Arousal related CSA

[Loggerhead]

Interesting...very fatigued, split night with AHI of 60 with 30 Centrals in the diagnostic portion, all CSA arousal related.  Titration portion resolved all OSA, but CSA persisted. Started on CPAP and this is 3 months after therapy, still feels like crap. 

I think ASV will wash this all away. 

   

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[Jay51]

If you are having this many CA's after 3 months of therapy, this obviously is not working.  

An ASV would stop CSA by forcing breaths to break up the 10 second or greater CA's.  ASV uses a "dynamic" back up rate based on your own personal respiratory rate during sleep (uses a rolling 90 minute average for minute ventilation, etc.). 

I was diagnosed with severe OSA, severe CSA, and hypoventilation - why I ended up on a ventilator.  

An ASV is for treating CSA with no other pulmonary (COPD) or neurological problems, etc.  

ST (S) and IVAPS are used to treat COPD, Neurological, etc.  

It is interesting that your CA's kind of resemble Cheyne Stokes.  They most likely are not since Cheyne Stokes is largely associated with heart failure and a few other things.  

I have a used ASV as well.  Nice machine.  Stops all CA's (unless you have an OA and your pressure on the ASV is too low, the ASV should work.  Only other exception of ASV not working is a low tidal volume and/or low respiratory rate.  Since it uses the 90 minute rolling average of your own breathing, it can stay low if your natural breathing is too low, etc.  

Just some thoughts.  You are probably knowledgeable of Cheyne Stokes (I read your other thread), but if not here is some reading from our wiki:  

• Cheyne-Stokes respiration
  

[Loggerhead]

This isn't me, this is another person and I'm not their doctor.  Their doctor ordered an ASV titration, but the tech didn't do it because the CSA was all arousal related.  

This periodic breathing is pretty omnipresent throughout the CSAs.  I thought this was fascinating. This delves into an area of sleep medicine I want to understand more, why the sinusoidal pattern of periodic breathing that appears to be CSR, but in the absence of CHF, stroke, seizures, or narcotics?  Likely idiopathic. What is the mechanism of action on this?  I have seen dozens and dozens of patients with periodic breathing with no known reason. I have a high level of respect for the RPSGT and so I need to learn more about how to manage arousal related CSA...not because this is my patient, but because someone like this COULD become my patient.

[Jay51]

My apologies for the mix up.  

Great points you make.  Good for you trying to learn more about this particular phenomenon.  I don't have the answer either, but I have seen what you are pointing out as well.  Only guess I have is that people have different levels of sensitivity in their chemoreceptors, etc.

If anyone else has any thoughts on this please post.