Does CPAP Cause Central Apneas?

[Pugsy]

I believe the source said "about one third to two thirds of patients."

Did it now....I didn't/don't have time to go read it and I actually thought 1/3 was very decent odds....but then I am a glass is half full kinda gal.

Let's see what my options are...
I have OSA but the treatment for OSA happens to cause me to also have central apnea...I need to treat the OSA with cpap and there's a chance that the central apnea will go away and I don't have a money tree in the back yard and I don't have the knowledge to self treat and I can't get my doctor or my insurance to take mr know it all's comments as the gospel written in stone...what should I do???

Damn...common sense and logic says....treat the OSA and cross your fingers that you are in the 1/3 to 2/3 where the centrals simply go away on their own.
My other option is do nothing but whine about my inability to get the machine that mr know it all on the internet says I just have to have....
Do nothing or at least try something....no brainer for me but I guess not for some people.
If a person doesn't at least try they have zero chance of attaining anything at all except maybe the award for most annoying person on the innerweb.

[jnk...]

It was in the portion I quoted.

And I believe that is just lab-titrated CPAP, not patient-tweaked fully-optimized-pressure CPAP. And with only 90 days of use, if I recall/understood correctly.

[Pugsy]

It was in the portion I quoted.

Well crap...I am blind in one eye and can't see out of the other. I would have sworn that only the 1/3 was there.
I honestly only saw 1/3.
You can beat me the next time you are in town.

Hell, better odds yet.

I actually wish that there was only one machine out there for cpap stuff...one that would do all modes for all people and didn't cost an arm and a leg. There's no reason for ASV or the other bilevels with back up rates to cost so much more than plain cpap.
They would all be fully data capable too.
But you know the saying "wish in one hand and poop in another and see what you get first".

[jnk...]

No desire to beat you. Only hugs.

It was easy to miss. I only pointed it out in support of you and all you do. You have directly helped a number of my friends that I've sent here for help. Thank you, Pugsy.

As for "most annoying guy on the Interweb," I didn't even know that was a thing, or I woulda been trying even harder than Mr. Know-It-All to win that award!

[LSAT]

unfortunately insurance doesnt care how you feel as long as they can say they gave you treatment at the lowest cost

and what does my problem with one asshole at the insurance got to do with anything
i will have my machine soon in spite of her attempts

My doctor said i needed teh ASV
just because i knew i needed it because i have had central apnea for decades is irrelevant
he diagnosed me with mixed/complex apnea and primary central apnea
the only FDA approved treatment is the ASV
the ASV is both medically necessary and appropriate

the one thing for sure is that the bipap the sleep lab tech wrote an Rx for on the FAMILY doctors name was a total fail
i could not sleep at all with it

i would rather go without any machine then be tortured with that bipap thing again

What does you doctor say about your mental capability?

[Okie bipap]

As for "most annoying guy on the Interweb," I didn't even know that was a thing, or I woulda been trying even harder than Mr. Know-It-All to win that award!

If you want that award, you need to get busy and post much more than you have. I less than 4 months, he has posted almost 200 more posts than you have in almost three years.

[ajack]

In support of Pugsy's points:

" . . . CompSAS [comlex sleep apnea syndrome] resolves in only about one third to two thirds of patients treated with CPAP . . . ASV is superior to CPAP in both acute and long-term control of SDB. Further research should focus on expanding clinical and physiological evaluation of patients with CompSAS to better define the subset of patients that are unlikely to benefit from CPAP and who require more advanced forms of PAP therapy. . . ." -- SLEEP, Vol. 37, No. 5, 2014 https://academic.oup.com/sleep/article- ... .5.927.pdf

Thanks for putting that up, it's always nice to have a study to show when asked. I did post 2 sound bites from experts giving lectures to respiratory doctors saying the same thing, But it wasn't accepted because it wasn't a study.
The video was very good in explaining the phenomenon in a very easy to understand way, My thing with the video was that it didn't expand on the phenomenon more and say that they will resolve in most cases and unless very severe can be just monitored.

