machine causes central apnea?

[vsheline]

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.

Well, long term CPAP use would be accompanied by normal aging. Lots of health conditions take time to manifest themselves and only cause symptoms after we grow older. For example, even some genetic diseases which we may have at birth might not exhibit themselves until old age.

As we age while using 'PAP therapy I suppose we might coincidentally (unrelated to our 'PAP use) develop susceptibility to CA.

Also, it is common that as we age our pressure needs increase, and for those who are susceptible to CA it is common that higher pressure tends to cause more CA events. It might be that dewfend's APAP machine is needing to use higher pressure now than years ago in order to prevent obstructive events, and the increase in required treatment pressure is allowing more CA events to occur.

If dewfend did not have any CA events in his initial diagnostic study years ago (he hasn't told us this yet) and now after years of 'PAP use CA events show up in a recent diagnostic sleep study, this would represent a possible association between long term 'PAP use and becoming susceptible to CA events, but would not necessarily indicate causation. That "A" happened before "B" does not necessarily mean A caused B.

If dewfend had CA events in his initial diagnostic study years ago (he hasn't told us this yet) then he was susceptible to CA events back then, and shame on his doctor back then for allowing a CPAP machine to be dispensed which does not distinguish and report CA events versus OA events.

[0rangebear]

My experience on Apnea types is:
When my pressure is too low (5) I get mixed apneas OB CA UA and H with 75% of the event classified as UA an 15 % classified as H ad no RERA

When I set the pressure too high (16) I get no H no UA no CA with and even split between RERA and OB I also get more sleep Wake junk and my sleep cycle is shortened ( I wake up more)

When the pressure is in the sweet spot I only get H. except when I have insomnia and hypoglycemia

[archangle]

Your doc's an idiot if he didn't immediately tell you to get a fully data capable CPAP machine when you had your sleep test showing central apnea.

A fully data capable CPAP machine will give you a "mini sleep test" every night. It will detect central apneas, and will show how serious they are, and how long they last.

With a fully data capable CPAP, a competent doctor can adjust your treatment remotely and check to see the results. They can either do this with a cell phone modem or by mailing the SD card to the doctor.

If you have concerns about central apnea, you REALLY need a fully data capable CPAP machine that records your actual central apnea numbers in the home while receiving therapy. You are flying blind without a fully data capable CPAP machine.

An in-lab $leep te$t doesn't tell you much about how the treatment is working in your own home during CPAP treatment. It looks like those $leep te$t numbers are done without CPAP pressure, so they don't give you any numbers about how your therapy is working at home.

Also, if he wants to treat central apnea without a fully data capable CPAP machine, you'll have to have another in lab $leep/titration te$t to find the right pressure. Then, he still won't be able to tell what is actually happening at home as you adjust to different pressures.

Your Escape Auto does give you SOME data, mostly nightly AHI numbers. Figure out what those are, but you really need a fully data capable machine, like an S9 AutoSet, and A10 AutoSet, a PRS1 Auto, or a DreamStation Auto.

There is information in the Useful Links in my signature line at the bottom of this post about which machines are fully data capable.

[vsheline]

My experience on Apnea types is:
When my pressure is too low (5) I get mixed apneas OB CA UA and H with 75% of the event classified as UA and 15 % classified as H and no RERA

When I set the pressure too high (16) I get no H no UA no CA with an even split between RERA and OB. I also get more sleep Wake junk and my sleep cycle is shortened (I wake up more)

Hi 0rangebear,

When a ResMed machine scores apneas as UA (Unclassified Apnea) this means only that the Leak was too high (above 30 L/minute) to allow the machine to run the Forced Oscillation Technique which ResMed machines use to detect whether an apnea is central versus obstructive.

[dewfend]

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.

Hi DeepBreathing, following your suggestion I turned off the EPR, maintaining max pressure 14. This morning I feel better! Hope this setting still works tonight. I will continue reporting.

