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[Treatment] New with central apnea
#1
New with central apnea
I was recently diagnosed with central apnea having gone to the doctor complaining of restless leg problems.

I had an overnight session in a sleep clinic after which I was told I had central sleep apnea with apneas 45 times an hour.   As a result of this I was loaned a res-med airsense 10 with the P10 nose buds.    The pressure was started at 4 and ramps up to 7.  Constant pressure.   This cut the apneas to around 15 an hour.   Despite another overnight visit to the sleep clinic and juggling of the pressures up and down, the best I can get is down to 11 apneas an hour.

An MRI of the head was arranged as well as a visit to a cardiologist.  The MRI is done and nothing really showed up.  I go to the cardiology lab in a couple of weeks.

These are the figures I get on sleepyhead for one night.

AHI                   11.02
CSR                   11.16%
Large leak              0.19%
Clear Apnea        6.93
Obstructive         0.00
Unclassified        0.00
Hypoapnea         6.93
RERA                 0.45

Can anyone tell me if the treatment is on the right track ?   Some comments on the data would also be of help.   I cannot find much on central apnea except relating to someone who has other major illness.

I am 60 years old and weigh 156 lbs  being 5'9".  I do not have any heart problems I know of, nor any major illness other than type 2 diabetes which is well controlled.

Thanks everyone..
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#2
RE: New with central apnea
get some charts up for the forum to help
For a start, I'd raise the pressure one more CM, if 7 to 8 for the hypopnea and see if that brings them in line. The ca will still be there, I would turn off any EPR on the S8
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: New with central apnea
I got switched to a loaner resmed 10 and we tried the pressure a touch higher but the readings got worse.   The S8 was purchased to use while I was away a couple of months overseas.

Just now the system will not allow me to upload attachments etc  given my newbie status
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#4
RE: New with central apnea
If you have central apnea the Airsense 10 is not the solution. There are machines to treat that. I see you also are experiencing some CSR - thus the cardiology lab. Until that's done there is no way to determine the correct treatment.
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#5
RE: New with central apnea
(07-13-2017, 07:21 PM)petnew Wrote: I was recently diagnosed with central apnea having gone to the doctor complaining of restless leg problems.

I had an overnight session in a sleep clinic after which I was told I had central sleep apnea with apneas 45 times an hour.   As a result of this I was loaned a res-med airsense 10 with the P10 nose buds.    The pressure was started at 4 and ramps up to 7.  Constant pressure.   This cut the apneas to around 15 an hour.   Despite another overnight visit to the sleep clinic and juggling of the pressures up and down, the best I can get is down to 11 apneas an hour.
Given the diagnosis of central sleep apnea I'm surprised they set you up with an ordinary APAP.  The usual machine that is needed to properly treat central sleep apnea is a much more expensive machine called an ASV.

However, some insurance companies do require a trial on CPAP to see whether it helps before being willing to authorize an ASV.  

I would talk to your sleep doctor about the plan for treating the central apnea in both the short term and the long run. Be explicit and ask the questions: How long do we wait for my AHI to come down to under 5 on APAP?  And if my AHI on CPAP remains well above 5, what's the next step?  When would you recommend sending me in for a titration on an ASV machine?
Questions about SleepyHead?  
See my Guide to SleepyHead
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#6
RE: New with central apnea
I doubt they will prescribe an ASV for 6 centrals an hour. There would have to be very significant o2 desaturation with them. Also some may be pressure induced from starting cpap and will settle down. I would be working with getting rid of the hypopnea for now.
How many centrals an hour were in your sleep study?
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#7
RE: New with central apnea
Thanks everyone for the input.

I suspect that the sleep specialist is waiting for the cardiology reports before moving ahead with anything else.   I did wonder if there is some other medical issue in the background.

Although I do not have insurance there is some government assistance from the province here in Ontario under the assistive medical devices programme.

Peter
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#8
RE: New with central apnea
Hi petnew,
WELCOME! to the forum.!
Good luck to you with CPAP therapy and getting the machine you really need.
Hang in there for more responses to your post.
trish6hundred
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#9
RE: New with central apnea
Petnew, the correct therapy for central and complex apnea is adaptive servo ventilation (ASV) which is a variant of positive air pressure (PAP) devices that can intervene on a breath by breath basis to provide increased pressure that causes a breath to be taken.  The ASV is a wonderful device and I hope you will research it.  The current models are the Resmed Aircurve 10 ASV and Philips Respironics BiPAP SV Advanced.  My preference is strongly in favor of Resmed for the ease that people seem to have in adapting to it and its effectiveness. 

Since you don't have insurance, you need to check into Supplier #2, SecondWindCPAP.  They have the recently discontinued Resmed S9 Adapt, which is a very good machine and has most of the features of the current Aircurve 10 ASV.  It would work great for you, and they sell it for $1049-$1249 USD.  I think once you research this, you will agree that is a bargain, and they will ship to Canada once you get your prescription sorted. 

If you have questions about ASV, don't hesitate to ask.  It is normal for doctors to verify your CA does not respond to CPAP, and to ensure your cardiac health is not a risk factor. before prescribing ASV.  Recent studies by Resmed found that patients with congestive heart failure and a left ventricular ejection factor less than 40% are at some increased risk when treated with ASV.  Provided that does not apply to you, it is very effective and comfortable therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#10
RE: New with central apnea
petnew - As far as I can tell from (what I think is) the latest ADP document on respiratory devices, there are no ASV devices covered. If this is true, and you and your doctors conclude you need an ASV, you might as well check with Supplier #2 for one of their machines.
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