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New to CPAP and not experiencing relief...
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Sleepster Offline
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Post: #21
RE: New to CPAP and not experiencing relief...
(10-07-2012 10:47 AM)Extrospect Wrote:  I'm thoroughly bummed about the whole thing. Indications are that my hope of treatment for my OSA is ineffective for CA, which isn't helpful given my cognition complaints.

I understand how you feel, but it's way to early to draw that conclusion. That CA index will likely drop as you get acclimated to CPAP therapy. If after a week or two you are still concerned you can talk to your doctor about lowering the pressure. That's the classic approach to treating CPAP-induced central apnea.

Sleepster
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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.
10-07-2012 11:45 AM
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Extrospect Offline

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Post: #22
RE: New to CPAP and not experiencing relief...
Quote:If after a week or two you are still concerned you can talk to your doctor about lowering the pressure. That's the classic approach to treating CPAP-induced central apnea.

How long is the typical acclimation period to evaluate whether central events are worth addressing?
10-07-2012 04:42 PM
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zimlich Offline

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Post: #23
RE: New to CPAP and not experiencing relief...
Only a sleep test in the lab will accurately diagnose central apnea. If you talk to your sleep doctor about your fears you can have a sleep test with a trial of an ASV machine. This getting adjusted to 'PAP is a process and for some it's a long one. It took me four years of changing between machines and about 7 sleep tests to end up on ASV. Might be feasable for you- the ASV.
Good Luck. This whole process can be incredibly easy or very hard as you know, Extrospect
10-07-2012 05:10 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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Post: #24
RE: New to CPAP and not experiencing relief...
(10-07-2012 04:42 PM)Extrospect Wrote:  How long is the typical acclimation period to evaluate whether central events are worth addressing?

That's a question that can't be answered. Just wait at least a week or two to see if the CA index goes down. If it doesn't you can call your doctor and have your prescription pressure lowered.

I know it's hard, but patience is called for here. You're doing better than you were before, so just wait now and see what happens. I know it's hard because you're focusing on this new CPAP machine in your bedroom and its effect on your life, but try to spend your time thinking about other things. Things in your life that make it worth living. That's the real reason you're on CPAP therapy anyway.

If you really can't wait then call your doctor and explain your concerns.

Sleepster
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www.ApneaBoard.com


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.
(This post was last modified: 10-07-2012 05:26 PM by Sleepster.)
10-07-2012 05:24 PM
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vsheline Offline

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Post: #25
RE: New to CPAP and not experiencing relief...
Archangle Wrote:You should also look at the airflow graph for central apneas. See how long they last and how completely you stop breathing. If you're only stopping breathing for 11 seconds, or are only partly stopping breathing, that's a lot better than a long, complete cessation of breathing.

(10-06-2012 11:08 PM)Extrospect Wrote:  Prior to the beginning of each central event, I have some pretty erratic flow activity (as shown in the attached file). I'm not breathing for the duration of each event, with some events lasting between 30-40 seconds.

Hi Extrospect. I think you are to be congratulated for persevering on a path to get your sleep problems correctly diagnosed and thoroughly treated. I trust you will not give up prematurely, before you have arrived at the destination.

Your attached file looks like an example of Cheyne-Stokes Respiration (CSR), an extreme form of Periodic Breathing (PB). The Wiki says Cheyne-Stokes respiration is a pattern of breathing with gradual increase in depth and sometimes in rate to a maximum, followed by a decrease resulting in apnea; the cycles ordinarily are 30 seconds to 2 minutes in duration, with 5–30 seconds of apnea.

If you continue to see these events in your sleep data, you may benefit from an adaptive servo-ventillation (ASV) machine. An ASV machine calculates the tidal flow through your lungs, and changes the pressure as much as needed, both to avoid obstructive apneas and to maintain adequate tidal flow into and out of your lungs even when you completely stop attempting to breathe.

Maybe it would be helpful to give paper copies or pdf electronic copies of your data to your doctor (zoomed-in close-ups from many nights, like the example you posted) and ask for a prescription for an overnight ASV titration.

By the way, this is what I did, and my sleep doctor has recently given me a prescription for an overnight ASV titration. I want to find a facility which has a ResMed machine available for the ASV titration, so I can be titrated using the exact algorithm used in the S9 VPAP Adapt (the ASV machine I would try to get).

I don't really know whether the ResMed ASV algorithm is much different than the Respironics algorithm, but I am familiar with my present ResMed machine and want to be able to monitor the data from the ASV machine and bring to my doctor's attention any issues I find, and I am simply unaware how well I would be able to monitor the data if using a Respironics ASV machine. For all I know, a Respironics setup might also allow me to monitor the data adequately.

Take good care of yourself.

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.
(This post was last modified: 10-07-2012 11:56 PM by vsheline.)
10-07-2012 11:21 PM
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archangle Offline
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Post: #26
RE: New to CPAP and not experiencing relief...
(10-06-2012 11:08 PM)Extrospect Wrote:  Prior to the beginning of each central event, I have some pretty erratic flow activity (as shown in the attached file). I'm not breathing for the duration of each event, with some events lasting between 30-40 seconds.

Even supposing we want to say these events aren't long enough to cause significant drops in oxygen, they're still probably disruptive to sleep.

Keep working with your doctor.

