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machine causes central apnea?
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dewfend Offline

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Machine: S9 auto escape
Mask Type: Full face mask
Mask Make & Model: mirage quattro
Humidifier: unsure
CPAP Pressure: 4-14
CPAP Software: SleepyHead

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Sex: Male
Location:

Post: #1
machine causes central apnea?
Hello everyone, two years ago I was diagnosed OSAHS and from then I used machine with pressure ranging from 4-14 (APAP mode) to treat my syndrome. It was fantastic with brain refreshed every morning. I think everyone who used it knows the feelingSmile
Recently I felt tired again like before, so I did another sleep test, which suggests I have central and hybrid apnea besides obstructive...
The doctor explained that with help of machine, my breathing muscle's movement is less intensive than before, after long time, my brain becomes less sensitive and sometime will miss sending breathing signal.
Does this happen to you?
And I was suggested to use Bi-level machine. I am afraid using Bi-level machine will make me more dependent and my brain less sensitive, how do you guys think?
Thanks in advance.
04-02-2016 07:55 PM
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Dawei Offline

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Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #2
RE: machine causes central apnea?
That explanation from your doc doesn't make much sense to me. ..."breathing muscle movement less intense..." leading to centrals? What would make this happen? Brain becoming less sensitive to sending breathing signals? Really sounds strange to me, but others will have more experience with the question of new centrals. I say new because it seems you didn't have them earlier when all was well with your therapy. Unfortunately, your machine cannot provide sleep data on an hour-by-hour (and minute by minute) basis to let you (and your doc) know what's happening.
Can you get info showing the results of your recent sleep study (the numbers, etc.)? A copy of that report would tell smart folks on the forum a lot about what exactly the study showed.

David
04-02-2016 08:41 PM
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Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #3
RE: machine causes central apnea?
One more thought, dewfend. The only possibility I'm aware of where a machine can cause centrals is if the pressure set is too high. This possibility was a concern of my pulmonologist when I was telling him I wanted a script for an APAP.

David
04-02-2016 08:51 PM
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DeepBreathing Offline
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Posts: 2,297
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Perth, Western Australia

Post: #4
RE: machine causes central apnea?
G'day dewfend, welcome to Apnea Board.

It's not unusual for APAP treatment to cause some central apneas, especially in new patients. However in the majority of cases it goes away after a short time. The reason this happens is a bit complicated, and I don't understand it completely, so I will give you the simplified version...

During metabolism, oxygen levels in the blood will fall and carbon dioxide levels will rise. "Sensors" in the body detect the level,of CO2 and when it gets high enough they send a message to the brain. The brain in turn sends a message to the chest saying "breathe now".

Under xPAP therapy sometimes the CO2 level doesn't rise enough for the breathe now signal to be triggered and you body just forgets to breathe. This is a central apnea.

It's unfortunate that you have an Escape machine which doesn't provide full data, because to sort this out you really do need the data. If there is any way of getting hold of an Autoset machine, even on loan, I would do it. With a data capable machine, you or your doctor will be able to look at the flow patterns, pressures, apneas and other events and have a very detailed picture of exactly what is happening. Otherwise you're just guessing.

There are a couple of simple things you can try to eliminate the centrals. First, bring the top pressure down a bit. It's a bit of a balance between having the pressure high enough to treat obstructive events but not so high that it causes central apneas. Second, if you're using EPR, turn it down to 1 or else turn it off. In many cases these simple tricks can reduce or eliminate the centrals. But you won't know if they're effective without a data capable machine.

If the central apneas persist then you may need to consider a different type of machine. A bilevel might help, but mostly you need to be looking at an ASV machine. These are really expensive, but work extremely well. Because they are so expensive the system usually makes you jump through hoops to get your hands on one. And if it's possible to reduce your central apnea to an acceptable level without spending all that money, that is a better outcome.

One final question - do you know how many centrals you are having? What is your overall AHI and what proportion of that is central?

DeepBreathing
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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.
04-02-2016 09:03 PM
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dewfend Offline

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Posts: 6
Joined: Apr 2016

Machine: S9 auto escape
Mask Type: Full face mask
Mask Make & Model: mirage quattro
Humidifier: unsure
CPAP Pressure: 4-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #5
RE: machine causes central apnea?
Thanks to Dawei and DeepBreathing, really appreciating your kind response.
my sleep study tells that my AHI is 9, Apena index is 4.4, Hypopnea index is 4.6, detailed as follows:
Hypopnea: 37 times, 51.4%, longest time 64 secs
RERA: 0
Obstructive:20 times,27.8%, longest time is 87 secs
Central:13 times, 18.1%, longest time is 69 secs
Hybrid: 2 times, 2.8%, longest time is 39 secs.

