Central Sleep Apneas (THought anyway)

[Jcochran]

I've done lots of reading, but am still unsure of what exactly is Central Sleep Apnea. I know that during my first PSG, it was determined that I did not suffer from OSA. After talking with the doctor about the results, he decided to order another PSG and use an additional sensor in my nose that would monitor the amount of air I breathe. This PSG showed a mixture of apneas I was told. I was told I ahve hypopneas, not Apneas. It really wasn't explained well to me. I've been on Cpap now for 3 months and no changes in my therapy. I have the Respironics M Series Auto, I can't use the machine on Auto. The machine always runs at max pressure and wakes me up. It will not go back down. I can press the ramp button, but it maxes out again eventually. I've been playing with different pressures on straight CPAP and still can't get my AHI below 7. I have seen that ResMed makes a new machine that is "designed" for Central Sleep Apnea. The Vpap Adapt SV. I believe the new machine is called the S8 Autoset II, is this correct? It is supposed to adjust breath to breath. The runaway experienced from the Respironics will not correct itself for upwards of 40-45 min. according to my DME. I'm just trying to figure out if this new unit will be beneficial to me. Any input is greatly appreciated.

[txnative]

I have seen that ResMed makes a new machine that is "designed" for Central Sleep Apnea. The Vpap Adapt SV. I believe the new machine is called the S8 Autoset II, is this correct?

No, the S8 AutoSet II is just an AutoPAP. It is not what you are looking for if you need a machine designed for CSA.
I will let others more knowledgable about CSA comment on which machine would be better.

[ozij]

The Vpap Adapt SV. I believe the new machine is called the S8 Autoset II,

No, its called the VPAP Adapt SV.

http://www.vpapadaptsv.com/

O.

[chrisd]

First off, who told you that you had CSA? Have you been diagnosed with CSA? If so, then you have been prescribed the wrong device. CPAP, whether auto or not, does an extremely poor job of treating CSA. Most people can resolve their CSA on traditional Bipap, others need a Bipap with a backup respiratory rate, and some cases also require the use of supplemental oxygen.

Basically, to answer your questions, I need a lot more information than you provided. You say you have an auto adjusting CPAP, what pressures were you prescribed? You can't use the auto feature, so what pressure are you using in traditional CPAP?

Also, Respironics also has their own version of a bilevel SV.

[rested gal]

This PSG showed a mixture of apneas I was told. I was told I ahve hypopneas, not Apneas.

J, before you think about what machine you might need, it's of the utmost importance to know "what you're trying to treat." The ASV type machines are very specialized machines which might not be what you need to use at all. Likewise, the older S/T machines when used in anything other than just spontaneous mode.

You really need to get the full NPSG (Nocturnal Polysomnogram) report(s) from your sleep study and have your sleep doctor, or another sleep professional go over it with you and explain exactly what the "mixture" is and what your diagnosis is.

This PSG showed a mixture of apneas I was told. I was told I ahve hypopneas, not Apneas. It really wasn't explained well to me.

It sounds to me like the doctor may have been describing UARS (Upper Airway Resistance Syndrome.) If so, then regular cpap, autopap, or bilevel machines can treat that.

This is oversimplifying, but UARS is kind'a like having a brain that is overly sensitive to the least little collapse in your airway during sleep. A person with UARS might be aroused ("arousals" wreck sleep without actually waking you up) to "breathe better" many, many times during the night. The arousals might be happening before the collapse of the throat gets bad enough to score it as a full apnea. And before oxygen levels get a chance to drop badly enough to score as hypopneas or obstructive apneas.

Being told that you have hypopneas, not apneas, is what makes me think it might be UARS causing arousals before the beginnings of the airway collapse can deteriorate into full apneas.

