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OSA & CSA mixed sleep apnea treatment
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Sleepless12 Offline

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Post: #1
OSA & CSA mixed sleep apnea treatment
Hi all. I've been posting a lot during the past couple of weeks... I was diagnosed with very severe OSA (AHI 63), but have just found out that I also have CSA. The cause of my CSA is not known. I will undergo another sleep study, but my doctor does not believe that the current CPAP treatment is useful since it only helps with the OSA but may make the CSA worse over time. Does anyone here have mixed sleep apnea? How do you treat it? Any success stories?
(This post was last modified: 12-04-2015 05:37 AM by Sleepless12.)
12-04-2015 05:36 AM
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PaytonA Offline
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Post: #2
RE: OSA & CSA mixed sleep apnea treatment
I do not have mixed apnea but it is treated with ASV Adaptive Servo Ventilator. The treatment apparently works well. There will be some folks with actual experience come along soon.
12-04-2015 02:04 PM
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Terry Offline

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Post: #3
RE: OSA & CSA mixed sleep apnea treatment
(12-04-2015 05:36 AM)Sleepless12 Wrote:  Hi all. I've been posting a lot during the past couple of weeks... I was diagnosed with very severe OSA (AHI 63), but have just found out that I also have CSA. The cause of my CSA is not known. I will undergo another sleep study, but my doctor does not believe that the current CPAP treatment is useful since it only helps with the OSA but may make the CSA worse over time. Does anyone here have mixed sleep apnea? How do you treat it? Any success stories?

If you have CSA that's severe enough to require treatment, all it means is that your insurance company needs to cough up a few more $$$ for an Auto Servo Ventilator machine that knows how to fix them.

It's more expensive hardware, but isn't a big problem otherwise.

The insurance companies tend to push back because an ASV machine is 2x-3x the price of a standard APAP.
(This post was last modified: 12-04-2015 02:32 PM by Terry.)
12-04-2015 02:16 PM
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Journey to Sleep Offline

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Post: #4
RE: OSA & CSA mixed sleep apnea treatment
Hey OP, I've had the same problem. I fixed it quite easily by using the "ramp" feature on my CPAP. Stopped having issues after doing that.

I put up a post on my blog about it a few days ago. Can't link to it since I'm new here. But my blog name is in my signature.

Good luck.
12-04-2015 06:38 PM
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DeepBreathing Offline
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Post: #5
RE: OSA & CSA mixed sleep apnea treatment
G'day Sleepless12. Without over-complicating things, central apneas may be either naturally occurring (idiopathic) or pressure induced. They can also be related to drugs (especially opioids), chronic heart failure and obesity.

If they are naturally occurring, they will show up in your initial sleep test. Depending on the severity these centrals are likely to need treatment with an ASV machine, as mentioned above. This is my situation, for which I have a Resmed S9 VPAP Adapt. This is a great machine and has my apneas totally controlled. The ASV feels a bit different from an ordinary CPAP but you will very quickly adjust. It's just a matter of getting your breathing synchronised with the machine. In this regard I found the Resmed much easier than the Respironics, though other people have found the opposite.

Pressure induced apneas will only show up once you've started CPAP therapy and are caused by the CO2 level in your bloodstream being too low. The brain relies on the CO2 reaching a certain level before it send the "breathe now" signal to your lungs. Pressure induced apneas often go away of their own accord once you get used to the machine, or otherwise can be controlled by reducing the maximum pressure and increasing or reducing the level of EPR / Flex. It's often a fine balance between having the pressure high enough to suppress obstructive apneas but not so high that it causes centrals.

A third type is often experienced as people transition into and out of sleep. These aren't anything to be concerned about, though they can skew your numbers. I suspect this is the type that Journey to Sleep has controlled using the ramp. I've not heard of using the ramp for this purpose, though I guess bringing you gradually up to pressure might be beneficial for pressure induced apneas. However for naturally occurring apneas the only guaranteed treatment is an ASV machine. These are expensive but in my experience they work extremely well. Because of the cost, be prepared for your insurance company to make you jump through hoops.

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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.
12-04-2015 11:17 PM
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Jimsp1 Offline

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Post: #6
RE: OSA & CSA mixed sleep apnea treatment
DeepBreathing - Thanks for your excellent explanation of pressure induced apneas. I'm new to all this and have been using an APAP machine for just a little over a month. I think I've adjusted to it very well but have noticed a curious problem. Some nights I feel I've slept very well and the AHI is 3 or less. Other nights I know I haven't slept as well and the AHI has doubled. I noticed on the good night there were no central apneas and the pressure levels were low. On the not so good nights the pressure is up and there are several central apneas. Because I have limited data available to me with my DreamStation I called the respiratory therapist at the DME supplier to see if she could supply me with more data. She didn't give me more data but also noticed the problem I was having and thought it might be related to pressure induced apneas. Since it takes a fairly low pressure to stop my obstructive apneas she suggested to just use a low constant pressure that would stop the obstructive apneas but not high enough to trigger the central apneas. I've just started that and initially it looks like it might work.

