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Updates on Central Apneas
#1
Updates on Central Apneas
A little background here..  http://www.apneaboard.com/forums/Thread-...dy-Results

But in a nutshell, diagnosed with sleep apnea about a year ago, the A10 had me under control for about 9 months with a very low AHI.  Then I started seeing centrals, and lots of them.

New sleep study, found i was getting pressure induced centrals, told me to lower my pressure to 8 and go straight CPAP, no more APAP.

That's what I've done and I still feel like crap.

This is last night's data, which is pretty typical.  I get more and more events the longer I sleep.  I also included a close up on one of the central clusters.

Any thoughts?  Is CPAP ever going to fix this?  I failed BiPAP in my last study.  Is ASV in my future?

I'm just tired of being tired.

Thanks to everyone.


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#2
RE: Updates on Central Apneas
KC, we optimized your therapy as best we could by fixing pressure without EPR, and you are on the bleeding edge of efficacy. I think I have compared your results with another member SpyCar who ultimately went to ASV and was extremely happy with that choice.

It's not an easy path from your current machine and results to ASV, and a lot depends on how you are feeling. We can drill down to efficacy and SpO2 results, but I don't think it is a given that your results improve from here. You have been patient and made the changes to optimize results, but you're not quire there.
Sleeprider
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#3
RE: Updates on Central Apneas
Sleeprider,

Most days I wake up feeling tired and lean on caffeine to get me through the day. I'm tired all the time. I often end up taking a nap mid day just to get through the day. I'm lucky that I'm self employed and can do that.

So, if there's something we can do, I'd love to do it. I just don't know where to start.
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#4
RE: Updates on Central Apneas
Have you had a thyroid profile run?
Crimson Nape
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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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#5
RE: Updates on Central Apneas
The first decision is whether to work with your primary doc or the sleep specialist. Your AHI remains above clinical levels, and it is only that low due to fixed pressure and no EPR. Who do you sense is most receptive to your overall health and lack of efficacy? In addition to yourself, is there an advocate you can recruit to help move forward?
Sleeprider
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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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#6
RE: Updates on Central Apneas
Thyroid is fine.

I would most likely work with my primary doc. Lucky for me he worked in sleep medicine early in his career so he is familiar with many aspects, although not an expert. However, he is very receptive to helping me. Both myself and my wife have worked as patient advocates in the past, we are ready to roll.
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#7
RE: Updates on Central Apneas
Well, CPAP is not going to deal with the centrals that remain, and we know a bilevel without backup rate will fail miserably. You have done what you can to control them, and any bilevel titration will quickly reveal a higher incidence of CA, that should take the titration to ASV. Your task is to work with the doctor to explain the progression of your therapy. You have tried auto CPAP, CPAP with EPR which is similar to bilevel, and ended up with a fixed pressure CPAP which gave the best results. Those results fall short of efficacy and leave you with symptoms that you are more qualified to describe.

The logical solution is ASV. In order to get there, the therapy must be deemed medically necessary to relieve you of fatigue and other symptoms, found physically qualified for that therapy (LVEF%>45%) and ASV efficacy must be evaluated (bilevel/ASV titration). Alternatively just buy the machine, but the insurance pathway seems to be what you are pursuing.
Sleeprider
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____________________________________________
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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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#8
RE: Updates on Central Apneas
As Sleeprider suggests above, the chart is roughly comparable with mine prior to ASV. You actually have a higher percentage of CA events than I typically did, although at the end my AHIs might have been ever-so-slightly higher on average.

I really pushed to try ASV as I was feeling poorly. A 5 night trial with Bi-level was a disaster.

I think the sleep doc was mildly skeptical, but an in-lab ASV sleep study (despite a very poor night's sleep) showed efficacy.

The ASV experience has been very helpful. It was well-worth pushing for ASV. It would never have happened without a push. When I thanked my sleep doc for facilitating the ASV, he said: "this was all you, you knew what you wanted, and you were right."

The only part of that was wrong is that it wasn't "all me." I had lots of help from this forum and especially from Sleeprider that made my self-advocacy possible.

ASV has been very helpful to me with numbers that don't look much different than yours. I would strongly urge you to press forward and see if ASV helps you too.

Best,

Bill
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#9
RE: Updates on Central Apneas
In my opinion, I'd try to make the push towards ASV by a focus on how you're consistently tired, you're seemingly feeling worse each day, things of that sort. I believe this type of action helped convince my doc to authorize an ASV sleep study, confirming my medical necessity for ASV.

Best to your success
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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#10
RE: Updates on Central Apneas
So, from the sound of things, I need to get LVEF tested.
My sleep study just a few weeks ago did try bilevel and failed miserably. Will I still need to do an ASV sleep study now that we know CPAP/Bilevel both failed?

Thanks to all
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