Luckily I had tried autoset and I recorded the data. but it seems not able to upload here...

I learnt that the EPR setting may cause CA from other thread and here. My current setting is 2, which could be the reason. I will turn it off and see how do I feel.

Have a nice daySmile
(This post was last modified: 04-02-2016 10:01 PM by dewfend.)
04-02-2016 09:52 PM
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DeepBreathing Offline
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Posts: 2,297
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #6
RE: machine causes central apnea?
I don't think you're having enough centrals to worry at the moment, but the duration is very long. In your position I'd concentrate in getting the obstructive apneas and hypopneas under control first then see what's happening with the centrals. I'm not a medical person, but apneas up to 87 seconds long don't sound too good.

It would be good to see the data. New members have limited ability to upload files or links - it's to help prevent spam. However you can attach a screen shot from Sleepyhead. See the instructions here: http://www.apneaboard.com/forums/Thread-How-to-HOW-DO-I

DeepBreathing
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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.
04-02-2016 11:27 PM
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zonk Offline

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Machine: A10 AutoSet
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Sex: Male
Location: Australia

Post: #7
RE: machine causes central apnea?
(04-02-2016 09:52 PM)dewfend Wrote:  I learnt that the EPR setting may cause CA from other thread and here. My current setting is 2, which could be the reason. I will turn it off and see how do I feel.

Have a nice daySmile
The machine listed in your profile S9 Escape Auto report AHI but doesn't detect central apnea or score it
Also no leak or detailed data graphs on the SD card
Here is the run-down of S9 series http://www.resmed.com/int/products/produ...nc=dealers

I don't think SleepyHead works with this machine, you can see some data on ResScan but no detailed data

As for pressure settings 4-14,
I would bump the minimum pressure closer to 95% pressure to allow the machine respond to events in a timely manner YMMV
04-03-2016 12:33 AM
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vsheline Online

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #8
RE: machine causes central apnea?
(04-03-2016 12:33 AM)zonk Wrote:  I would bump the minimum pressure closer to 95% pressure to allow the machine respond to events in a timely manner YMMV

Hi dewfend,

If your tiredness is primarily caused by obstructive events then raising the Min Pressure to nearly your 95% pressure would likely help eliminate most obstructive events and improve things. Your 95 percentile pressure is the pressure the machine was at or lower than, for at least 95% of the time; it was also the pressure the machine was at or higher than for at least 5% of the time. I'm not suggesting you do this or not do this - merely clarifying when it would help.

During your recent diagnostic sleep study, the long central apneas may have been mis-scored as purely central when actually they may have been mixed, starting as central but finishing as (transitioning into) obstructive apneas (perhaps causing their extreme length). If the very long CA events were mis-scored these would have been mistakes by whoever was supposed to analyze and interprete the data in counting the number of each type of event. I only suggest this as a possibility because a CA which lasts 69 seconds seems unusually long.

I suspect your Doctor has a misunderstanding of what causes CA. Typically, the number of CAs a new 'PAP user gets decreases in the course of the initial weeks or months of 'PAP treatment, as the body adjusts to treatment. I've read a few papers regarding CA and treatment-emergent CA, and have come across nothing similar to what is hypothesized by your doctor.

Your recent diagnostic sleep test shows you are susceptible to CA, even when not being treated.

The machine you have does not provide central apnea versus obstructive apnea detection and therefore is inappropriate for a patient who is susceptible to CA (someone who is already having a significant number of CA during the diagnostic study while sleeping without 'PAP therapy).

I suggest asking for insurance preauthorization for a bilevel titration, with agreement to change during the titration to ASV algorithm if CAI (Central Apnea Index) is above 5 and central apneas outnumber obstructive apneas when being titrated using standard bilevel PAP.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 04-03-2016 02:20 PM by vsheline.)
04-03-2016 09:38 AM
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
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CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #9
RE: machine causes central apnea?
Hi dewfend,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you.

trish6hundred
04-03-2016 10:26 AM
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Mosquitobait Offline

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Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #10
RE: machine causes central apnea?
I don't know the details, but I know I read that, for a small percentage of patients, long term cpap use can lead to development of centrals. I don't think they know why although I'm sure there will eventually be a physiological explanation for it. In other words, the problem WAS there before you even started cpap, but the cpap machine was a trigger. Insurance REQUIRES you to try a bipap before moving on to the next machine designed for treating centrals.
04-03-2016 02:03 PM
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