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Need guidance in responding to Doctor
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u2canbuild Offline

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Posts: 47
Joined: Oct 2012

Machine: ResMed Air-Curve 10 ASV
Mask Type: Nasal pillows
Mask Make & Model: Sept 1 Nasal Pillows Swift FX
Humidifier: Res-Med
CPAP Pressure: 3-8
CPAP Software: SleepyHead Other Software

Other Comments: 4 months AHI = 0.2 !! Adding 1.5 to 2 Liter O2

Sex: Male
Location: Central Massachusetts, USA

Post: #1
Need guidance in responding to Doctor
I just saw a fairly young neurolgist at a major US East coast medical center who seems like a smart and caring doctor regarding memory issues.

The topic came up regarding that I have almost no obstructive SA events; they are now almost 100% central.

However;
I am not sure if he understands Sleep Apnea terminology ...... Thinking-about

Good thing is that he will correspond via e-mail........Cool and I do not want to alienate him.


He wrote........
In response to your original email:
"It’s fairly unusual to have both obstructive and central apneas. One common reason to have central apneas is too high pressure settings on your CPAP. I would discuss these with your Sleep Doc since it may mean you need a BiPAP instead of AutoPAP"

I beleive he should have said "adaptive-servo ventilation" in place of BiPAP.

Do I correct him? or Should I just forget what would apear to be an error ?

And is his statment regarding "both obstructive and central" being unusal correct?


Not sure how to respond/correct him ......... if at all ..........Oh-jeez

So what would you do?
09-03-2013 09:05 PM
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eviltim Offline

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Posts: 408
Joined: Aug 2013

Machine: Resmed S9 VPAP
Mask Type: Full face mask
Mask Make & Model: Resmed AirFit F10
Humidifier: H5i heated humidifer
CPAP Pressure: 5 exhale/9 inhale
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #2
RE: Need guidance in responding to Doctor
That does sound sort of odd. It's true that OSA sufferers may have central events because of the PAP machine, but as I understand it you can definitely have a serious case of both. According to your profile you have an AHI of 1.7 though? That's great.
(This post was last modified: 09-03-2013 09:08 PM by eviltim.)
09-03-2013 09:08 PM
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big_dave Online

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Posts: 409
Joined: Apr 2012

Machine: PR System One DS560
Mask Type: Nasal pillows
Mask Make & Model: F&P Pilairo Q or ResMed Mirage Activa
Humidifier: PR System One
CPAP Pressure: 14 - 20
CPAP Software: SleepyHead

Other Comments: Former ResMed S8 Autoset II user

Sex: Male
Location: Eugene, Oregon

Post: #3
RE: Need guidance in responding to Doctor
(09-03-2013 09:05 PM)u2canbuild Wrote:  He wrote........
In response to your original email:
"It’s fairly unusual to have both obstructive and central apneas. One common reason to have central apneas is too high pressure settings on your CPAP. I would discuss these with your Sleep Doc since it may mean you need a BiPAP instead of AutoPAP"

I beleive he should have said "adaptive-servo ventilation" in place of BiPAP.

Do I correct him? or Should I just forget what would apear to be an error ?

And is his statment regarding "both obstructive and central" being unusal correct?


Your neurologist's suggestion that you may need a BiPAP is odd since you are already using a similar machine, a VPAP Auto. Although he may not realize this, he is literally suggesting that you switch from a ResMed machine to a comparable Phillips Respironics machine, which would serve no useful purpose. BiPAP and VPAP are both trademarks for machines known generically as bilevel machines.

If your AHI is 1.7, your treatment is working properly and does not require adjustment. The remaining "centrals" may or may not be true centrals, and can be caused by any number of other things such as environmental conditions (noise, room temperature, pets in the bedroom, etc.) or unrelated medical conditions such as aches and pains. Events may even occur when falling asleep and when waking up--these events are disregarded during a sleep study as meaningless.

Rather than correcting your neurologist, it may be better to say something like "I feel that my sleep apnea treatment is working well" or "I am not ready to make changes to my sleep apnea treatment at this time." He sounds inexperienced with treating sleep apnea.
09-04-2013 12:09 AM
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STL Mark Offline

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Posts: 44
Joined: Jul 2013

Machine: Resmed S9 VPAP Adapt 36037
Mask Type: Full face mask
Mask Make & Model: Resmed Quattro Air
Humidifier: Resmed H5i
CPAP Pressure: Original Titration: 18 cm H2O
CPAP Software: ResScan SleepyHead

Other Comments: Mode: ASVAuto, Min EPAP: 4, Max EPAP: 15, Min PS: 3, Max PS: 15, Ramp: Off

Sex: Male
Location: Saint Louis, MO USA

Post: #4
RE: Need guidance in responding to Doctor
I believe your ResMed VPAP auto is treating your obstructive apnea. What is making up your 1.7 AHI is the central apnea that the machine can not treat. So it is probably true that 98% of what goes untreated is centrals. These are many times in clusters right at the point of waking or falling asleep. Our machines do not report untreated AHI levels the way a sleep study does. With an AHI of 1.7 you are probably not going to qualify for an ASV or a titration for that type of machine.

On another topic your doctor responded that you may need BiPAP instead of AutoPAP. I'm not sure if you told him you had an AutoPAP or where he got that from but the VPAP Auto in your profile is a Bi-Level or BiPap Machine. An AutoPAP would be a machine like the Autoset.
09-04-2013 12:15 AM
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PaulaO2 Offline
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Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #5
RE: Need guidance in responding to Doctor
There is a condition called Complex Sleep Apnea where the person has both. This is treated, as others have said, by a "variable" machine, also known as a "servo variable" (SV).

Bilevel CPAPs do not treat central events. They treat the obstructive events of people who, for various reasons, have problems breathing out against the pressure.

The diagnosis of sleep apnea, in any of its forms, is to have more than 5 events an hour which would be an AHI of 5 or more. For example, Jo Smith has an AHI of 68. His AI (apnea index) is 22, his HI (hypopnea index) is 10, and his CI (central index) is 34. The sleep doc puts him on a regular CPAP. His AI and HI goes down to less than 5 but his CI does not change. He will need to have a SV-PAP to treat both conditions.

If your AHI is below 5, no matter what those events are, then you are doing good. If you are currently using a bilevel machine (which is what the VPAP is), then you do not have complex sleep apnea nor central apnea. What you have is a normal thing where central events, for whatever reason, happen while you sleep. As long as the CI remains below 5, then a different machine isn't needed.

For help with all the alphabet soup:
http://www.apneaboard.com/wiki/index.php?title=Acronyms

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
09-04-2013 01:46 AM
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DocWils Offline

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Posts: 1,271
Joined: Jul 2012

Machine: Philips Remstar series 60
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10
Humidifier: same as machine
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Switzerland

Post: #6
RE: Need guidance in responding to Doctor
I am more curious as to why, given your low AHI, he feels you should seek to alter your treatment - true, he seems to have his terminology a bit mixed up, probably because he checked some neuro reference guide on CA treatment rather than having done a rotation in the sleep lab (neurologists generally don't get to do such rotations in their residency, pneumologists and other disciplines in chest, ears nose and throat do), so I would very gently point out that the particular model you have is pretty much what he does recommend, but from another manufacturer, thanking him for taking the time to consider the problem, and ask, given the low AHI, what he felt needed doing and what he suspects as a problem. It can be he is responding to something else in your case file, or he is just determined to get that 0.0 for you, which is chasing phantoms, alas. Either way, be gentle and polite, and thank him for his being thorough with you. He is trying to help, but, it seems to me, that he is a bit wide of his area of expertise.
09-04-2013 05:07 AM
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