Periodic breathing

Posted awhile back about my husband who has very high centrals (AHI 20-30+, almost all CA events) since starting CPAP. Saw the doctor and everything checks out health wise. He’s healthy with no cardiac issues. Initially he had improvement with just keeping the settings min 6 and max 8 but then allergy season hit and he needed more pressure for the obstructives. Since this time he’s pretty much never had an AHI below 15. He’s tried three different masks and is now using the air touch full face.

Hubby is convinced this is just his normal breathing pattern. He has no desaturations with them. Every fourth breath he just seems to hold his breath for about 15 seconds. Hubby can hold his breath for 2.5 minutes at baseline so maybe he really isn’t affected by these CAs?

Initially hubby felt awesome starting CPAP and it was like night and day. Lately though he is saying that he isn’t sleeping well because his machine is constantly giving those oscillatory pulses to tell him to breath and it’s distrusting his sleep. I did some searching and it looks like that feature can’t be turned off.

Doctor suggested BiPAP trial. Hubby thinks he just needs a CPAP machine without the oscillation for CAs.

So questions are
1) is there a CPAP that doesn’t oscillate for CAs
2) would bipap even help or does he need ASV specifically? Is the ASV uncomfortable as it forces you to breath? I feel like he would hate that.

Thanks!

Yes - look at the ResMed 10 Airsense Auto, possibly the 'For Her' model (nothing to do with him vs her, just a bit more polished).

I returned my Respironics because of the pulsing thing!

Can you please post a recent detailed report from your husband's machine?

nairb49 wrote: ↑

Tue Jun 30, 2020 5:30 pm

1) is there a CPAP that doesn’t oscillate for CAs

No...any machine worth anything at all will do something to try to figure out if there is no air flow because the person simply isn't breathing or can't breathe because of airway obstruction. This is something that is critical to know. You don't want to be sticking your head in the sand about this.

The ONLY machine that won't do those occillations.....The ASV machine from ResMed. It doesn't do them because it just treats them straight away if it thinks a central is happening...it doesn't do the FOT thing to decide which is what.

nairb49 wrote: ↑

Tue Jun 30, 2020 5:30 pm

2) would bipap even help or does he need ASV specifically? Is the ASV uncomfortable as it forces you to breath? I feel like he would hate that.

The idea is that a person would be asleep when the central apnea happened and the machine forces the breath and you don't know it.
ASV isn't uncomfortable when it gives you that burst of air to jump start the breathing.... it's for one or two breaths only.

I thought he was doing better...your last post said his AHI was down to below 5....what happened to make it worse?

Thanks!

Yes he has the Resmed auto set and definitely noticed the pulses.

He was doing better for a few nights and then allergies hit and he couldn’t breath through his nose for weeks despite meds and sprays. Needed higher pressures due to the nasal congestion.

Now nose is better and I’ve got it back to lower pressures but the centrals haven’t come down and now he’s driven crazy by the oscillation perhaps making it worse.

Hmmm may have to try the ASV - sucks because insurance won’t cover it at this point.

Date from last night

Zoomed in


Going to try max 10 tonight

Insurance companies have their hurdles people have to jump before they will pay the big bucks. It is what it is.
Depending on the insurance...one of the first hurdles is not do well with cpap/apap then the next hurdle is bilevel and then when a person doesn't do well with regular bilevel they get to move on to ASV bilevel for central treatment.
Unfortunately insurance companies won't accept the fact that he doesn't like FOT occillations as a legitimate reason for paying for ASV.
Regular bilevel machines still do the FOT or something to distinguish between central and obstructive apneas. They just have to so that they can respond accurately and appropriately.

If he is noticing FOT while awake then he is breathing in a manner that is confusing the machine. It wouldn't be doing the FOT thing if he was breathing nice and normal. He's doing (or not doing) something that is causing the machine to trigger the FOT thing.
FOT won't happen unless the breathing is irregular for some reason or other.

Was he awake or asleep when all those centrals got flagged last night?
Does he spend a lot of time awake with mask and machine on?

I think he was in and out of sleep during the flagged centrals. He can fall asleep easy but wakes up very easily.