I was using an APAP machine because during the titration testing I slept very little and had a low tolerance for the pressure so they couldn't determine a recommended pressure setting. During the initial sleep test I slept for about 4 hours and had just 2 central apneas. During the 2 hours I slept during the titration testing I had many apneas half of them being central apneas. Perhaps this should have been an indication I might have a pressure induced apnea problem.
12-05-2015 08:26 AM
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Sleepless12 Offline

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Post: #7
RE: OSA & CSA mixed sleep apnea treatment
(12-05-2015 08:26 AM)Jimsp1 Wrote:  DeepBreathing - Thanks for your excellent explanation of pressure induced apneas. I'm new to all this and have been using an APAP machine for just a little over a month. I think I've adjusted to it very well but have noticed a curious problem. Some nights I feel I've slept very well and the AHI is 3 or less. Other nights I know I haven't slept as well and the AHI has doubled. I noticed on the good night there were no central apneas and the pressure levels were low. On the not so good nights the pressure is up and there are several central apneas. Because I have limited data available to me with my DreamStation I called the respiratory therapist at the DME supplier to see if she could supply me with more data. She didn't give me more data but also noticed the problem I was having and thought it might be related to pressure induced apneas. Since it takes a fairly low pressure to stop my obstructive apneas she suggested to just use a low constant pressure that would stop the obstructive apneas but not high enough to trigger the central apneas. I've just started that and initially it looks like it might work.

I was using an APAP machine because during the titration testing I slept very little and had a low tolerance for the pressure so they couldn't determine a recommended pressure setting. During the initial sleep test I slept for about 4 hours and had just 2 central apneas. During the 2 hours I slept during the titration testing I had many apneas half of them being central apneas. Perhaps this should have been an indication I might have a pressure induced apnea problem.

I too had a lot of trouble falling asleep in the lab and kept waking up when they increased the pressure. I just could not get used to it. I think I got only 2 hours of sleep. But they concluded that my AHI was 63 and that I had both OSA & CSA. But they were not able to determine the appropriate pressure. I am using a CPAP but the doc says I need to change. They will do another sleep study in January. I hope that will go better, though it's not likely since I can't sleep when I'm not in my own bed, especially with a mask. They are considering prescribing me a sleeping pill, which I've never taken. But it may be the only way.
(This post was last modified: 12-06-2015 05:11 AM by Sleepless12.)
12-06-2015 05:10 AM
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DeepBreathing Offline
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RE: OSA & CSA mixed sleep apnea treatment
(12-06-2015 05:10 AM)Sleepless12 Wrote:  I too had a lot of trouble falling asleep in the lab and kept waking up when they increased the pressure. I just could not get used to it. I think I got only 2 hours of sleep. But they concluded that my AHI was 63 and that I had both OSA & CSA. But they were not able to determine the appropriate pressure. I am using a CPAP but the doc says I need to change. They will do another sleep study in January. I hope that will go better, though it's not likely since I can't sleep when I'm not in my own bed, especially with a mask. They are considering prescribing me a sleeping pill, which I've never taken. But it may be the only way.

It does get easier with practice, but taking a sleeping aid is probably not a bad way to go. They can increase central apneas a bit, but it's more important that you actually do get some shut-eye time. I think the most important thing at this stage is to ensure the treatment can control the centrals - it's no use being titrated on a non-ASV machine then having to go back later for yet another test. You should discuss this with your doctor before the test and make sure all the contingencies are covered. So long as they can definitely confirm you do or don't need the ASV, then setting an exact pressure isn't so important. With an auto machine and the appropriate software you can home in on the exact settings you need later.

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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.
12-06-2015 05:33 AM
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shaloum Offline

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Post: #9
RE: OSA & CSA mixed sleep apnea treatment
(12-04-2015 05:36 AM)Sleepless12 Wrote:  Hi all. I've been posting a lot during the past couple of weeks... I was diagnosed with very severe OSA (AHI 63), but have just found out that I also have CSA. The cause of my CSA is not known. I will undergo another sleep study, but my doctor does not believe that the current CPAP treatment is useful since it only helps with the OSA but may make the CSA worse over time. Does anyone here have mixed sleep apnea? How do you treat it? Any success stories?

Check the Mayo Clinic web site for two drugs that have been used for CSA, Acetazolamide and Theophylline.

One of the drugs is a Xanthine, with properties similar to caffeine. I have a cup of coffee just before going to sleep, and I have found that it helps to control my CSA. If it doesn't keep you awake at night, a little caffeine may help; the other drug is a sulfanilamide, which I' allergic to. Good luck.
(This post was last modified: 12-08-2015 11:09 PM by shaloum.)
12-08-2015 11:08 PM
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