrillation.  Only the polysomnography showed the cause.


Hello ! Yes. I had worn a Holter monitor at one stage, after my heart palpitation symptoms began . That's where I got the ectopics count of just under 300 over 24 hours . At the time my cardiologist made nothing of it, saying everyone has ectopics . I was not very assured by his words, since the feeling of irregular beats was not easy to ignore. There was clearly something going on in my chest trying to give me some message . Fortunately the symptoms subsided after a week or so . These days with more regular physical and breathing exercises I only have palpitations occasionally.

To put things in perpective, the cardiologist from York posted a Youtube video about the case of a person who had an ectopic count of 20,000 without being aware of any symptoms !  I slept well after watching that video . And by the way, you would never have guessed: They eventually found out that he had OSA .
Post Reply Post Reply
#16
RE: How does a CPAP machine identify CA events ?
(11-08-2019, 08:10 PM)daviddm Wrote: I'm quite touched by the generosity and willingness of the board members to help struggling CPAP-users like me . My thanks, in particular, to DeepBreathing and S-Dave for waking me up from my slumber regarding the relevancy of sleep-study charts and tables . It's not that I doubt their usefulness, but more  the case where I feel my OSA knowledge is not yet at the point to properly digest and make use of them  . In fact, I'm kind of overwhelmed, saturated with information being offered in this forum . At this stage I'm grateful to gain enough clues just to walk with my CPAP machine without falling over . It's my good fortune to know that there are many here who can run and fly with it , and also willing to show me how.

I guess my difficulties are not just physical, but also emotional and psychological . Being easily agitated, getting unnecessarily anxious over things, I often have to remind myself repeatedly : "Don't sweat too much. Go sleep on it !"  .    Well, that strategy won't be of much use for OSA problems, will it  .  Smile

David we're here to help however we can with your sleep apnea therapy. Just 8 more words after this for this eve.

I was there too. You will make it.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice.


Wiki Info for Beginners
OSCAR Chart Organization
Mask Primer
Post Reply Post Reply
#17
RE: How does a CPAP machine identify CA events ?
Hello David and welcome from a fellow Aussie.

As you've discovered, the approach to OSA in Australia is haphazard to say the least. My experience, while similar to yours, was expedited by my GP approving a Medicare sleep study that was bulk billed. I went to a clinic in Southport, Gold Coast that specialized in this and they did a good job. The only issue was that Medicare required that diagnosis, then titration, were done at different times. Something to do with them not authorising two bulk billed examinations on the same day. My titration was a few weeks after my diagnosis.

To cut a long story short, after titration I was put on CPAP 13 fixed. Like you, after all sorts of issues I discovered this wonderful website and about 8 months after starting xPAP therapy it was finally starting to work for me.

Australia has some very long drives and many of our truckies do these drives. On top of that many of our truckies have undiagnosed sleep apnea. With this in mind I wonder why our medicos are not taking this more seriously.
Post Reply Post Reply



Donate to Apnea Board  
#18
RE: How does a CPAP machine identify CA events ?
I did not know what "ASV" means until today after some more reading of posts in this forum. Based on the experiences reported by many posters here, am I correct to deduce that CPAP machines are not effective in the treatment of Central Apneas ?  In fact there seems to be the opinion that they could even be the cause of treatment-emergent CA's .

What are the criteria for deciding that ASV devices should be used instead of CPAP's  ? A high pre-treatment ratio of CA's over OA's ?

I've now begun to understand more clearly what DeepBreathing and S-Dave have been trying to impress upon me regarding the results of the diagnostic sleep study . Thank you again. My money should have gone to you instead of the reticent sleep doctors !  Wink
Post Reply Post Reply
#19
RE: How does a CPAP machine identify CA events ?
If we are dealing with CA, then a ResMed Aircurve 10 ASV like mine is great for it.

CA to OA I think needs a CA bias. Mine was skewed heavy on CA at 124 to 24 OA.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice.


Wiki Info for Beginners
OSCAR Chart Organization
Mask Primer
Post Reply Post Reply
#20
RE: How does a CPAP machine identify CA events ?
daviddm Wrote:What are the criteria for deciding that ASV devices should be used instead of CPAP's ? A high pre-treatment ratio of CA's over OA's ?

The criterion I have seen quoted (which I believe is from the US Medicare) is a central AHI of 5.0 or higher and central apnea constituting more than 50% of the total AHI.

In the United States (where most of our members are from) they have to go through a series of tests, "failing" at each step. So, start on a CPAP / APAP, fail that, try an ordinary bilevel, fail that, do a titration study with ASV and maybe then the insurance company will pay for it. In general we don't have that type of procedure here in Oz - As Holden said, its a bit more haphazard. It basically getting a doctor or therapist who knows about central apnea and is prepared to recommend an ASV (note - a prescription is not required to purchase any xPAP machine in Australia). Having said that Medicare / Centrelink are unlikely to cough up for an ASV except in the direst circumstances. Your health fund (if privately insured) will pay a flat amount regardless of what type of machine, and depending which table you are on. A member recently did the sums and determined that the extra premium he would have to pay to go up to a higher table would exceed the cost f the machine (imported from the US).

Quote:Based on the experiences reported by many posters here, am I correct to deduce that CPAP machines are not effective in the treatment of Central Apneas ? In fact there seems to be the opinion that they could even be the cause of treatment-emergent CA's .

Yes, generally speaking that is correct. If your central apnea is not too bad it is possible to fine tune the pressure and EPR/Flex settings to control the centrals to some extent. Experience shows that in many cases this is just a stop-gap, as it's almost impossible to keep the centrals at bay consistently using his type of machine. As Bonjour likes to say "central apnea is consistently inconsistent".

Treatment emergent central apnea will often go away of its own accord over a period of weeks or months as your body accommodates the change in CO2 levels. But sometimes they're impossible to resolve without going to an ASV.

Quote: My money should have gone to you instead of the reticent sleep doctors !

I'll send you my BSB and account info. Smile Seriously Apnea Board would gladly accept any donation no matter how small, to help keep everything running.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
Post Reply Post Reply



Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  The times next to events on OSCAR Crispy983 2 50 3 hours ago
Last Post: jaswilliams
Ohmy Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent sherwoga 35 684 7 hours ago
Last Post: JoeyWallaby
  [CPAP] Trying to identify whether these are real central apneas dogfish1977 22 317 9 hours ago
Last Post: SarcasticDave94
  Central apnea events not associated with O2 drop? Schlafer 14 217 11-13-2019, 08:14 AM
Last Post: Sleeprider
  [Equipment] Is it possible for a foreigner to buy a CPAP machine using the prescription from heartrick 12 507 11-11-2019, 12:26 PM
Last Post: DaveL
  Clear airway events after waking and going back to sleep Mpadgett714 28 538 11-05-2019, 05:46 PM
Last Post: alexp
  Did Dreamstation or OSCAR fail to flag or misclassify abnormal breathing events ChinaMan 34 599 11-01-2019, 06:48 PM
Last Post: SuperSleeper


New Posts   Today's Posts






About Apnea Board

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