Links to Central Apnea

[rested gal]

First, a link to JohnBFisher's great post about studies and articles about Central Apneas and Complex Sleep Apnea:
viewtopic.php?p=457468#p457468

In this topic:
how serious is periodic breathing and clear airway
viewtopic.php?p=554372#p554372
Note the excellent explanation by JohnBFisher to this question:
"What is the difference between periodic breathing and a central apnea event?"


Some old links provided by christinequilts to websites explaining what "Central" apneas are:

Central Sleep Apnea: Details
Comment by christinequilts: good diagrams but a little too focused on Cheyne Strokes breathing
http://www.apneos.com/csa.html#causes

Central SLeep APneoa- UK article
Comment by christinequilts: this is the most complete description of central apneas in laymens terms though it is lacking when it comes to describing treatment due to age of the article & difference in healthcare between US & UK.
http://www.britishsnoring.co.uk/central ... pnoeas.php

_____________________________________________________

One of my favorite posts by christinequilts is in this topic:
Oct 24, 2005 subject: Central Apnea
viewtopic.php?t=5331

Part of her excellent post:
"Everyone has central apneas- take 3 or 4 very slow & deep breaths right now, then count how many seconds after the last inhale until you feel the need to inhale again. Was it more then 10 seconds? If it was, you just had a central apnea. Next time you sigh take note how long before you inhale again....yep, another central apnea. Yawn? same thing can happen. Pick up a heavy box or weight- did you remember to breath? if you didn't, then you had another central apnea. Think of what you hear exercise trainers lecture about breathing while exercising- its human nature to not breath when we exert themselves.

Of course all of these are awake apneas- but any time you don't breath for 10 seconds, you technically have an apnea. While sleeping, you can have similar things happen- you can take several deep breaths and not need to breath for several seconds."

______________________________________________________

At another apnea board:
http://www.apneasupport.org/viewtopic.php?p=24677

In a reply titled "Nope" sleepydave (RRT, RPSGT and manager of an accredited sleep center) responds to honda's question:

honda wrote:
"Thanks for the comments, one other question though, do the 4 central apneas have any significance ?"

"None whatsoever.
sleepydave"

sleepydave's nicknames on cpaptalk are "deltadave" "StillAnotherGuest"(SAG) "Muffy" and "NotMuffy"

_____________________________________________________


Regarding concern about "pressure induced centrals"

viewtopic.php?t=14225
Page 2

The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels. BiLevel, Pressure Support (PSV) and Proportional Assist (PAV) Ventilation are another matter. You need some mechanism to drive the pCO2 below the sleeping apneic threshold, and plain old CPAP rarely is able to do that. OK, if you wanna argue that CPAP increases base lung volume (Functional Residual Capacity)(FRC), and since that increases gas exchange, some people can generate centrals that way, fine. But it's not as many as you might think.
SAG

SAG ("StillAnotherGuest") is also "deltadave", "Muffy" and "NotMuffy" on cpaptalk and "sleepydave" on another board.

___________________________________________________

"Sleep onset centrals" are normal:

viewtopic.php?t=18117
page 2, from a post by StillAnotherGuest:

Assuming that the obstructive events are properly managed, then the likelihood of these being sleep-onset centrals is fairly high (you'd need PSG to be 100%) and those things are pretty much a normal event.

___________________________________________________


Below are some links to message board discussions about central apnea.
Note especially the posts by JohnBFisher and christinequilts (aka christine) who have firsthand experience with predominately Central Sleep Apnea.
Also take special note of posts by StillAnotherGuest (aka Muffy and sleepydave), posts by -SWS, by split_city, and by ozij:

Jan 3, 2011 subject: Resmed's Central Sleep Apnea Detection - Resmed publication -- ozij posts link to ResMed white paper
viewtopic.php?p=552854#p552854

Dec 31, 2009 subject: Clear Airway Apnea = Central Apnea? -- StillAnotherGuest/Muffy and -SWS
viewtopic.php?p=435312#p435312

Oct 01, 2004 subject: Central sleep apnea? -- christinequilts
viewtopic.php?t=92

May 26, 2007 subject: Not such a goodknight MrPaul -- christinequilts and StillAnotherGuest
viewtopic.php?t=20405

