So I took a clonopin and called the insurance company ....

[PaulaO2]

Check out SecondWind, Supplier #2 in our Supplier's List (link at top of every page). They have the PR 760 that iSnore mentions for $650 plus $70 for humidifier or $75 for the conversion kit to turn it into one that takes a heated hose.

As for "converting to CSA", no, that doesn't happen. They are two different beasties. A person can have both but having one doesn't mean you have the other or that you are more inclined to get the other or that you will develop the other. CSA is a brain thing, OSA is a throat thing. Basically.

[iSnore]

Complex Sleep Apnea - "CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices."

[PaulaO2]

Yes, but that's not what the OP meant.

So now they are officially acknowledging CPAP induced CA events? Because this Complex SA is different from Mixed SA.

[vsheline]

Complex Sleep Apnea - "CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices."

I think PaulaO2 was merely pointing out that obstructive apneas and central apneas are different in nature or cause, and CPAP therapy does not cause one to "convert" into the other.

Although some in the medical community may use the terminology "obstructive apneas which convert to" central apneas, I think language which is more clear would be "obstructive apneas which are replaced by" central apneas.

An example would be if a fraturnity moves out of a building and a sorority moves in, I think it would be more clear to say the male occupants were replaced by females, rather than the male occupants were converted to females.

CPAP therapy can cause obstructive apneas to go away and, in a small minority, can cause central apneas to appear (at least temporarily).

[iSnore]

Yes, but that's not what the OP meant.

So now they are officially acknowledging CPAP induced CA events? Because this Complex SA is different from Mixed SA.

Paula,
I gotta admit when I saw a forum moderator with over 7,000 posts say, "As for "converting to CSA", no, that doesn't happen." I was pretty shocked.

I've only been digging CPAP info for a couple of weeks and every place I've been defines Complex Apnea as that. Then it occurred to me perhaps some of you old-timers who haven't kept up with modern day apnea science haven't heard of it. And I certainly mean no disrespect by that. Complex IS different than Mixed Apnea, which is a mix of OS and CS pre-therapy or unrelated to the therapy.

At any rate, I've been trying to get the OP not to buy even a bi-level out of pocket, since he may find it increases CSAs and he really needs an ASV. I'm pretty sure he was responding to that.

[PaulaO2]

Paula,
I gotta admit when I saw a forum moderator with over 7,000 posts say, "As for "converting to CSA", no, that doesn't happen." I was pretty shocked.

I've only been digging CPAP info for a couple of weeks and every place I've been defines Complex Apnea as that. Then it occurred to me perhaps some of you old-timers who haven't kept up with modern day apnea science haven't heard of it.

Not a ten foot pole long enough for me to touch that.

And I certainly mean no disrespect by that. Complex IS different than Mixed Apnea, which is a mix of OS and CS pre-therapy or unrelated to the therapy.

At any rate, I've been trying to get the OP not to buy even a bi-level out of pocket, since he may find it increases CSAs and he really needs an ASV. I'm pretty sure he was responding to that.

Then I'll leave you to answer his questions. Sorry to have interrupted.

[DeepBreathing]

Paula,
I gotta admit when I saw a forum moderator with over 7,000 posts say, "As for "converting to CSA", no, that doesn't happen." I was pretty shocked.

I've only been digging CPAP info for a couple of weeks and every place I've been defines Complex Apnea as that. Then it occurred to me perhaps some of you old-timers who haven't kept up with modern day apnea science haven't heard of it.

That's a bit rich coming from somebody with no machine yet.

And I certainly mean no disrespect by that.

Yeah, a bit like the graduate engineer who told me I'm old school. He didn't mean disrespect either but he doesn't work for me any more!

And to repeat what Paula said - obstructive apnea does not convert to central. I suggest you read Vern's explanation above.

[Sleepster]

CSA is a brain thing, OSA is a throat thing. Basically.

Complex Sleep Apnea - "CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices."

The abbreviation CSA can mean either "central sleep apnea" or I suppose "complex sleep apnea".

If you truly have central sleep apnea (or mixed sleep apnea, which consists of both central and obstructive sleep apnea) then it's something that exists when you're sleeping without a CPAP machine.

