are these real CSA events?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
sue60
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Re: are these real CSA events?

Post by sue60 » Mon Nov 20, 2017 6:08 pm

https://i.imgur.com/p8K9hF1.png


This is a 3 minute span around central #26, I see now what you were talking about, my thinking abilities are impacted I fear

I set my range 4-15 and the PS to 4 to see how it goes, thank you

I will request a pulse ox study and call my DME first! Thanks for that tip too!

sue60
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Re: are these real CSA events?

Post by sue60 » Fri Nov 24, 2017 10:24 am

https://imgur.com/a/Su0At

I did try setting Pressure support to 4 with no real improvement in CSA events. I do not remember removing it, but must have. I was reading some older posts online and decided to reset the aircurve back to factory default and then put in the original 4 to 15 range. This was the original setting prescribed after sleep
study. I had 2 sleep studies a couple of years ago that identified only OSA with resolution at 15, it did not identify CSA either time. Both of the sleep
studies I did take pain meds and sleeping meds and yet no CSA

So now I am wondering if the machine itself is causing the centrals? I feel it is impacting my short term memory. I used an oximeter and uploaded screen shots from last night. My question is are the desats significant to be concerned? And can a bipap or cpap cause CSA while resolving the OSA? If so, am I just in a darned if I do and darned if I don't as far as treating apnea? I see the sleep doc in a few weeks and not sure what to ask her. Thanks anyone

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Pugsy
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Re: are these real CSA events?

Post by Pugsy » Fri Nov 24, 2017 11:53 am

Yes, sometimes the use of cpap pressures can trigger centrals in some people. Sometimes not enough of them to be a real problem though and sometimes enough to be a problem.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be
They start with plain OSA and when cpap pressures are added they change the breathing in a manner that can cause an unstable balance in the carbon dioxide. It's actually the levels of carbon dioxide in the body that causes the brain to trigger the "breathe" button...it's not low oxygen.
The carbon dioxide levels need to get high enough so the brain knows to signal the body to breathe and the unstable breathing causes the body to blow off too much carbon dioxide so it doesn't build up like it needs to so that it gets high enough for the brain to send the breathe trigger.

Sometimes it is simple to fix if the the cause of the unstable breathing is higher pressures and there's some room to reduce the pressures below a line where the centrals aren't triggered but I have seen people get the centrals in large numbers from as little as 6 cm pressure so it isn't always related to higher pressures and if you look at yours...you have times with higher pressures and the centrals aren't really a problem and your centrals are happening at much lower pressures.

It's all fixable though. Sometimes with just time and sometimes with just a change in the settings and sometimes it needs a different machine.
Since you have already done the time thing (you aren't new to therapy) and going with adding Pressure Support didn't help...it might be that your doctor will want to try something else in terms of settings or he may want to go to a different machine.

You are having some desats but not horribly horrible desats....like down in the really low numbers. Your lowest was 90% and while that is lower than your normal...it's not dangerous low. I think that people (having low O2 issues in general and not necessarily sleep apnea related) have to go down to 88% for a certain amount of time before adding oxygen gets talked about.

You do need to keep that appointment with your doctor and discuss how he feels about the number of centrals you are having and how best to reduce them.

A handful of centrals isn't that big of a deal but you are having much more than a handful for some reason....so best to have things checked out.

It might be that you would do better with a machine that can deal both with the obstructive apnea events and also be able to breathe for you when you have the central apnea events....that would be what we call the ASV type of machine. Adapto Servo Ventilation.
In the ResMed model line...the big brother to your current bilevel machine
https://www.resmed.com/us/en/consumer/p ... 0-asv.html

So you aren't totally screwed...there is a machine that can do both...treat your obstructive sleep apnea stuff and still help with the central side of thing which your current machine can't do because it can't increase the pressure fast enough to breathe for you when you don't breathe on your own.

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sue60
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Re: are these real CSA events?

Post by sue60 » Fri Nov 24, 2017 12:26 pm

Thank you for your insight Pugsy! ; I will keep my appt and hope for the best

cchild2
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Re: are these real CSA events?

Post by cchild2 » Fri Nov 24, 2017 1:08 pm

To keep your pulse ox on during the whole night, put a sock over your whole hand and up your arm. I haven't had one fall off this way.

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Jay Aitchsee
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Re: are these real CSA events?