@ Pugs, the second person to answer the questioner from this section, answers it quite well and questions the long term use of an ASV in these cases, He wants the use of multimode machines, so the therapy can return to cpap after the centrals subside. In the US insurance world, where even a new machine isn't a prerequisite. A bank of asv to give to those badly affected, for a period of 3-6 months before returning to cpap, would be a cost effective solution and provide effective treatment.
https://www.youtube.com/watch?v=Nr08K5I ... .be&t=2851

[jnk...]

Part of the problem is the cacophony of the mix of input data from machine manufacturers whose interest is to promote their machines, payers whose interests are to save money, researchers who aren't so much interested in quality of life issues, clinicians who just want a clear protocol, and patient advocates who want reasonable access for all to help that is informed by recent findings related to health and sleep. When you throw into the mix a "diagnosis" involving a moving target of a certain relative number of centrals that are somehow related to OSA treatment, and that problem being given a name no one can consistently define with any widespread agreement other than a sort of working definition, then clarity on the use of ASV for CompSAS is unlikely to fall into place any time soon. After all, a few influential research docs still refuse to admit CompSAS even exists as a separate entity, still believing it to be a made-up problem invented by machine salesmen. Add to that the recent warnings about ASV use for some with specific conditions, and ASV's reputation with some docs isn't all it could otherwise be. In some ways treatment for SDB is still in its infancy, medically speaking.

[RogerSC]

Commenting on the original question of whether cpap can cause CA's, I had no CA's in my sleep study. However, while using cpap I've been having a few every CA's every night for over 5 years now, regular as clockwork. Not enough to worry about, not enough to merit the cost and overhead of tuning an ASV, but enough that I see them in my sleep data. Lately my AHI has been between about .5 and 1.5, and nearly all of those are CA's. Doesn't worry me, though I do find it a bit ironic. And I don't think that I'm unusual (peculiar, maybe).

[ajack]

If you had them in your original sleep study without cpap, I think the odds are you are going to keep them. It's just a part of you. As you know, it's just how many and for how long that's important

[jnk...]

NonASV bipap can be a very effective treatment for some who have a significant amount of mixed and central events before treatment. I am an example of that. There are many others. Bipap is part of the literature for making therapy more comfortable for some with a seemingly significant number of PSG-scored central events. A patient with centrals during a titration will sometimes calm right down into a steady breathing rhythm when toggled over to bilevel.

Nonobstructive pauses in breathing are often ignored and not scored during lab/center diagnostic and titration studies when they are deemed insignificant to sleep. So the fact that none "show up" in the PSG as being scored does NOT mean those pauses didn't happen. Those pauses will show up as events on home-treatment machine data, though, because a home-treatment machine has no way of discounting them as being insignificant without brain data or highly-sensitive O2 data to confirm the insignificance. That fact confuses some patients into believing they "suddenly developed central apnea" during treatment, when in actuality, they are merely seeing insignificant pauses in breathing now being reported to them by a machine too dumb to know if those pauses meet scoring criteria for a PSG. A home machine can detect some forms of periodic breathing related to central-sleep-apnea issues, but it is unable to comment on other forms of nonobstructive breathing pauses beyond tagging them as open-airway (modern models).

So-called sleep-transition apneas occur not only when transitioning from wake to sleep (or sometimes even sleep to wake) but also at times during transitions between stages of sleep during sleep cycles, such as in and out of REM or Stage 3.

It isn't just about slower rates of breathing, either. It is also about short quick breaths followed by a long pause that is similar to a sigh as the body attempts to sense when the next breath is needed for clearance of waste gases.

The above is my understanding as a nonprofessional. And I'm probably just wasting, um, my breath. But still.

[Guest]

jnk, thank you very much for your post.

[palerider]

NonASV bipap can be a very effective treatment for some who have a significant amount of mixed and central events before treatment. I am an example of that. There are many others. Bipap is part of the literature for making therapy more comfortable for some with a seemingly significant number of PSG-scored central events. A patient with centrals during a titration will sometimes calm right down into a steady breathing rhythm when toggled over to bilevel.