Apr 04, 2007 subject: No air provided if no inhalation on BiPap? sharonius -- christinequilts
viewtopic.php?t=18792

Mar 28, 2007 subject: Centrals Now? WearyOne -- StillAnotherGuest
viewtopic.php?t=18588

Mar 09, 2007 subject: APAP Discussion CollegeGirl -- StillAnotherGuest
viewtopic.php?t=18054

Dec 16, 2006 subject: Central Sleep Apena I think but told Obsructive.. {new here} visionoftruth -- christinequilts
viewtopic.php?t=15901

Nov 03, 2006 subject: Recognizing Central Apneas Justin_Case -- christinequilts
viewtopic.php?t=14844

Oct 10, 2006 subject: Effects of too much pressure 3 page topic (pages 4 & 5 were spam, later deleted): Archoliva (accidentally "guested") and cwsanfor -- -SWS and StillAnotherGuest
viewtopic.php?t=14225

Jul 04, 2006 subject: Pressure-Induced Central Sleep Apnea sleepydave looks at SnoozeHunter's sleep study
http://www.apneasupport.org/viewtopic.php?t=5054

Oct 14, 2006 subject: complex sleep apnea and BiPaP use. StillAnotherGuest posts charts and explains "mixed apnea".
viewtopic.php?t=14359

Oct 24, 2005 subject: Central Apnea LoneRider -- christinequilts
viewtopic.php?t=5331

Aug 29 2005 Are all hyponeas Obstructive?? Guest -- sleepydave and christine
http://www.apneasupport.org/viewtopic.php?t=759

Aug 26 2005 subject: Central apnea from high pressures? pinetree -- christinequilts and ozij
http://www.talkaboutsleep.com/message-b ... hp?t=12391

Aug 22 2005 subject: CSA OSA autoC-pap, Bi-pap, etc. etc. Guest -- sleepydave and christine
http://www.apneasupport.org/viewtopic.php?t=695

Jun 22, 2005 subject: Three Sleep Studies in 3 months?????? MoSleep -- christinequilts]
viewtopic.php?t=3393

Mar 26, 2005 subject: 1 mo. CPAPer/mild apneac with doubts & detailed PSG resu noahmckinnon -- christinequilts - "Think about when you exercise or concentrate hard- if you're not aware you can hold your breath which is essentially central apnea."
viewtopic.php?t=2051

Sat May 14, 2005 subject: having to noticably catch my breath bdmiller -- links to several posts by christinequilts
viewtopic.php?t=2844

Jan 26, 2005 subject: Apneas, Central Apneas and Hypopneas Janelle -- christinequilts (accidentally "guested")
viewtopic.php?t=1056

Jan 21 2005 subject: AutoPAP failed, Bi-Level is worse, Help!!! jhoeger -- christinequilts
http://www.talkaboutsleep.com/message-b ... php?t=4923

Jan 05 2005 subject: APAP VS. BPAP Question emsyessy and frequenseeker -- -SWS and christinequilts - "ballroom dancers" and "passenger car" analogies
http://www.talkaboutsleep.com/message-b ... php?t=4798

Feb 21, 2005 subject: Remstar Auto - Non-responsive events? cpaper -- -SWS
viewtopic.php?t=1483

Feb 11, 2005 subject: Shallow breathing on CPAP SuckingWind -- -SWS
viewtopic.php?t=1301

Jan 23, 2005 subject: Mixed Apnea Procrastinator -- -SWS
viewtopic.php?t=990

Apr 16, 2005 subject: Medical Rationale for CPAP over APAP? Newsgrouper -- -SWS(5 page topic; -SWS's comments begin on page 3)
viewtopic.php?t=2422

Apr 26, 2005 subject: Newbie to the CPAP World, Also a few questions... ChicagoCpap -- christinequilts
viewtopic.php?t=2585

May 28 2005 subject: Central Sleep Apnea caulie -- links to posts by christinequilts
http://www.talkaboutsleep.com/message-b ... hp?t=11041

Jan 04, 2005 subject: obstructive vs. central apnea sleepydave Guest (different person from "sleepydave" on another board) and bsleep -- -SWS
viewtopic.php?t=694

May 26 2004 subject: Apnea worse with CPAP!? papaglock -- christinequilts
http://www.talkaboutsleep.com/message-b ... php?t=3008

