centrals / worth switching to APAP?

[awakeinnj]

Hi, all. I see similar active threads on here, but my question is a little different from them and I didn't want to hijack the others.

I was diagnosed with sleep apnea and have been using a CPAP machine for over 6 months now. It helps a little, but I'm still fatigued and getting headaches which are worst in the morning. My numbers are what I'd consider consistently good for months now (AHI typically around 3 to 5, acceptable 95%ile leak). I'm not sure what else the dr is actually looking at, but at this week's visit he's leaving the pressure at 8 -- the same as it's been for the last few months.

The only issue I could see in Sleepyhead is that most of the events are clustered during REM sleep at the end of the night. That's typical, and the dr confirmed as much, but is it worth asking for an APAP to try to control those events since I'm still not feeling better? I would think "yes", but these events are coming up as centrals ("clear airway") so I don't see how a change in pressure could help. Plus I'm usually shy about asking questions, esp. if they seem like 2nd-guessing, and since my other doctors are still trying to rule out other causes of fatigue and headaches .

I'd greatly appreciate some advice.
Thanks.

[Wulfman...]

Hi, all. I see similar active threads on here, but my question is a little different from them and I didn't want to hijack the others.

I was diagnosed with sleep apnea and have been using a CPAP machine for over 6 months now. It helps a little, but I'm still fatigued and getting headaches which are worst in the morning. My numbers are what I'd consider consistently good for months now (AHI typically around 3 to 5, acceptable 95%ile leak). I'm not sure what else the dr is actually looking at, but at this week's visit he's leaving the pressure at 8 -- the same as it's been for the last few months.

The only issue I could see in Sleepyhead is that most of the events are clustered during REM sleep at the end of the night. That's typical, and the dr confirmed as much, but is it worth asking for an APAP to try to control those events since I'm still not feeling better? I would think "yes", but these events are coming up as centrals ("clear airway") so I don't see how a change in pressure could help. Plus I'm usually shy about asking questions, esp. if they seem like 2nd-guessing, and since my other doctors are still trying to rule out other causes of fatigue and headaches .

I'd greatly appreciate some advice.
Thanks.

It would help if you would put your equipment information in your profile (including pressure, humidity and any other settings). You mentioned the "95%", so I'm guessing you're using a ResMed machine.....?

Did you ever see or do you have a copy of your sleep study? Were there Centrals noted in it?
To my mindset, a person with Centrals (particularly the "pressure induced" variety) using an APAP in a range of pressures would be a "No No".

Sometimes, software will misidentify some of the events, so it's important to know if you actually had them in your sleep study.


Den

.

[awakeinnj]

OK, I updated my profile with the treatment info -- yes, S9 Elite. I summarized in Sleepyhead that my AHI over the last 3 mos. is 3.19, and the leaks are a little worse than I thought (95%ile = 19; median = 3.34).

In short, I didn't have that many centrals during the study. Here are the bottom-line results.

"RESPIRATORY PROFILE: The patient was monitored for 374 minutes. The patient experienced 225 respiratory events as 17 obstructive apneas, 15 central apneas, 144 hypopneas, 6 mixed apneas yielding an apnea-hypopnea index of 36.1 per hour. Supine position was 31.8 minutes with a supine index of 66. Mean Heart Rate: 91. Mean Oxygen Saturation: 96% with only 0.1% of the study time at a saturation less than 90% or 0.2 minutes.
IMPRESSION: Moderate sleep apnea with significant supine-related sleep apnea."

Unfortunately, this was a home study and it thought I was sleeping the whole 6 hours when I know for sure that I was awake for the 1st hour and the 1st hour since I can't really sleep on my side and back. During the in-lab titration, I had more trouble, and slept just enough for the dr to be comfortable making the diagnosis. So, the dr started my treatment at 5 (rather than to repeat the expensive study), then moved to 7 and then 8. At each increase in pressure, per the machine and Sleepyhead, the obstructive apneas/hypopneas have gone down. What's left seems to be borderline hypopneas and whatever it's counting as 10 or even 20+ second centrals (although, I too am not totally convinced that they are). They're definitely grouped during the latter part of sleep, in REM/dream phase though - consistently.

Thanks.

[bwexler]

I used to think I was pretty knowledgeable. But since I got my ASV machine last Oct, I feel like a newbe.
With your troubled titration (or even withe a good study) I would have insisted an an Auto machine. That would basicily allow for a home titration every night. With near 50% Centrals I would probably push for an ASV machine.
I think I have reached my limit. Let the experts tear me apart.

[Pugsy]

Could you please post an image of one of your typical detailed nightly reports?
If you don't know how we talk about it here and there's also some examples of what we like to see.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

[Wulfman...]

Thanks for the additional info.
I see Pugsy is chiming in. Thanks, Pugsy. I'm not all that well-versed on Sleepyhead software, so her input is appreciated.

I still think an APAP could be problematic dealing with Centrals, but in general, if you gradually push your pressure up and see more Centrals, you should probably back off on it. If you don't see more, see if you can find a "sweet spot".
Also, watch the leak data.
Are you using EPR? If so, you could try different settings or turning it off.