I'm of the opinion (but I'm not a doctor!!!) that if a person has UARS, their brain might also be extremely sensitive to changes in airflow from the treatment machine. The ASV machines are designed to handle "central" apneas. Centrals involve no collapse in the airway...just a brain that isn't sending a timely signal to "breathe now." The extreme pressure swings that ASV machines use to nudge the sleeper's brain into taking another breath in a more timely fashion, could be very sleep disturbing (cause arousals) for someone (the UARS person) whose throat may already be hypersensitive to changes in airflow.

If what your doctor said showed up was a lot of "mixed" apneas, a "mixed apnea" is a single apnea that starts like a central (no effort to breathe) but ends as an obstructive apnea showing effort (a struggle to get a breath measured by the belts around chest/abdomen) to breathe. I may be wrong, but I think a "mixed" apnea can be considered more like an obstructive apnea than as a central apnea, even though it shows characteristics of both in the one apnea. Thus, it's called a "mixed" apnea.

Even if some pure central apneas showed up in the sleep study, it's doesn't mean a person has "Central Sleep Apnea." A few scattered centrals during a study or during sleep at home are no big deal. A "few" would not be worth trying to knock out with a specialized machine that might disturb one's sleep in so many other ways.

Bottom line... I would NOT be contemplating getting a machine specialized to treat "centrals", unless "central" apneas (not "mixed" apneas which are a completely different thing from just "central" apneas) are the biggest part of the sleep disordered breathing problem.

I've been on Cpap now for 3 months and no changes in my therapy. I have the Respironics M Series Auto, I can't use the machine on Auto. The machine always runs at max pressure and wakes me up. It will not go back down. I can press the ramp button, but it maxes out again eventually. I've been playing with different pressures on straight CPAP and still can't get my AHI below 7.

If...big if...you have UARS, it may be that a plain BiPAP machine would treat you well. Two pressures -- one higher one for inhaling, and a lower one for exhaling. Perhaps the hypersensitive UARS brain would relax after getting used to two steady pressures -- the lower exhale pressure making it very easy to breathe out. I'd try bipap before I'd start thinking "ASV."

[One Tired Puppy]

The Vpap Adapt SV. I believe the new machine is called the S8 Autoset II,

No, its called the VPAP Adapt SV.

http://www.vpapadaptsv.com/

O.

Ozij,

This is a great site with videos explaining Complex Sleep Apnea. Thanks for the link.


Anne

[ozij]

Yes, it is a great site - but I think RG is very right about what jcochran needs at this point.

O.

[Jcochran]

Thanks for all the replies. You all were spot on. I've spent most of the day dealing with my doctor and DME. My doctor told me I had mostly "reres"(?) which is upper airway resistance. The DME did tell me that the Respironics Auto M does not recognize the reres and that it is not helping me any. She is getting me a ResMed APAP to try and if that doesn't work then a Bipap. There is hope!!! Thanks for all the input and advice. I'll keep everyone posted once I get the new machine.

[rested gal]

My doctor told me I had mostly "reres"(?) which is upper airway resistance.

RERA -- Respiratory Effort Related Arousals. Yes, RERAs are typical of what happens when you have UARS (Upper Airway Resistance Syndrome.)

The DME did tell me that the Respironics Auto M does not recognize the reres and that it is not helping me any. She is getting me a ResMed APAP to try and if that doesn't work then a Bipap.

She told you right and wrong. No treatment machine "recognizes" RERAs. Or even any kind of effort or arousal. A person has to be wired up for a full PSG study for "RERAs" to be seen.

It's quite likely that the minimum pressure set for your autopap is not high enough to keep your airway well and truly open. It might be a change in settings that's needed, rather than a different brand of autopap. And, it might be that one single pressure (if set high enough to be effective) would work for you better than autotitration. Or... the soothing feel of a bipap's steady two pressures might do the trick..but again, only if the EPAP is set high enough to be effective.

There is hope!!! Thanks for all the input and advice. I'll keep everyone posted once I get the new machine.