Keep an eye on it, especially if you start getting lots of apneas and they have a long duration. Somethings are not that concerning for a few nights, but are harmful long term. If your AHI or the duration gets too high, you should get more concerned.

We need your pressure graph, too.

It's a little troublesome that you're getting these "central" apneas at a pressure of 7. Centrals usually go up with pressure. On the other hand, your centrals didn't seem to go up that much on the ResScan chart when pressure went up. Maybe they'll go away over time.

They do sort of look like "real" centrals, not simply miscategorized obstructives.

However, as has been pointed out, your current condition is much better than before CPAP, assuming your sleep study was done right.

Watch the gabapentin. That's serious medicine. In particular, I think you have to be very careful to increase or decrease the dose very slowly. And follow the other instructions and watch for side effects.

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.
10-09-2012 08:49 AM
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archangle Offline
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Post: #27
RE: New to CPAP and not experiencing relief...
(10-07-2012 11:21 PM)vsheline Wrote:  Your attached file looks like an example of Cheyne-Stokes Respiration (CSR), an extreme form of Periodic Breathing (PB). The Wiki says Cheyne-Stokes respiration is a pattern of breathing with gradual increase in depth and sometimes in rate to a maximum, followed by a decrease resulting in apnea; the cycles ordinarily are 30 seconds to 2 minutes in duration, with 5–30 seconds of apnea.

If you continue to see these events in your sleep data, you may benefit from an adaptive servo-ventillation (ASV) machine. An ASV machine calculates the tidal flow through your lungs, and changes the pressure as much as needed, both to avoid obstructive apneas and to maintain adequate tidal flow into and out of your lungs even when you completely stop attempting to breathe.

It's way, WAY, WAY!! too soon for Extrospect to start worrying about that sort of stuff unless this goes on for a long time, or the "central" apenas get a lot longer or more frequent.

It could come to that later, though.

In particular, I think you need a lot longer time period of weird breathing before you can start talking about CSR or even PB.

This is the worst 4 minute period of the whole night. It looks like the rest of the night was much better.

We may be having a geekasm talking about the technical aspects and possibilities, but let's not scare the newbie into hypochondriac insomnia with all the horror stories.

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.
10-09-2012 09:01 AM
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vsheline Offline

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Post: #28
RE: New to CPAP and not experiencing relief...
(10-09-2012 09:01 AM)archangle Wrote:  In particular, I think you need a lot longer time period of weird breathing before you can start talking about CSR or even PB.

This is the worst 4 minute period of the whole night. It looks like the rest of the night was much better.

Thanks archangle - very good points.

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.
10-09-2012 12:06 PM
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Extrospect Offline

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Post: #29
RE: New to CPAP and not experiencing relief...
Quote:It's way, WAY, WAY!! too soon for Extrospect to start worrying about that sort of stuff unless this goes on for a long time, or the "central" apenas get a lot longer or more frequent.

I'm a pretty well-adjusted guy and can appreciate information without unnecessarily obsessing over it. If anything, it's helpful in preparing me for more productive conversations with my doctor.

Quote:This is the worst 4 minute period of the whole night. It looks like the rest of the night was much better.

Though it is a small sample, I've been confused by that pattern since beginning CPAP. The spike in erratic respiration precedes every single CA event recorded. Additionally, it's present at other times and followed by similarly depressed breathing where the duration is not long enough to warrant detection as an apnea.

Makes me curious if this can be linked to my heart pain complaints.

I'd like to reiterate my thanks to all of your for the commentary! It's great to benefit from the wealth of experience this community holds.
10-09-2012 01:17 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Post: #30
RE: New to CPAP and not experiencing relief...
(10-09-2012 08:49 AM)archangle Wrote:  Watch the gabapentin. That's serious medicine. In particular, I think you have to be very careful to increase or decrease the dose very slowly. And follow the other instructions and watch for side effects.

I have about 95% permanent hearing loss and loud tinnitus from taking various medications, mostly antibiotics. At no time did my doctors ever warn me that hearing loss or tinnitus or vertigo can be permanent side effects of these medications. Recently I found a great resource (book) for easily looking up the ototoxic (toxic to the ears) effect of many common drugs. I'll give the link below to the author's web site, where the book can be purchased for about $40 for a pdf copy. (Warning - do not buy this book on Amazon, because I just checked and to my shock the rip-off prices from unethical re-sellers of "used copies" were outrageously astronomical. I am going to suggest to the author to sell his books on Amazon, to force prices down to resonable levels.)

Anyway, Neil G Bauman in the book "Ototoxic Drugs Exposed" classifies many many drugs in a scale ranging from Class 1 (least ototoxic risk) to Class 5 (worst ototoxic risk). In his judgement, gabapentin is a Class 4 risk, which is high. It can harm both eyes and ears, especially if taken for months. But if stopping, one must taper off slowly, under doctor's supervision.

Also, when taking any medications, be very careful of drinking much grapefruit juice, because (as explained in the book) it contains a substance which can greatly increase the potency of some drugs, by slowing down the body's normal process of eliminating drugs from your system. As you continue to take your regular dose of whatever medications you are on, if the drugs are not being eliminated at the normal rate expected, the drugs build up to higher concentrations in your blood than desired.

Link to author's web site:
http://www.hearinglosshelp.com/products/books.htm

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.
(This post was last modified: 10-09-2012 04:36 PM by vsheline.)
10-09-2012 03:47 PM
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