Cenral Apnea clues w/resmed s8 vantage auto

[desertPAP]

I just ordered an s8 Vantage Auto cuz my s8 escape doesn't log anything but "ON time". Can a Vantage auto help someone diagnose central apnea. I'm to burned out right now to get into details, but my sleep is total hit or miss on any given night. I'm 48 yrs old and been suffering since 16. Any insight you folks can give would be really appreciated.

If you need any addl info please ask, I used to be a functional human, but as of the last few years, I feel like I got one foot in the grave. Thanks. And Thanks to who ever thought of this website.

-steph

[GoofyUT]

Though the S8 Vantage is a great APAP, auto-titrating xPAPS are generally not thought to be a good idea with primarily central apneas. The increased pressures that it may get to can aggravate centrals, though the S8 algorithm is designed to NOT titrate in the face of an apnea. It therefore, may not amke things worse DURING a central, but it may aggressively titrate to a higher pressure AFTER the apnea passes, and that may provoke more centrals.

On the other hand, ResMed's new VPAP ADAPT ASV is perfec for either central apneas or mixed central/obstructive apneas (CSDB). Howver, it is awfully expensive. Nonetheless, you ought to explore it.

Hope this helps.

Chuck

[christinequilts]

Did your original study suggest central apneas? Sleep apnea alone, whether obstructive or central, isn't the only cause for bad sleep and sometimes we have to look at other possibilites too. If your original studies didn't suggest centrals may be an issues, treating yourself is probably not the option and you really should be talking with your doctor.


Chuck- as far as I know, the new VPAP Adapt has been assigned the same billing code as BiPAP STs- which makes sense. So for me, it just means a swapout of machines. BiPAP ST are fairly expensive, especially in comparison to CPAP & regular BiPAP- the Medicare rental is around $650 per month. I just have to hope & pray that this is finally going to be the machine that works for me after all these years of struggling with CSA.

[GoofyUT]

Good information on the VPAP Adapt HCPCS code, Christine. Thanks!

I just re-read DesertPAP's oriugninal post,a nd the question posed is whether the S8 Vantage is good for DIAGNOSING centrals. the answer to that is a resounding NO!

I just reviewed a report I have from ResMed's AutoScan v5.7 software with my old S8 Vantage. There is NO mention of centrals anywhere. It just reports "Apnea events". So, NO, the S8 is not appropriate fro diagnosing centrals. Only a good, attended PSG should be trusted for that.

Respironic's Encore Pro WILL report "Non-responsive apneas" which are presumably central in origin, but even so, it should NOT be the only means of diagnosing centrals, in my opinion.

BTW, Respironics has also introduced the HeartPAP which is indicated for primarily centrals, I believe.

Hope this helps.

C

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[desertPAP]

Thanks Chuck. The information you posted tells me I really need to look into this more. I"ve cancelled my order.

I've had three sleep studies done in the past 3 or 4 years. The first two were flawed in that I was not cpap tritrated in the first study even though I had well above the limit of apneas to warrant it, and in the second study the tech had trouble keeping the data collection systems working and kept waking me up consistantly and titration was never properly established as far as I know. I still had to pay full price for both however. In the third study, I was properly titrated for cpap.

My ENT told me he was suprised to see that in neither of the last two sleep studies did I show any sign of what he called REM rebound. I guess that means a significant increase in proper REM due to previous deprivation. Does this possibly indicate Central Apnea? Or something else?

Even when using cpap I still need 60mg of Adderall daily to feel alert and somewhat functional. But I think the medication is wearing me out. I stopped the 15 mg of Ambien every night because after a year or so I wasn't sure whether it was really helping the situation. I even tried Xyrem ( GHB ) for a while to affect my sleep architecture but the expense and the hassle far out weighed any perceived benefit.

You know, it would be really nice to have somekind of health professional that could guide folks like myself through this arduous process. The specialists only want to look at you through the lens of their profession while the generalists don't know enough.

I'm convinced that if I walked into an Optometrist's office with this set of symptoms, I'd walk out with a pair of glasses 30 minutes later.

Yah, I'm frustrated.

[desertPAP]

thanks christine and goofy. You both posted while I was replying to chuck.

[Goofy-guest]

DesertPAP-

I'm SO SORRY for your travails!

I hope that you can find a dcent pulmonologist who knows what he/she is doing with regard to sleep medicine. Perhaps if you post your location here, someone will chime in with a recommendation.