Post by Jay Aitchsee » Fri Nov 24, 2017 3:15 pm

Sue, I agree that you should talk to your doctor about your central apnea events. To facilitate your conversation, I suggest you go over to http://www.apneaboard.com, register, and request to download a copy of ResScan, ResMed's ("Official") software. Once registered, you will request ResScan and a link to download will be sent to you by email. There are instructions on the site.
I suggest this because your doctor may dismiss your SleepyHead results out of hand (even though they will be the same as ResScan's) because Sleepyhead is "unofficial" and your Doctor may not be familiar with it.
Once you have ResScan installed, you can spend a little time learning how to use it. You will see that it produces the same information as SleepyHead and if you need some help with it, many people on the forum can assist.
Make up your ResScan reports to take to the doctor and take your SD card from your machine with you. Your doctor's office staff or the Doctor should be able to download the information from the card and see the information for themselves, but some aren't very good at it.

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sue60
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minimum and maximum PS setting?

Post by sue60 » Fri Dec 29, 2017 6:48 pm

I saw an NP who was covering for my sleep doc today. She acknowledged my AHI numbers were much worse, all CSA and I was having alot of hypopneas,

My current settings are
Max IPAP-15
Min EPAP-4
PS -4

she said to change the settings to
Max IPAP-20
Min EPAP-4
Minumum PS -4
Maximum PS- 8

I am confused because I only see one PS setting- I do not see a minumum or maximum PS? Also, I asked if raising the pressure would make the centrals even worse and she shrugged her shoulders and said maybe....not exactly a confidence booster but I guess I need to try something

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Pugsy
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Re: are these real CSA events?

Post by Pugsy » Fri Dec 29, 2017 7:03 pm

sue60 wrote:Minumum PS -4
Maximum PS- 8

I am confused because I only see one PS setting- I do not see a minumum or maximum PS?
Your AirCurve 10 VAuto machine only offers one PS setting. PS is fixed.

Minimum PS and max PS is something that is available on a ResMed ASV model machine.

Now the Respironics mode 760 (Respironics equivalent to your ResMed) a flexible PS but it won't fix the central issues.

I am thinking you will likely need a different model machine.
She has sort of the right idea (but usually PS max is 15) as to how to go about dealing with the centrals with more PS but your current machine can't do it.
ResMed AirCurve 10 ASV most likely.

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ajack
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Re: are these real CSA events?

Post by ajack » Fri Dec 29, 2017 10:18 pm

You aren't being treated right, after 2 years these CA aren't going away anytime soon. You may need to see the doctor to have a sleep study with another machine called an ASV. This machine treats central apnea.

Your respiration and tidal volume was fine on pressure support PS:0. It seems you don't need the pressure support. some people are worse with pressure support.
If It was my chart, I would go back to PS:0 I would have min epap 9 max epap 12. lower pressure and no pressure support have helped others.

There is some other stuff. I would join the apneaboard forum. start a thread. "help central apnea"
http://www.apneaboard.com/forums/index.php
sleeprider and others will help you get the least amount of CA, till you can see your sleep doctor. If they don't organise a sleep test to determine what machine you need. Then I would change doctor.

best of luck

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sue60
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Re: are these real CSA events?

Post by sue60 » Sat Dec 30, 2017 8:19 am

Thanks Pugsy, I make sure she Knows I have the bipap and not asv. Maybe based on my data my insurance might okay an asv

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Pugsy
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Re: are these real CSA events?

Post by Pugsy » Sat Dec 30, 2017 8:41 am

Based on your data I don't see how the insurance can put up many road blocks.
She probably thought your bilevel machine was an asv bilevel instead of a regular bilevel. Lots of docs, etc think that the only bilevels out there are the ones for treating centrals and don't understand about regular bilevels.

Be aware though that if you do end up with a ResMed ASV they don't flag centrals apart from OAs separately.
There is only a UA basket and a hyponea basket on the ResMed ASV. If someone has centrals and they don't tie the machines hands with a restrictive PS max...the centrals won't happen because the machine will breathe for you.
It's the higher PS range that does the breathing for you when a central happens and it's a fast response so the machine has to be able to go higher on inhale (with that higher PS range) It goes up fast and back down fast.
If PS can't go high enough it can't ventilate you well enough. That's why with centrals often the PS is left to max of 15 and they just let the machine decide. It may or may not use the full 15 but it normally needs more than the 8 she was suggesting.