Den

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[awakeinnj]

OK, I'm hoping I did this right. Some screenshots from last night, which was pretty typical...
http://s1265.photobucket.com/user/awake ... sort=3&o=2

http://s1265.photobucket.com/user/awake ... sort=3&o=1

http://s1265.photobucket.com/user/awake ... sort=3&o=0



Is there something else I could provide? Maybe also use another type of software?


As for EPR, your response is the first time I'm seeing that term. Now that I know what it is, I'm going to check the setting -- probably off. Although I'm not still not clear as to what the benefit of each setting (on/off) would be...I'll look it up. (Note that I never mess with the settings that the technician changes for me -- I only look at the AHI/smiley face and adjust the humidity on occasion. But I know I can, somehow.)

Thanks.

[palerider]

for better screenshots, turn off the calendar (click the ^ next to the date) and turn off the right sidebar,

pick the "details" tab on the left sidebar.

arrange your strip charts so we can see
event flags
flow rate
pressure
leaks
snore
flow limitation

(or at least as many as will fit on the screen) you can drag the charts to get them in that order.

you can also resize them

[awakeinnj]

lol, sorry. I actually printed the screen, pasted them into Word to crop and then moved them from there. pathetic, i know.

[chriscummings83]

I just read a lot about VPAP machines and to me it says they created it for people that have CPAP and APAP Machines that are having lots of CA's.

So it learns how you breathe and when you get off course or stop it picks up and keeps u breathing

My 2cents

[archangle]

I just read a lot about VPAP machines and to me it says they created it for people that have CPAP and APAP Machines that are having lots of CA's.

So it learns how you breathe and when you get off course or stop it picks up and keeps u breathing

My 2cents

That's a description of ASV or T-mode bilevel machines. VPAP is a trademark for bilevel. Bilevel machines are for those who find it hard to exhale. "Normal" bilevel machines are not really for central apnea. They may help, but they may hurt, too. ASV and T-mode bilevel machines are classified as bilevel machines for regulatory and insurance reasons, but they're a considerably more complicated animal than the "normal" bilevel machine.

[awakeinnj]

Take 2...

http://s1265.photobucket.com/user/awake ... sort=3&o=0
http://s1265.photobucket.com/user/awake ... sort=3&o=2
http://s1265.photobucket.com/user/awake ... sort=3&o=1


PS - I can see on there that the EPR = 0 -- never thought to look into it.

Also, would getting an oximeter be worthwhile? I'm looking into everything I can think of as I've been tired for far too long.

Thanks again.

[Pugsy]

Are you sleeping solidly through the night or awake for brief or any period of time during the night?
Many awakenings? Take any meds of any kind?

Looks like your pressure is 8 cm with EPR turned off.

The one report that I could see the AHI was a little over 3 if I saw it right. About half and half central and hyponea. That's not enough centrals to warrant doing anything about them even if they were all real centrals. Remember some central occurrence is just normal. Like sleep onset centrals. Need over 5.0 Central index shown consistently night after night before someone wants to starting thinking complex sleep apnea.

APAP mode machines don't respond to centrals because more pressure doesn't fix centrals. You would need a lot more centrals than shown here before the docs would want to do anything about them.

I don't see enough centrals to warrant doing anything but shrugging my shoulders on this report.
I also don't see any urgent need to try apap at this point.

[awakeinnj]

Hi.

I sleep solidly through the night -- usually 7-10 hours and closer to 10. I'm getting better about consistent bedtimes, but it's never enough. I'll occasionally wake up if I hear the mask leaking badly, but that usually don't happen and when it does I only remember it for a few seconds. My typical night is like what I posted -- straight through, with the events (registering mostly as central, but who knows) at the end when I'm having exhausting, deep dreams. I take meds for acid reflux, Cymbalta (anxiety/depression), vit's b-12 and D. All those problems are well controlled. We'll see what the neuro and endo have to say about the fatigue/headaches when I go in a few weeks, but I'm trying to experiment before then.

My gut instinct is that the sleep doc is right -- i.e., that the CPAP therapy is working and that something else is contributing to the problem. Numerically, things are indeed way better than they were at the start.

[Pugsy]

Go research your meds...dig deep on the potential side effects.
Especially the Cymbalta

Look it up under its chemical name duloxetine

Here's just one source
http://en.wikipedia.org/wiki/Duloxetine
This is only part of the side effects but very likely applies to your situation
Nausea, somnolence, insomnia, and dizziness are the main side effects, reported by about 10% to 20% of patients

Don't know what somnolence is? Excessive sleepiness during the day.
All those type of meds ( SNRIs and SSRIs) are pretty much known to mess with sleep quality and/or cause issues with sleep architecture and daytime sleepiness.

Look up whatever meds you are taking for acid reflux...sometimes they mess with sleep also but I suspect your primary suspect is the Cymbalta

Talk to your doctor about the possibility that part of your unwanted symptoms could be related to your meds. You wouldn't be the first.