BTW, I haven't found one myself yet, either.

Keep up your good attitude and strength, and you'll get it turned around.

Chuck

P.S. I presume that your internist has approved the use of amphetamine salts?

[desertPAP]

They're prescribed by my neurologist. He's the one I was referred to when my more than capable ENT didn't know what to do. I just recently moved from Austin tx, I'm about 90 miles North of Phoenix now and with the recent population growth here it's next to impossible to get into see a doc. I've got an appointment with the mayo clinic in Scottsdale in november. Maybe they can figure out what to do.

You know just about every ailment I've dealt with over the years can be directly attributed to sleep deprivation. I was 22 yrs old and working for a computer company. Not to brag, but I was one of the best trouble shooters around, but at 10:00am just about every morning, I would lock myself in the restroom, turn off the light, and fall asleep HARD. Occationally my supervisor would pound on the door and startle me awake, at which point I would attempt to stand up and instantly fall over cuz my legs had fallen asleep. Weird allergies have crept-up, severe sinus infections prompting no less than three major sinus surgeries, muscle cramps in my shoulders and neck. The brain fog and ADD symptoms are the worst. I was a very successful software architect about 8-10 years ago. Shit some days I can't hardly even load up the dish washer cuz the dish placement seems to complex. I'm not exagerating, I've walked away from the kitchen not knowing where to put the cup in the dishwasher. I really don't like being like this, I just don't know what the hell to do.

You walk into most Doctor's offices and start going down the list of symptoms and you can just watch their eyes glaze over. It wouldn't matter if at some juncture I just pointed out the window and screamed BIGFOOT. They just think you are a hypochondriac and then order up a battery of tests and usher you out the door. Next.

But I'm not bitter, nope. Just put on that happy face.

[kteague]

DesertPAP - That brain fog thing can be so maddening when the simplest decision can seem too complex to face. That experience is not uncommon among those with long term sleep deficiencies. Seems to me a priority to getting you further down the recovery road is to find out unequivocally if your cpap therapy is effective. My doc approved a loaner autopap for 2 weeks because the cpap after 8 months just wasn't helping me. Turns out my pressure of 10 needed to be 13. Tell your doc you still feel horrible and need to not stop here. If you can confirm that your apnea is being therapeutically treated yet you still feel tired, then it's time for your doc to run more tests to find out what's making you tired. Be upfront with your doc about your expectations and say "I want answers - now what do we have to do to get them?" Hopefully you be able to turn this around in the near future.
Kathy

[CollegeGirl]

DesertPAP - you still didn't say why you believe you have centrals. Is there reason behind your theory that this is the cause of your still being sleep-deprived, or are you just not sure, and this is something you want to check out?

I really wish you the best. I, too, went decades without being diagnosed, and a year and a half on CPAP treatment before seeing any results. I wish you all the luck in the world. It is SO worth it when you finally get it right.

[Snoredog]

I agree with Chuck, the Vantage is probably the worst machine to have if you suspect you have central or mixed apnea.

You should pull out and study your last PSG's and titrations. If you don't have copies of those, you need to go back to your ENT or Sleep lab and demand a copy even if there is a small fee to obtain the copy. You have every legal right to these copies and you NEED them.

Your PSG's should note if you have central apnea or mixed or if they are good even Complex Sleep Disordered Breathing (CSDB).

Personally, I think you are going to an inexperienced Sleep doc (REM rebound.... the guy's a quack!). REM rebound rarely shows up on a titration study, only lasts about 2 weeks tops and all it is you want to stay in REM much longer, you feel fantastic from it but it soon fades. Everyone tries to get back to there but it is like being born, you fight to get out then spend the rest of your life trying to get back in.

I would go to http://www.absm.org and select your state and look for a pulmonologist sleep specialist doc in your area. Next, I would take copies of all your PSG's with you.

In the mean time: I would take the pressure found by the sleep lab and set you machine's Max pressure to that value (in fact I'd even go .5cm to 1cm below it). If your pressure from the lab was <10cm you can still use apap mode, but I'd recommend a 30-minute settling time and setting your Min. pressure to like 6.0 or 7.0cm.

You might also want to search for CSDB here (Complex Sleep Disordered Breathing). If you have CSDB autopap and even cpap can be contradicted with CSDB.