If you want to read up on how they come up with settings during an official titration you might read this.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
While for a different brand the basics behind the premise is the same no matter which brand.
Use EPAP for the obstructive stuff and let PS plus IPAP max deal with the centrals.
ResMed has a similar document but for me it wasn't quite as detailed as the Respironics document.
http://www.resmed.com/assets/documents/ ... lo_eng.pdf
page 40...this shows the S9 Adapt which is the same machine as the AirCurve 10 ASV.

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sue60
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Re: are these real CSA events?

Post by sue60 » Sun Dec 31, 2017 10:25 am

https://imgur.com/a/NDpWg

Thanks for info Pugsy, I did look at it. Last night I put the machine 4 to 20, PS at 4 still- and got my worst numbers ever. I feel hung over, much worse, not used to feeling this bad, very spaced out. I zoomed in on #35 and #200. The pressures look different but not the result. I took no sleep med or muscle relaxer hoping for just a little improvement. So my guess is the higher pressures do make me worse, but it was only one night. Do I panic at one night and put the number back to 4 to 15? or try another night? I will get in touch with the NP next week to report.

Does anyone out there use an ASV with good results? Did you have to have another sleep study? Anyone have an MRI of the brain to rule out cause? If the machine does not report centrals, how do you get data to show its working?

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Pugsy
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Re: are these real CSA events?

Post by Pugsy » Sun Dec 31, 2017 10:43 am

PS on your machine does nothing but keep EPAP and IPAP apart by whatever the setting.

With the minimum EPAP of 4 plus PS of 4 you have IPAP of 8 and then EPAP/IPAP goes up as the machine senses obstructive in nature event precursors.
Interesting that your OAs weren't all that numerous.
Your centrals don't necessarily get worse with pressure increases...look at 5:30 and the pressures really haven't changed from the 4 plus 4 and you have a truckload of centrals.

I don't know what all you have done or tried and it's painfully obvious that this now isn't working.
You really, really need to get some real help from a doctor who knows how to deal with centrals.
In the meantime how about trying something a little different? I have no idea what will happen but let's remove PS from the mix and see if the centrals reduce. The reason...sometimes PS itself can trigger centrals.

How about trying this?
EPAP min of 6
PS of 0
IPAP max 15

This will make the machine function more like an apap single pressure machine that can move around as needed for the obstructive stuff.
The central stuff the machine ignores anyway.

This is a really big long shot but I have seen people have significant central reduction when we reduce or turn PS off.
I have no idea if you might be one of those people...it's a very rare small subset of people who get centrals from PS but at this point...you don't have anything to lose by trying.

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sue60
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Re: are these real CSA events?

Post by sue60 » Sun Dec 31, 2017 11:20 am

THANKS for the suggestion Pugsy , I really do agree I have nothing to lose at this point and I will let you know how it goes, at least I have one more day off tomorrow before back to work. I live near Atlanta and the Emory hospital sleep program is almost all neurologists? I thought this was interesting and I may just set up an appointment for a second opinion if this doesn't help. My current doc is internal medicine, Piedmont is all pulmonologists . Again, appreciate your insight and I will pursue this. I want to wish everyone in the community a Happy, Healthy and Restful new year. Without this community I would have been so alone in this venture for 2 years. Reading many posts here and the support I have received is what has got me through it thus far!

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Pugsy
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Re: are these real CSA events?

Post by Pugsy » Sun Dec 31, 2017 12:02 pm

Let me know how it goes.
While I don't really expect much ....at least it is something to try. I would be like you...just wanting to try anything and everything.

As far as specialist...a neurologist would be first choice and hopefully one with a sub specialty in sleep disorders.

Should you end up needing ASV...it's not that big of a deal. I actually have an ASV machine myself (not because of centrals but just because I wanted to try it) and it's not that big of a beast to tame at all.

I would strongly suggest making that appointment and I mention this experiment for now because I know you won't be able to do anything appointment wise until after the first and it's something to try tonight. If it works though...go buy a PowerBall ticket because you are extremely lucky.
I personally know one person that it did work for but her centrals weren't nearly as numerous as yours are.
It will only work if PS is the lone sole cause of the centrals and that's a very remote possibility. There are so many potential causes for the centrals that for it to be something as simple as PS....I can hope for your sake but I can't promise anything as much as I wish I could.

Don't take any muscle relaxers/pain meds or anything that might remotely affect your breathing or airway patency if at all possible though.

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