Feb 04 2004 subject: Resmed VPAP II ST vs Respironics Synchrony ST Thomas123 -- christinequilts
http://www.talkaboutsleep.com/message-b ... php?t=2352

Jan 31 2004 subject: Seeing new Doc for Central ! <Nancy> Guest -- christinequilts
http://www.talkaboutsleep.com/message-b ... php?t=2323

Dec 14, 2004 subject: Cardiac oscillations Question (2 page topic) chrisp -- -SWS; also the posts by Nev and Titrator
viewtopic.php?t=514

Aug 07 2004 subject: CPAP vs AUTOPAP vs BIPAP?
http://www.talkaboutsleep.com/message-b ... php?t=3422

________________________________________

Topics about "Complex Sleep Breathing" (CSBD) - involves "centrals" but not the same thing as "having occasional centrals":

Twenty+ page thread:
Jul 22, 2006 subject: Resmed VPAP Adapt SV - for Central Sleep Apnea
viewtopic.php?t=1145

Jun 28, 2006 subject: APNEA -v- HYPOPNEA
viewtopic.php?t=10545

This one has been dubbed "TMOAT" (the mother of all threads) by some, due to its length:
Nov 06 2005 subject: Sleep Disordered Breathing - a New Category. Excellent artic
http://www.talkaboutsleep.com/message-b ... hp?t=13557

[luckylinda]

rested gal,

You are certainly a work horse for all of us! I truly appreciate the time you selflessly put into the educational and helpful posts you make.

I appreciate you and just wanted you to know that

Most sincerely,

[neversleeps]

Absolutely! I second the motion!!!

You have helped me immeasurably!

[neversleeps]

bump

[christinequilts]

Rested Gal-

Here are a couple other good outside links for CSA:

Central Sleep Apnea: Details- good diagrams but a little too focused on Chenye Strokes breathing
http://www.apneos.com/csa.html#causes

Central SLeep APneoa- UK article from 1996...this is the most complete description of central apneas in laymens terms though it is lacking when it comes to describing treatment due to age of the article & difference in healthcare between US & UK:
http://www.britishsnoring.co.uk/pdf/j11.pdf

[rested gal]

Thanks sooooo much, christine! While updating the links just now, I added those sites to the top of the list. If you come across more that will help people's understanding, please let me know and I'll add more to the top. Your information is invaluable!!!

[JohnBFisher]

Rested Gal, I decided to add some of my entries to your list. Hope it helps others.

Here's an article that discusses how central sleep apneas occur during sleep onset:

Ventilation is unstable during drowsiness before sleep onset
http://jap.physiology.org/cgi/reprint/99/5/2036

This happens to everyone and is normally not an issue. However, if someone has problems with their central nervous system (particularly in the brian stem area), with their heart (such as congestive heart failure) or their kidneys (yup that was a surprise to me), then the sleep onset central apnea frequency and duration increases.

So, one or two central apneas, it's normal. Don't worry about it. If it happens ALL the time, then it's time to discuss it with your doctor. It is often due to an underlying problem, which may need to be addressed.


Here's some Central Sleep Apnea articles:

Central Sleep Apnea: Pathophysiology and Treatment
http://chestjournal.chestpubs.org/conte ... l.pdf+html

Central Sleep Apnea: Implications for Congestive Heart Failure
http://chestjournal.chestpubs.org/conte ... l.pdf+html

Effective Treatment for Idiopathic Central Sleep Apnea?
http://www.ncbi.nlm.nih.gov/pmc/article ... .2.130.pdf


Here's some Adaptive Servo-Ventilation articles:

Efficacy of Adaptive Servoventilation in Treatment of Complex and Central Sleep Apnea Syndromes
http://journal.publications.chestnet.or ... id=1085594

Adaptive Servoventilation (ASV) in Patients with Sleep Disordered Breathing Associated with Chronic Opioid Medications for Non-Malignant Pain
http://www.ncbi.nlm.nih.gov/pmc/article ... .4.311.pdf

Adaptive servo-ventilation and deadspace: effects on central sleep apnoea
http://www.sciencesleep.org/ziliao/Adap ... apnoea.pdf

