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Persistent Central Apnea
#1
Would appreciate feedback about my apnea situation (details below) and whether anyone has used the Rematee Bumper Belt with success.

Started APAP therapy in October 2016 following a July sleep study that generated an AHI of 29 over 5.5 hours of sleep. My OAs and HAs were successfully treated with my APAP device, but at the cost of generating lots of centrals. During the sleep study, only 10% of apneas were centrals. So this is clearly treatment induced central apnea. 

Centrals continue to comprise more than 75% of my apneas. No improvement has been seen over these many months. (I did try lessening EPR for a few weeks but it was not comfortable and I saw no improvement, so went back up to an EPR of 3.) My AHI varies from 3.5 (rare) to close to 20, with most between 5 and 12. I have tried several min/max pressures and CPAP pressures without much change in outcome. CA index is much higher on nights where I wake once or twice as they cluster at these times.

Have been monitoring SleepyHead data daily and added a pulse ox a while ago to check on SpO2 levels. Those levels occasionally drop to low 80s, but mostly mid-to high 80s as I initially fall asleep -  when CAs appear in a thick cluster. The rest of the night, SpO2 levels jump around mostly from 91-98, correlating to OAs and CA occurrences.

in my most recent consult with my sleep Doc, I pointed out that my sleep study showed that my apnea was far worse in supine position, and not so bad in non-supine: OAs were zero, HA index was 4.5, and CA index was 0.37. I have been trying to sleep on my side, but always seem to wind up on my back for some part of the night, so during that consult I asked if there was a reliable method that would keep me on my side while asleep. He mentioned there was a belt that seemed to work well for some. He actually thought it was a good idea to try this approach. I could test discontinuing APAP and just use the belt. In theory, centrals should mostly go away and OAs and HAs would be reasonably low. I found a few online and wondering if these have worked well for anyone. From what I read, the Rematee Belt could be a solution - if not permanent, at least for now. 

My calibration study (in order to demonstrate that I require ASV) comes up on 3/11, and the followup appt. is not until 5/2. So, this is a long wait yet to come. (My original sleep study did not include a split study as it took 314 minutes to reach REM, where my AHI climbed to 65. By then the study time was about over.)
Hope this isn’t too rambling… I am very impressed by the knowledge and help this group provides. I’d be grateful to receive advice on my situation. Thanks.
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#2
Well, you clearly know what direction you are heading in order to resolve complex apnea. An ASV will be your best solution. In the meanwhile, it looks like you would like to combine lower pressure with positional therapy. I agree, good strategy. The device you mentioned looks like a Medieval torture vest, but, whatever works. Personally, I'd try a wedge pillow, and consider an ergonomic pillow or soft cervical collar ($10) to support the neck and prevent the chin from moving towards the chest. Back sleeping causes apnea by letting the soft tissues in the throat sag into the airway, but for a lot of people it is the unsupported neck and raised head that is the real problem. If I can save you from growing humps on your back. Smile

Meanwhile with the positional therapy, I assume you plan to significantly drop CPAP pressure. I'll just add that if you're using EPR, turn that off as well.
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#3
Thanks Sleeprider. It's good to hear that I may be heading in the right direction. Seems ASV is where I will wind up, but it might be interesting to see how the belt works in the months I'd have to wait. 

I am actually considering not using PAP at all during a trial period if the belt keeps me on my back. I have 2 ways of finding out if I wind up on my back: my husband reports my snoring it to me in the morning, and I plan to use my pulse ox to monitor desaturations. If the belt doesn't work reasonably well, back to the PAP.

There are a couple of reasons that I think it might work better without PAP for me. Even with lower pressures, the centrals still haunt me. I have five months of data that show quite a variation in CA index at each of many APAP and CPAP pressures. And if I have my mask on, I really like to start no lower than 9 cmH2O. Feels like there isn't enough air if I go lower. Without the mask, however, its not an issue. If it doesn't appear to work without PAP (based on snore report and SpO2 desats) while wearing the belt, then I will play with lower pressures while wearing the belt. 

I did try to lower EPR for a few weeks. It did not appear to help moderate centrals, but I only lowered it to 2. I found it uncomfortable not using full EPR.
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#4
The belt is certainly an option.
I use a Therapedic Reading Wedge to bolster my back and prevent me from rolling onto it.
Any firm pillow or wedge may work, with prices in the $50 - $70 range,
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#5
Good luck with your ASV titration study in a couple weeks, and hope you find a way to be comfortable until you are properly setup. I was not aware of the variety of settings you have attempted, and still found numerous centrals. Good luck and keep in touch.
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#6
Hi tiredDogs,
I wish you good luck at your ASV titration and also with getting your therapy dialed in to better meet your needs.
trish6hundred
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#7
(03-01-2017, 10:54 PM)Sleeprider Wrote: Good luck with your ASV titration study in a couple weeks, and hope you find a way to be comfortable until you are properly setup.  I was not aware of the variety of settings you have attempted, and still found numerous centrals.  Good luck and keep in touch.

I did have a titration study on 3/11, which included BiPap. (Not an ASV titration; that would come next.) Centrals persisted at every combination of pressures applied, and ASV was the Sleep Doc's recommendation, however, we also discussed taking some time to trial other options. I do have rhinitis, which inhibits airflow to varying degrees, and my obstructive apneas occur only when supine. So I am testing out use of a nasal Rx and a Rematee belt that keeps me off my back while asleep. I started these only four days ago, so cannot provide any meaningful evaluation yet.