Obstructive sleep apnea (OSA) is the most common type, which is the well-known condition where your airway collapses. What can happen when you sleep with a CPAP machine designed to treat OSA is that you start having apneas even though your airway is not obstructed. People refer to this as CPAP-induced central apnea. Sometimes the condition is temporary and it subsides on its own, in other cases it doesn't and then treatment becomes difficult. Lowering the pressure can reduce the frequency of non-obstructive apneas, but it could be at the expense of increasing the frequency of obstructive apneas and hypopneas. An auto-adjusting CPAP machine might be helpful here as it can allow one to spend more time at lower pressures helping decrease the frequency of non-obstructive apneas, and allow one to spend time at higher pressures only when needed to reduce the frequency of obstructive apneas and hyponeas.

Less known, but nevertheless documented, is the inducement of non-obstructive apneas when you sleep with a bi-level CPAP machine (also known as a BiPAP or VPAP machine). All of what I said above still applies, but additionally one can reduce the pressure support (difference between the two pressure levels of the bi-level therapy) to help treat it.

Buying a machine designed to treat central sleep apnea when it doesn't exist, just to cover your bases in case it's induced by a CPAP machine, is a gamble. Personally, I wouldn't advise taking that gamble as I don't see it as being worth the huge extra cost for the slim chance that it might be needed. One can get a used CPAP machine. It's a third alternative for the OP who is considering a new machine versus the suggestion of a used ASV machine.

(Note that I have used the term "non-obstructive" so as to avoid the confusion over the difference between central apneas and clear-airway apneas. One needs more than a CPAP machine to determine if a clear-airway apnea really is a central apnea. Respironics makes this distinction, ResMed does not, and it leads to confusion interlaced with the other confusions I'm trying to address.)

[Mark Douglas]

So let me see if I have a very basic understanding of the Obstructive Sleep Apnea to Central Sleep Apnea or some combination thereof phenomenon from what I read here?

1. The impetus to breath comes from CO2 content.
Oxygen content does NOT initiate this process.
2. I would imagine after years of belabored breathing the body adapts to higher levels of CO2 as normal and so it takes a higher level of CO2 to initiate breathing.
3. Upon CPAP therapy respiration improves (possibly dramatically)
4. Body now sees reduced CO2 , to what should be normal level, as indication there is no need to breath.
5. CPAP machine sees this as a problem and an autoCPAP may surge to a higher PAP pressure aggravating body's confusion - especially if high upper pressure level setpoint available.
6. A bi-levelCPAP machine may aggravate this effect even more than other machines because exhalation is improved and the lungs collapse more than would with a straight CPAP or autoCPAP machine.

If this is correct using any PAP machine will raise the possibility of induced CSA.
An autoPAP even more so.
And using a bi-levelCPAP increases this chance beyond the first two.
In time the body may respond to the new normal CO2 level and the CSAs retreat???

[PaytonA]

So let me see if I have a very basic understanding of the Obstructive Sleep Apnea to Central Sleep Apnea or some combination thereof phenomenon from what I read here?

1. The impetus to breath comes from CO2 content.
Oxygen content does NOT initiate this process.
2. I would imagine after years of belabored breathing the body adapts to higher levels of CO2 as normal and so it takes a higher level of CO2 to initiate breathing.
3. Upon CPAP therapy respiration improves (possibly dramatically)
4. Body now sees reduced CO2 , to what should be normal level, as indication there is no need to breath.
5. CPAP machine sees this as a problem and an autoCPAP may surge to a higher PAP pressure aggravating body's confusion - especially if high upper pressure level setpoint available.
6. A bi-levelCPAP machine may aggravate this effect even more than other machines because exhalation is improved and the lungs collapse more than would with a straight CPAP or autoCPAP machine.

If this is correct using any PAP machine will raise the possibility of induced CSA.
An autoPAP even more so.
And using a bi-levelCPAP increases this chance beyond the first two.
In time the body may respond to the new normal CO2 level and the CSAs retreat???

I am going to step into this morass to say one thing. The auto machines do not respond to apneas where they can sense no obstruction.

Before they developed methods for sensing the patency of the airway the auto machines would not respond to any apnea that occurred at a pressure of over 12 cm/H2O (I think that is the correct cut-off) in order to avoid potentially making the situation worse.

Best Regards,

PaytonA