Still some questions:
1) Easily understandable that 0 or low EPR will help rise CO2 in body to prevent the brain from fogetting to breath, what is the reason high max pressure will cause central apneas?
2)I have autoset report created by SleepyHead and would like to share with you, After uploading the image to a site and when inserting the link as you instructed, I am told that I am not allowed to post image.
That report tells my AHI is 3.31, most of events are CA.

---

Your doc's an idiot if he didn't immediately tell you to get a fully data capable CPAP machine when you had your sleep test showing central apnea.

A fully data capable CPAP machine will give you a "mini sleep test" every night. It will detect central apneas, and will show how serious they are, and how long they last.

With a fully data capable CPAP, a competent doctor can adjust your treatment remotely and check to see the results. They can either do this with a cell phone modem or by mailing the SD card to the doctor.

If you have concerns about central apnea, you REALLY need a fully data capable CPAP machine that records your actual central apnea numbers in the home while receiving therapy. You are flying blind without a fully data capable CPAP machine.

An in-lab $leep te$t doesn't tell you much about how the treatment is working in your own home during CPAP treatment. It looks like those $leep te$t numbers are done without CPAP pressure, so they don't give you any numbers about how your therapy is working at home.

Also, if he wants to treat central apnea without a fully data capable CPAP machine, you'll have to have another in lab $leep/titration te$t to find the right pressure. Then, he still won't be able to tell what is actually happening at home as you adjust to different pressures.

Your Escape Auto does give you SOME data, mostly nightly AHI numbers. Figure out what those are, but you really need a fully data capable machine, like an S9 AutoSet, and A10 AutoSet, a PRS1 Auto, or a DreamStation Auto.

There is information in the Useful Links in my signature line at the bottom of this post about which machines are fully data capable.

Thanks for your advice, I am thinking of buying a new S10.

[dewfend]

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

Thank you Vaughn. To set the min pressure to 95%, if I understand correctly, is to keep high pressure and to prevent obstruction?

I had tried autoset and I have the report, I am asking help to show them here.

According to the daily report, CA is most part of the events. During night when I am about to fall asleep, sometime I can sense that I stop breathing and I wake up to breath. So I think now CA is my main concern, hopefully turning EPR off will help resolve it.

Cheers.

[DeepBreathing]

2)I have autoset report created by SleepyHead and would like to share with you, After uploading the image to a site and when inserting the link as you instructed, I am told that I am not allowed to post image.

Sorry, I should have been more clear. New members can attach an image to a post, but can't create links. So if you go here http://www.apneaboard.com/forums/Thread-How-to-HOW-DO-I look for the instruction on how to attach an image. Once you have 8 or more posts you will be able to create a link.

[archangle]

Thanks for your advice, I am thinking of buying a new S10.

Be sure to get the Elite or AutoSet model if you go with the AirSense 10 line. The base "CPAP" model lacks the full data you need for central apnea.

[0rangebear]

My experience on Apnea types is:
When my pressure is too low (5) I get mixed apneas OB CA UA and H with 75% of the event classified as UA and 15 % classified as H and no RERA

When I set the pressure too high (16) I get no H no UA no CA with an even split between RERA and OB. I also get more sleep Wake junk and my sleep cycle is shortened (I wake up more)

Hi 0rangebear,

When a ResMed machine scores apneas as UA (Unclassified Apnea) this means only that the Leak was too high (above 30 L/minute) to allow the machine to run the Forced Oscillation Technique which ResMed machines use to detect whether an apnea is central versus obstructive.

I went back through the last 100 days and the low pressure UA all do appear to be associated with leaks. Does that mean they were not actually apneas?

It would seem( based on your analysis) they went away because I got control of the leaks. Nevertheless when I and raised the pressure the CA and H also went away. I now see RERA in addition to OB which I never saw at lower pressure with the leaks.

[archangle]

I went back through the last 100 days and the low pressure UA all do appear to be associated with leaks. Does that mean they were not actually apneas?

It would seem( based on your analysis) they went away because I got control of the leaks. Nevertheless when I and raised the pressure the CA and H also went away. I now see RERA in addition to OB which I never saw at lower pressure with the leaks.

The UA events are probably real apneas. The machine just can't determine whether it's obstructive or central/clear airway.