I stopped using CPAP altogether a few weeks ago as my hypersomnia was no better with it, and actually seemed to be worsening.(In fact, my CA index was climbing.) Without the ability to review the Resmed Airsense 10 data everyday via SleepyHead, I am left to monitoring just my pulse ox data (CF50F). My Sleep Doc gave me some guidelines to judge results of the PO data:
ODi ≤5 is good;  ≤10 is okay
SpO2 > 90% is good;  >92 is excellent

From some reading I've done, ODi correlates strongly to AHI, so this is a great indicator in lieu of actual AHI values. However, SleepyHead automatically provides SpO2 desaturations, AND also provides an option to "clean up" desaturation values, which results in a much improved (lower) value. Can anyone tell me if the "cleaned up" desaturation values are what should be used. Any other wisdom tracking pulse ox data to monitor treatment is welcome.

Thank you!
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#8
A Rematree might help a mild OSA patient but I'm surprised it would benefit someone with CSA. Is your central apnea problem mainly prevalent when you are on CPAP pressure (aka complex apnea)? All of these treatments have to do with flow restriction. It's too bad the doctor did not arrange for your bilevel study to include ASV. Most titration clinics can do that (same machine). Good luck as you wait to get this on track.
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#9
(02-28-2017, 04:37 PM)tiredDogs Wrote: Would appreciate feedback about my apnea situation (details below) and whether anyone has used the Rematee Bumper Belt with success.

Started APAP therapy in October 2016 following a July sleep study that generated an AHI of 29 over 5.5 hours of sleep. My OAs and HAs were successfully treated with my APAP device, but at the cost of generating lots of centrals. During the sleep study, only 10% of apneas were centrals. So this is clearly treatment induced central apnea. 

Centrals continue to comprise more than 75% of my apneas. No improvement has been seen over these many months. (I did try lessening EPR for a few weeks but it was not comfortable and I saw no improvement, so went back up to an EPR of 3.) My AHI varies from 3.5 (rare) to close to 20, with most between 5 and 12. I have tried several min/max pressures and CPAP pressures without much change in outcome. CA index is much higher on nights where I wake once or twice as they cluster at these times.

Have been monitoring SleepyHead data daily and added a pulse ox a while ago to check on SpO2 levels. Those levels occasionally drop to low 80s, but mostly mid-to high 80s as I initially fall asleep -  when CAs appear in a thick cluster. The rest of the night, SpO2 levels jump around mostly from 91-98, correlating to OAs and CA occurrences.

in my most recent consult with my sleep Doc, I pointed out that my sleep study showed that my apnea was far worse in supine position, and not so bad in non-supine: OAs were zero, HA index was 4.5, and CA index was 0.37. I have been trying to sleep on my side, but always seem to wind up on my back for some part of the night, so during that consult I asked if there was a reliable method that would keep me on my side while asleep. He mentioned there was a belt that seemed to work well for some. He actually thought it was a good idea to try this approach. I could test discontinuing APAP and just use the belt. In theory, centrals should mostly go away and OAs and HAs would be reasonably low. I found a few online and wondering if these have worked well for anyone. From what I read, the Rematee Belt could be a solution - if not permanent, at least for now. 

My calibration study (in order to demonstrate that I require ASV) comes up on 3/11, and the followup appt. is not until 5/2. So, this is a long wait yet to come. (My original sleep study did not include a split study as it took 314 minutes to reach REM, where my AHI climbed to 65. By then the study time was about over.)
Hope this isn’t too rambling… I am very impressed by the knowledge and help this group provides. I’d be grateful to receive advice on my situation. Thanks.

one common recommendation is to put a tennis ball in a sock and pin it to your back
theory is you feel it when you roll onto your back and will then switch back to side
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#10
(04-05-2017, 06:12 PM)Sleeprider Wrote: A Rematree might help a mild OSA patient but I'm surprised it would benefit someone with CSA.   Is your central apnea problem mainly prevalent when you are on CPAP pressure (aka complex apnea)?   All of these treatments have to do with flow restriction.  It's too bad the doctor did not arrange for your bilevel study to include ASV.  Most titration clinics can do that (same machine).  Good luck as you wait to get this on track.

Yes, my centrals really got going after starting CPAP - so I do have complex apnea. Sorry if I was not clear about this. Last Summer, when I had my original (non-split) sleep study, I had a total of 11 centrals, with 53 OAs (all supine) and 85 HAs (mostly supine). AHI was 29. Though CPAP therapy lessened OAs & HAs to <5 AHI, it increased the CAs many fold. The 3/11 titration study had a total of 96 centrals.

The 3/11 titration did include bi-level, along with CPAP titration. It was done in order to demonstrate that I have persistent centrals along the pressure spectrum, including bi-level.

Given that all my OAs and most HAs occur when supine, the belt seems worth testing out. Also trying to reduce rhinitis for increased air flow seems like a step that should help. I'm recording pulse ox values to track how well it is working, but just really starting out a few days ago. Last night's ODi is under 3 (which is quite good) if I use SleepyHead's "automatic oximetry cleanup" option. So, I'm quite curious about what this cleanup option does and whether it skews results or provides better accuracy. The Jedimark website says they're on break, or I'd try asking them directly.
Thanks for your thoughts on this.
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