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reading high amount of central apneas while on machine but not sleeping
#1
reading high amount of central apneas while on machine but not sleeping
[attachment=3525]Okay here is my problem I can not seem to get a straight answer for. I have been on bipap for several months now after I was diagnosed with complex apnea on my sleep study. They were unable to titrate on the cpap the first night and since I could not afford a second sleep study they gave me an auto' bipap' machine. I have been doing well on it once I found the right mask ( airfit f10) and learned to tolerate somewhat higher pressures (10 epap 20 ipap ps of 5) on my aircurve 10 vauto. There is one problem though that is a little worrisome. On nights I do not sleep through the night I read a very large amount of central apneas. I am aware some people say they are not apneas if you are not sleeping but it seems a bit much to me any chance anyone has an suggestions on what this may be. I am going to try and post a screenshot of one of the worst nights you will see i was awake between 2 and 3 and then from 4 or so on. It shot my ahi up to like 17.5 i always check my ahi upon waking up and they are always much better when I am actually asleep then when awake/half sleeping. Sometimes in that half hour from when i first wake up they double from like 5 to 10 average over the night so this is "normal" for me. Hoping it would go away but it has not.My overall average AHI iover three months is like 7.5 so nothing super scary but still I feel a bit alone with this issue any input would help.
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#2
RE: reading high amount of central apneas while on machine but not sleeping
Welcome!

You say you were diagnosed with complex apnea but you are on a machine (bi-pap) that does not treat central apnea. It sounds like they are waiting for you to fail on the bi-pap before giving you the more expensive ASV machine which does treat central apnea.

It is not uncommon for people to experience "central" apneas when the brain changes from awake to asleep.  If you were drifting in and out of sleep at these times, that may be what was happening.  It could also be you tossing and turning and shifting trying to get comfortable and get back to sleep again, but the level is pretty high for that.  You may have been getting more short periods of light sleep than you realize.   The brain is not very good at distinguishing between wake and sleep at the early stages.
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#3
RE: reading high amount of central apneas while on machine but not sleeping
Plus, if you are awake, by definition it is not a sleep apnea, clear airway or obstructive. We tend to breath more irregularly when awake, so to look at the output of a device designed to look at and treat sleep apnea is fruitless and meaningless.

That said, if you are having clear airways stuff when asleep, you likely need to go the ASV route. To get that prescribed, chances are the Dr and DME are going to require another sleep study. If you cannot afford that the only choice may be to go the diy route, buy second hand machine from an individual which will not require another study, and self titrate.
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#4
RE: reading high amount of central apneas while on machine but not sleeping
when I am actually sleeping well though the night I have about 2.5 apneas per hour that are central and the same for obstructive.
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#5
RE: reading high amount of central apneas while on machine but not sleeping
Excellent point about the drifting in and out thing but when I did actually get decent sleep in between from about 3 to 4 there were very little if any centrals. Perhaps I am getting more than normal in that in between phase when some centrals are normal... One of the responses was that bipap did not treat centrals I thought that bipap and asv both were used for centrals?
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#6
RE: reading high amount of central apneas while on machine but not sleeping
Central sleep apnea (CSA) Central sleep apnea is a disorder in which your breathing repeatedly stops and starts during sleep. Central sleep apnea occurs because your brain doesn't send proper signals to the muscles that control your breathing. Central Apnea is best treated with an ASV machine. These are among the most expensive of all PAP machines. On an xPAP the best we can do is to minimize the Max pressure and utilize EPR or other relief (PS on BiLevel / BiPAP)if available, at the same time as raising the EPAP (min Pressure) to support obstructive events. These two treatments “fight” each other and it is a real balancing act. If an Auto band is used it is typically a very tight band.

So let's reduce your max iPAP to 15. I would expect additional recommendations as we try to make this work better for you. I know you said you failed CPAP in the lab
If you can tolerate it I'd suggest turning off the ramp. I would not be surprised to see an ASV in your future, but it will not happen until your Dr. is aware that biPAP is not working for you. Your sleep study was at a sleep lab, in a strange bed, a strange pillow, with you wired up to a lot of instrumentation, with your ability to change position hindered by all the attachments, let alone a mask and hose on your face for the first time, and breathing with a machine blowing in your face, yea I'm sure that was a real normal night (sarcasm intended). Don't be surprised if we ask you to try a CPAP setting at home in the future.
Fred Bonjour - 0 - LAUNCH Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#7
RE: reading high amount of central apneas while on machine but not sleeping
(06-03-2017, 10:45 AM)ronstar77 Wrote: Excellent point about the drifting in and out thing but when I did actually get decent sleep in between from about 3 to 4 there were very little if any centrals. Perhaps I am getting more than normal in that in between phase when some centrals are normal... One of the responses was that bipap did not treat centrals I thought that bipap and asv both were used for centrals?
ASV is a biPaP, just with a different algorithm.  Even a straight CPAP can be used to treat centrals in SOME people.
Fred Bonjour - 0 - LAUNCH Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download OSCAR
Organize Charts
Attaching Charts

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: reading high amount of central apneas while on machine but not sleeping
Yeah I have to completely agree about the sleep study results being iffy at best I was awake almost the entire night on an uncomfortable bed and when I finally did get to sleep I turned to my side and slept which is porbably another factor in how my airway reacts to the pressure. So they think your titrating at that pressure when really you just finally got exhausted/ used to it just enough on your first night. I am good turning ramp off it is only on 5 minutes now and the pressure does not bother me. I think trying 15 sounds like a plan after reading your responses I think I have a better understanding of the hopefully "onset central events" now  I believe the machine gets a little garbled with all those centrals reads one obstructive and ramps to annoyance. Do you have a suggestion for my epap my prescription was for 10 epap 20 ipap but I recently lowered the epap to 8 because I am trying to learn to side sleep. Would there be any benefit to putting it in bipap s mode and going 15 ipap 10 epap or something like that I really do not feel the presuure unless it starts to ramp up to max while I am awake.
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#9
RE: reading high amount of central apneas while on machine but not sleeping
(06-03-2017, 11:23 AM)ronstar77 Wrote: Would there be any benefit to putting it in bipap s mode and going 15 ipap 10 epap or something like that I really do not feel the presuure unless it starts to ramp up to max while I am awake.

Let's go 8 to 13 PS 5 for the first try ( I misread your chart ).  That is effectively the same as S mode.  The EPAP is the important number for Obstructive.  The next step will likely involve lowering the PS, perhaps to 0.  Look for the end result with this machine to be a narrow range or a straight CPAP (Vauto Epap 9???  IPpap 9??? PS 0) I really don't know what the numbers will be yet.

Read this post for a LOT of info.
Important-Info-about-Sleep-Apnea-and-your-Therapy
Fred Bonjour - 0 - LAUNCH Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download OSCAR
Organize Charts
Attaching Charts

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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#10
Wink 
RE: reading high amount of central apneas while on machine but not sleeping
perfect thanks for the info in the vauto menu it actually has the ability to switch between cpap, bipap s and vauto mode if you want I do not know if that makes a lick of difference though if you turn the ps down it may very well be the same thing just less settings to mess with. I really appreciate all the knowledgeableble advice you guys gave me quickly I was not expecting this kind of response after dealing with the frustaritions of doctors etc... it felt like the only ones involved in the process had their hand out for money, well except a few.
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