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Treatment Resistant Central Sleep Apnea?
#1
Treatment Resistant Central Sleep Apnea?
I've been using my Airsense 10 for about 2 weeks and although it's been somewhat successful in eliminating the obstructive events according to OSCAR, my central apneas seem to be getting worse over time.

According to my sleep study, I did have central apneas before starting therapy as well, and my doctor did recommend to watch out for whether central apneas would worsen with CPAP. 

Could this be a case of treatment resistant sleep apnea that I could get adjusted to over time with the APAP, or do I just have complex sleep apnea/CSA and should spring for an ASV instead?  Thinking-about


   

   

   
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#2
RE: Treatment Resistant Central Sleep Apnea?
Hi asdz123,
Welcome to Apnea Board!

From what I see on your chart, an ASV machine may be in your future.

Here's the problem, you also need to use EPR to help with the Flow Limitations, and Hypopneas, but using EPR will also aggregate the Centrals.  

Your doctor is aware that Cpap won't treat CA's, so talk to him about this.  

If you are going through insurance, they will put you through a process of starting with Cpap, then Bipap (which you will fail at too), before considering the ASV machine.  

If you are self funding, there are other ways to obtain a machine.  It will still be expensive, but there are deals out there.  Supplier #2 is a good starting point.
OpalRose
Apnea Board Administrator
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OSCAR Chart Organization


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.
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#3
RE: Treatment Resistant Central Sleep Apnea?
CPAP cannot treat central apnea becuse it relies on spontaneous respiratory effort and is only effective for obstructive events. It is encouraging that your doctor advised you to watch for this problem. You will ultimately need what is call an "Adaptive Servo Ventilator" (ASV), which is used by a considerable number of our members. The ASV uses pressure support (increased pressure during inhale) to support or cause a breath when you fail to spontaneously initiate a breath. If you want to learn more about ASV and other types of machines and their uses and limitations, read the Resmed Sleep Lab Titration Guide starting at page 27. https://www.resmed.com/us/dam/documents/...er_eng.pdf

To understand the insurance process and working with your doctor, read out Justifying Advanced PAP wiki http://www.apneaboard.com/wiki/index.php...P_Machines You should start calling your doctor's office immediately to advise him of the high central AHI you have and to expedite the process.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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.
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#4
RE: Treatment Resistant Central Sleep Apnea?
This would be a case of need for ASV. I would consider making notes of symptoms/complaints of what therapy with APAP is like, and that it's not working. Bring up these issues frequently with the doc, and be sure to mention that you want to start the path onto ASV. When that happens, I wholeheartedly suggest you choose the ResMed AirCurve 10 ASV. Suggest doc puts that on the script specifically, with Dispense As Written included on the script. Also see if your DME will issue a ResMed or Respironics when it comes to ASV.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Treatment Resistant Central Sleep Apnea?
Treatment Resistant. This term in and of itself says that an ASV is required.

A common thing we see is Treatment Emergent Central Apnea which in some individuals goes away in 2 To 3 months as your body adapts. This occurs as the CPAP increases your breathing efficiency, as it should, which increases the purging of CO2 from your body to below the apneic threshold resulting in a Central apnea. A relatively high CO2 provides the primary drive to breathe not a low Oxygen level as many believe.

Two weeks is not enough time for you to adapt. To give us a better idea post redacted copies of your sleep studies, full copies, not just the summaries.

My main question is where did the term resistant come from.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#6
RE: Treatment Resistant Central Sleep Apnea?
Thank you for your incredibly helpful responses everyone! Since I have a HDHP, I've actually been funding everything on my own though my HSA instead (the prescription was provided online through Lofta.com). It does sound like it might be more expedient to buy the ASV like I did for the APAP than try to go through insurance.

I've attached redacted screenshots from the 3-page sleep report that I received from Lofta/their resident sleep doctor. I'm not sure if these would be the full report; if not, I'll follow up and ask if they can provide the full copy.


Attached Files Thumbnail(s)
           
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#7
RE: Treatment Resistant Central Sleep Apnea?
OK it helps some in my opinion. If I'm reading correctly, the write-up page says CAI at 10 or so and OAI at 12 or so. These are close to being equal, which to me should indicate ASV necessity is possible. Other things to consider if you're trying to get a doc to agree with the ASV direction, how is sleep efficiency and how well do you feel. Create some notes on the symptoms and complaints of how poor sleep is. Fatigue, headaches, etc. as in the things you suffer by way of CA not being treated. Then present these to the doc, verbally or otherwise. If you want insurance to pay that is. If not and you have the means to buy it otherwise, all it may take then is to get doc to script it. I'd suggest the script includes the full name ResMed AirCurve 10 ASV, Mask of patient choice, default settings, heated hose (if you choose), humidifier (these ResMed 10s come with it but it doesn't hurt to state it), Dispense As Written.

BTW default settings is fine, as we can coach here what you'd likely need. This also does away with a lab titration; saves you money and the hassle of sleeping at the lab sleep study location. It's really not necessary unless you go via insurance and they may require it I suppose. Even so, almost all titrations come with poorly devised settings that users here learn the how and why, then do their own changes.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Treatment Resistant Central Sleep Apnea?
Well the central events outnumbered obstructive 33 to 27 prior to treatment and an extremely severe total AHI/RDI in your diagnostic.  You need ASV, and the best outcome would be if your LOFTA doctor will write the script based on your previous test and the outcome on CPAP.  

To buy ASV on your own, Supplier #2 sells the Resmed Aircurve 10 ASV for $1349 gently used with a one-year warranty and great service.  SecondWindCPAP will require a prescription.  I recently saw a Resmed Aircurve 10 ASV on the Fayetteville AR Craigslist for only $350.  If that is still there jump on it.  The usual precautions in dealing through Craigslist apply.  Once you have an ASV, the setup is simple and mostly automatic.  The recommended default setting is ASVauto mode, EPAP min 4.0, EPAP max 15.0, PS min 3.0, PS max 15.0.  We can basically help you dial it in after one night of data.

[Image: attachment.php?aid=4210]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#9
RE: Treatment Resistant Central Sleep Apnea?
Thanks, That study shows that 45% of your Apnea, 33 of 73, are Central. This also importantly shows that your current Central Apnea is not Treatment-Emergent since it exists prior to CPAP.
Ask your doc about a Titration study that includes ASV to prove efficacy. IMHO, and I'm sure the other guys will agree, do not accept another sleep study unless it includes ASV. This is to move you along this path.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#10
RE: Treatment Resistant Central Sleep Apnea?
Yes I'd 100% back what bonjour said. Ask doc for the study only if it includes time for ASV as well. If not, it's a waste of time and money.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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