Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

new to bipap, lots of central apneas
#21
RE: new to bipap, lots of central apneas
I think you need to push through this month of using the bilevel. I would encourage you to keep your doctor informed that you you are poorly treated with high CA event rates and are uncomfortable and unable to sleep well. He does not appear to be against ASV, but is going to let you demonstrate that this treatment fails to adequately treat you and that ASV is medically necessary. Do your part to try using the machine, and make any changes he suggests. The month trial will pass fairly quickly, but unfortunately this is the process insurance imposes on us.

Brief CA events are not harmful, but if they are longer or cause significant oxygen desaturation, then it is a bigger concern. You may want to invest in a recording oximeter. This would let you monitor your oxygen levels and bring them to your doctor's attention if there is a problem that he should act on more urgently. Supplier #19 is considered a good source of these devices, and several of the CMS oximeters work with Sleepyhead.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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.
Post Reply Post Reply



Donate to Apnea Board  
#22
RE: new to bipap, lots of central apneas
"Brief CA events are not harmful...".

a difference of opinion: brief or not, ca events may be tolerable and acceptable to the OP for a month trial (which is what I think was meant by this), but as a general statement I respectfully disagree that they are not harmful. before I got old and fat and developed oa, I suffered! for years and years from untreated ca. I can personally attest to the harm it caused.
Post Reply Post Reply
#23
RE: new to bipap, lots of central apneas
Yes, I expect they would be harmful over the long term, but not for just a month.
What is an OP?
Post Reply Post Reply
#24
RE: new to bipap, lots of central apneas
that's you (original post or poster) because I didn't take the time find and type your username. sorry.
Post Reply Post Reply



Donate to Apnea Board  
#25
RE: new to bipap, lots of central apneas
no problem, I was just baffled. Thanks for the clarification.
Post Reply Post Reply
#26
RE: new to bipap, lots of central apneas
We would like to avoid all apnea, but part of this process is unfortunately the demonstration that a particular option does not work. The bilevel trial is always the worst and the best way to shorten it is to stick with it, complain and show your doctor the problem. Sleepyhead reports the length of the apnea, and I did suggest that the problem can be directly measured. My hope is to help Bemused to push through this, and end up with the ASV sooner than later.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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.
Post Reply Post Reply
#27
RE: new to bipap, lots of central apneas
So I've been sticking with it per recommendations. Had a couple of nights where the total AHI dropped below 8 -- one below 5, but last night was back up again. One thing that seems off is the number of OAs that seem to be happening when from what I remember I was awake, or mostly so. In fact it seems like I get clusters of them during those wake or transition periods, then just isolated ones here and there when I'm asleep. But still lots of centrals. I have enough nights now to get an overview:
   
   

This is a shot from last night when I had the OA clusters:
   

It also shows some snores during that period -- but I was awake and restless so finally took the mask off. Seems like these shouldn't count, somehow.

Articles online say that XPAP emergent centrals can resolve over "2 to 4 weeks to months."  But the consensus here seems to be that with these numbers that isn't likely. Yet I did have the one night where they dropped below 5 -- and then immediately spiked up again. Sign of progress or no?

I read on another post that it might help to set the Trigger to Very High. Would that make sense in my case?
Post Reply Post Reply



Donate to Apnea Board  
#28
RE: new to bipap, lots of central apneas
Clusters of OA are frequently the result of chin-tucking or positional apnea. In this case, they are arising out of your minimum set pressure and near the onset or end of sleep. We can see the OA cluster does not break, even with the maximum set pressure of 12/9. If these are in fact occurring while you are awake, then you should not count them at all, and you should try to think about the mechanisms that lead to the OA. Are you swallowing or experiencing post-nasal drip? Normally, we would try a higher minimum pressure (epap to 5.0) and see if there is improvement, and might try a soft cervical collar to correct posture issues, but as I said before, your apnea is consistently inconsistent, and it will be hard to judge whether such measures are effective over the short term.

The theory of "XPAP emergent centrals" that resolve in time, are founded on the premise that the CA events are the result of CO2 reduction affecting respiratory drive, and that patients eventually adapt to the lower CO2 and the apnea events become less frequent or stop occurring. There is a direct therapy to target this loss of CO2 in the rebreathing space, Enhanced Expiratory Rebreathing Space EERS moves the exhalation vent farther away and creates a dead-air spce where CO2 can be re-breathed. Here is a wiki I wrote on the subject.
http://www.apneaboard.com/wiki/index.php...ace_(EERS) It may be worth trying if you're handy or your doctor will request an EERS module from the DME listed in the article.

Increasing the trigger sensitivity can help resolve some CA where there is some respiratory effort. As the bilevel then triggers IPAP, it sometimes stimulates the completion of a breath. It is far from foolproof because the Aircurve 10 follows respiration, rather than leading it with pressure, however it can't hurt to try.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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.
Post Reply Post Reply
#29
RE: new to bipap, lots of central apneas
Well the OA clusters are definitely happening when I'm awake or mostly so (as evidenced by the mask-off breaks), and it looks to me like the centrals are happening in response to the pressure spikes, which are happening because of the OAs. Not sure how that would fit with the CO2 hypothesis. In any case EEES wouldn't be an option, as I am using the Dreamwear nasal cushion and am comfortable with it, unlike everything else I've tried -- the tubing comes out of the top of the mask so not by the exhaust vent.

I will try to pay closer attention to what I am doing that causes the wake/transition OAs, and see if I can bring those down.

Just as a thought, what if I lowered the maximum ipap to 8, which seems to be what I need to keep on an even keel when asleep? That would stop the pressure spikes that seem to be triggering the centrals.

Or looking more closely, 9 or 10
Post Reply Post Reply
#30
RE: new to bipap, lots of central apneas
Lowering maximum IPAP is a logical response. As far as EERS, your mask can be adapted by occluding the vent where the hose connects, and moving it about 12" upstream using Corr-a-Flex tubing and the swivel vent mentioned in the article. It simply replaces the existing vent but adds dead-space that does not currently exist. It's a cutting edge approach, so I don't expect much adoption of it until the parts are commercially produced.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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.
Post Reply Post Reply



Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
Question Thirteen years of CPAP - now failing again. [Central apnea] tykelmice 4 93 2 hours ago
Last Post: OpalRose
  First 2 weeks of BiPap, looking to dial it in AFAIK 6 144 08-14-2019, 10:01 PM
Last Post: Dormeo
  Regarding settings on a replacement bipap?? RosieB08 32 490 08-05-2019, 07:41 PM
Last Post: RosieB08
  6 weeks in on bipap, still centrals, still sleepy bemused 20 797 07-31-2019, 12:42 AM
Last Post: jaswilliams
  Central Detection Driving Me Nuts!! Reznik 64 3,872 07-23-2019, 07:48 PM
Last Post: Reznik
  CAHI [How to determine the number of Central Hypopneas] Croweater 6 201 07-22-2019, 01:45 PM
Last Post: Sleeprider
Sad RELENTLESS sleep-transition central apneas idlewire 29 1,217 07-16-2019, 02:38 PM
Last Post: Sleeprider


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.