Nonobstructive pauses in breathing are often ignored and not scored during lab/center diagnostic and titration studies when they are deemed insignificant to sleep. So the fact that none "show up" in the PSG as being scored does NOT mean those pauses didn't happen. Those pauses will show up as events on home-treatment machine data, though, because a home-treatment machine has no way of discounting them as being insignificant without brain data or highly-sensitive O2 data to confirm the insignificance. That fact confuses some patients into believing they "suddenly developed central apnea" during treatment, when in actuality, they are merely seeing insignificant pauses in breathing now being reported to them by a machine too dumb to know if those pauses meet scoring criteria for a PSG. A home machine can detect some forms of periodic breathing related to central-sleep-apnea issues, but it is unable to comment on other forms of nonobstructive breathing pauses beyond tagging them as open-airway (modern models).

So-called sleep-transition apneas occur not only when transitioning from wake to sleep (or sometimes even sleep to wake) but also at times during transitions between stages of sleep during sleep cycles, such as in and out of REM or Stage 3.

It isn't just about slower rates of breathing, either. It is also about short quick breaths followed by a long pause that is similar to a sigh as the body attempts to sense when the next breath is needed for clearance of waste gases.

The above is my understanding as a nonprofessional. And I'm probably just wasting, um, my breath. But still.

+1

[ajack]

I think opiate induced centrals may be a good link to put up sometime, but in the meantime....perhaps pictures will help? Even with CA. An ASV isn't necessarily first choice. Ask phillips who makes the damn things.
http://c.ymcdn.com/sites/www.gameshme.o ... for_CP.pdf


Titration Guidelines for CPAP, Bilevel, servo ventilation and AVAPS

[Pugsy]

Opiate induced centrals are really just the opiates messing (potentially suppressing and if someone already has a rather weak respiration it magnifies things) with the respiration and making it potentially unstable and creating the likelihood that centrals might pop up. Again it doesn't happen to everyone. Back a few years ago I broke my wrist and had to have surgery and I had to take some pretty powerful opiates or there wouldn't be any sleep at all and I didn't have one extra central that I could point to as "real"....now I had some that were definitely related to arousals but that was arousal from the pain and I was likely holding my breath while trying to find some sort of comfortable position to sleep in.

Opiates, like cpap pressures, can cause centrals in some people but not in others and in the some people it does it can be a huge problem or a minor annoyance. Again that big YMMV sticker.

I think that there are likely other factors involved that we don't or can't know about when all we see is the software reports showing a truckload of centrals. There are other health issues that could be a factor and other breathing issues that could be a factor like the hypoventilation or COPD...other factors where maybe a targeted volume might be a better choice. It's rarely just one lone thing that causes any problem and this is where and why we say "talk to your doctor about this if it concerns you" ...no matter how small the whatever might be that we are seeing on the reports that someone is in a panic over.

I will tell people who are seeing more centrals than we would like that they may go away with time...and there's a decent chance that they will but I also tell them the other side....they may not go away and they might need a different machine....and it's something they need to discuss with their doctor. I don't know all the history or other medical issues....that's what the doctor is there for.

From my past experience...people who have opiate induced centrals will likely have them without cpap or in other words they get the complex sleep apnea diagnosis from the diagnostic study...I don't think those will go away with time unless opiates go away and usually people on those type of meds have some other stuff going on and they might not have an alternative that will work for them. But that's not what this thread is about...this thread is about those people who have a plain ordinary Obstructive diagnosis and whatever centrals they may have had in the diagnostic study wasn't enough to move up to the Complex diagnosis. Of course there are always outliers who don't fit the expect norm but in general if someone is on enough opiates to cause centrals they are more than likely to have them before they ever strap on a mask.

There are several different bilevel machine models that deal with centrals besides just the ASV and maybe the doctor thinks that something with a definite timed back up rate with targeted volume is a better way to go about dealing with them if they are numerous enough or prolonged enough to cause a problem and won't go away on their own.

What I hate seeing is someone who has been on cpap/apap for 3 or 4 years and complaining all the time that they feel like crap and no one listens and we look at the software reports and there's a truckload of centrals because that means someone dropped the ball and the fix could/would have been relatively simple in the grand scheme of things.