A Randomised Controlled Trial of Adaptive Ventilation for Cheyne-Stokes Breathing in Heart Failure
http://ajrccm.atsjournals.org/cgi/repri ... 2-1476OCv1

Adaptive Servo-Ventilation in Patients With Idiopathic Cheyne-Stokes Breathing
http://www.aasmnet.org/JCSM/Articles/020212.pdf

Adaptive Servoventilation Versus Noninvasive Positive Pressure Ventilation For Central, Mixed, And Complex Sleep Apnea Syndromes
http://www.resmed.net/us/documents/Morg ... ilevel.pdf


Here's some Complex Sleep Apnea articles:

Complex Sleep Apnea: It Really Is a Disease
http://www.ncbi.nlm.nih.gov/pmc/article ... .5.403.pdf

The Quest for Stability in an Unstable World: Adaptive Servoventilation in Opioid Induced Complex Sleep Apnea Syndrome
http://www.ncbi.nlm.nih.gov/pmc/article ... .4.321.pdf

Complex Sleep Apnea
http://www.chestnet.org/accp/pccu/compl ... a?page=0,3

[dsm]

John,

Outstanding collection of articles there. Between you & RestedGal we have an impressive collection of excellent info.

Thanks for your additions.

DSM

[Fred D]

John, Thanks for bumping this back up and adding the information to it. Now if I can just digest it I will be be more knowledgeable about this
CSA issue.

Fred D.

P.S.
My card reader will be arriving via UPS tomorrow. Have the Encore 2.2 software installed and if everything goes right I may need some wisdom
interpreting the data.....

[rested gal]

Thanks very much for the excellent additions, John.

[Patrick A]

RG
Thank you for the links. John Thank You too.

[westtiger]

качество класное качать можна

[JohnBFisher]

packitin shared a link to a website that explains the differences between CPAP, BiPAP, and ASV. It may not be a fancy site, but the content is quite good:

http://www.lakesidepress.com/CPAP/CPAP.htm

Also, it has extended information on ASV type units:

http://www.lakesidepress.com/CPAP/ASV.htm

packitin, thanks for sharing. Making this type of information available to all members and visitors to this forum is one thing that makes this forum stand out from others available online. And I think these two pages will be helpful for anyone researching issues with central apnea.

[Tielman]

John:

I love the quote by a Board certified in Pulmonary and Sleep Medicine Doctor:

We need ONE machine for patients with sleep disorders, with all modes built in. Not 6 different machines and over a dozen different models from just one company. The only valid objection is that the high tech machines cost more, and that the companies can't sell one machine at one price with a wide range of functions and still make a profit. This objection is easily overcome by charging for the program used, not the machine. Just as several people with the same identical cell phone can pay different rates depending on the service (phone calls only, internet access + phone, etc.) the charge could be based on the modality used: more for ASV and less for simple CPAP.

The sleep community needs an all purpose positive pressure machine that can do everything, whatever the clinical circumstance, and not this plethora of confusing, overlapping machines that are all too often poorly understood. Such an approach from industry might even sell more machines, especially if prices come down, and patients realize they can try different modalities while at home, without obsoleting their existing machine.

I've never understood why a Medical Device is sold like a car (oooo, ours is much shinier than theirs and has these unnecessary bells and whistles). Then again, I get confused when the US Patent office allows the patenting of Genes (either plant, or human!), or why medicine (human suffering) is "for profit", so it's probably me

[JohnBFisher]

Sorry for the delay in the response.

Though I understand the basic ideal behind the doctors thought - that we need just one machine - the fact is that most patients are fine with CPAP therapy. Why should most people pay more for therapies that they do not need. Let's say that it's about 90% that find some form of CPAP sufficient.

Of the remaining 10% of the population that uses xPAP therapy, most of those (say 90% of the 10%) find that BiPAP of some form meets their needs. Why should they pay more for therapies they do not need?

And then the remaining 10% of the 10% need some combination of ASV, AVAPS, etc ... to meet their respiratory needs.

One machine to meet all those needs would SUBSTANTIALLY increase the cost of the basic machines and ony marginally decrease the cost of the more expensive machines.

Sure we could build a car that we could use as a dump truck, but most of us don't need a dump truck. So it is with xPAP therapy. Most folks just want to pay for a unit that meets their needs - nothing more.