It's always fun to try different machines. But the DME saying that the M series Auto "doesn't recognize RERAs" and implying that the ResMed Autoset machine does... he/she is mistaken about what any autopap can/can't recognize. None of them recognize "RERAs." What they can do is recognize when airflow from you is becoming limited, indicating that an apnea could happen if they don't blow a little harder to get the airway open better. But they aren't going to indicate whether you have a RERA or not. The treatment machines by themselves can't see an arousal at all, and that's what a RERA is...an arousal due to respiratory related effort... effort to breathe in more air.

My edit was to put the quote box around Jcochran's "There is hope!!!" comment.

[Jcochran]

This poses new questions to me. If no machine recognizes RERAs, then how did my Cpap titration show 0 events at 6cm? Is it possible that the Cpap study would not show any events because I did not have the sensor in my nose that showed the events in the first place? I mean, if in my first study, no OSA. Then another study with a nasal sensor and then the events or RERAs. If the CPAP study was done with no nasal sensor then was it even accurate? The problem with the APAP is that it was set from 6-13cm, and the machine always ran up to the highest pressure and woke me up. This happened every night, and made the therapy impossible. I tried lowering the max pressure to 11cm, and it ran itself up to 11cm, and woke me up. Called my DME about this- "I don't know, we can try straight CPAP, but I don't know." I'm really starting to feel as if my initial titration may be incorrect.

[rested gal]

Here's a little experiment you could try if you want to... set your machine in auto mode, but set both the minimum and maximum pressure for the same pressure. Set them both for 10 cm. Don't set ramp (autoramp.) Set A-flex or C-Flex at "3" to give some exhalation relief.

The machine will work then as if it were a CPAP, blowing just one straight pressure of 10, but it will record everything as usual, including flow limitation data. If you set it in straight CPAP mode at 10, it would not look at flow limitations.

[dsm]

Here's a little experiment you could try if you want to... set your machine in auto mode, but set both the minimum and maximum pressure for the same pressure. Set them both for 10 cm. Don't set ramp (autoramp.) Set A-flex or C-Flex at "3" to give some exhalation relief.

The machine will work then as if it were a CPAP, blowing just one straight pressure of 10, but it will record everything as usual, including flow limitation data. If you set it in straight CPAP mode at 10, it would not look at flow limitations.

RestedGal,

That is an interesting test. My 1st reaction is that the data recording cpaps will record the same data as is gathered in auto mode. The only difference is that in cpap mode it doesn't activate the algorithms.

Only reason I wonder this is that the data I have recorded off Resmed cpaps (elite) and auto (spirit) was identical in the Autoscan reports. With reslink I could get snoreindex data off the elite (cpap). I have data off my old Respironics Auto but never had a Remstar Pro II so can't say if they were different,.

My guess would be (but noy having them means it is just my guess) that the M-Series cpap & M-series Auto, that record nightly data, will record the same data. If not, that info is worth knowing.

Tks

DSM

[dsm]

The advice from RestedGal & others is pretty well spot on. Going for an ASV machine seems more than you may need but don't write them off yet.

If a bilevel can't help you then you could consider ASV providing the dominant aspect of your respiration is hypopneas & flow-limitaions & few obstructive apneas.

ASVs do address both obstructive and central apneas (plus periodic breathing) so are very capable machines. One way you will be able to work out what you really need apart from the good advice of your RT, is that if you find that being on AUTO does not get rid of daytime drowsiness, then a bilevel is the next logical choice & if that in turn doesn't produce the desired results, then with further advice & assistance & based on what type of events are dominant, possibly try an ASV (Respironics Bipap SV or Resmed Vpap Adapt SV).

DSM

[Jcochran]

Thanks everyone. Any answers to whether or not the original CPAP titration is correct due to statement above?

[ozij]

That is an interesting test. My 1st reaction is that the data recording cpaps will record the same data as is gathered in auto mode. The only difference is that in cpap mode it doesn't activate the algorithms

That is not so for the Purtitan Bennett 420E. If you want full data recorded, you have to set it in auto mode, and have min=max. In cpap mode it does not record the additional data.
And I remember being told something similar about a Respironics auto.

O.