central apneas and hypoventilation?

[dataq1]

@wobbly
Here is where it is helpful to understand the terminology.

Your Xpap machine does not report "central apneas" - it reports "Clear Airway Apneas".
As well, (as you have discovered) XpAP machines DO NOT react (increase pressure) to Clear Airway Apneas.

It will react to a flow limitation that is observed.
So a flow limitation that occurs simultaneously and coincidentally with a clear air way apnea, you can expect the pressure to be adjusted in response to the flow limitation - but it's not reacting to the clear airway apnea.

A full understanding of how flow limitations are calculated can be found at https://www.apneaboard.com/wiki/index.p ... 0baseline.
But sufficed to say, flow limitations (and the arbitrary grading) is intended to warn of a POSSIBLE IMPENDING airway obstruction, hence the appropriateness of increasing pressure.

OTOH, clear airway apneas are caused by a whole constellation of factors, which can vary from the most benign to very serious.
That spectrum spans simple breath holding while repositioning in bed, to brain tumors.

Your home XPAP is simply unable to distinguish the causes of clear airway apneas.

However, a in-lab PSG (where the EEG signals from the brain are observed) and a medical history will provide the professional practitioner with clues to diagnose the causation of these clear airway apneas.

Thankfully, the majority of patients are determined to be at the benign end of the spectrum, but it may take a professional assessment to rule out that there is more profound causation of clear airway apneas.

For more information on Central Sleep apnea: https://www.ncbi.nlm.nih.gov/pmc/articl ... %20events.
and one causation I'm most familar with: early diagnoses of Parkinsons.
https://www.parkinson.org/understanding ... ht%20sleep

[wobblycrayon]

Thanks dataq1 thats a lot of food for thought.
We need an inlab sleep study for sure. Whether we will be able to get one or not I just don't know. The starting point is the sleep report and then to try to get someone to talk to me.

Clearly he is being undertreated. If there was more minimum pressure then there would be a chance of reducing clear airway/central apneas. Epr has to go.

I would like to think that many of the events are related to arousals, whether it be pressure changes or turning over in bed, but wonder that they seem to come in runs and are just too much of a consistent particular shape for that to be the main cause.
When I look at the overview page in oscar I also feel that these clear airway events were there there from the start and they just couldn't properly identify them with a home study.

https://imgur.io/a/gZAKkQJ

A parkinson's link is hard to think about.

[Julie]

Done.

[Wondering1]

A parkinson's link is hard to think about.

Yes, it really is.

But these things, thankfully, are the exception to the "rule" that centrals are always caused by micro-awakenings.

In my family I have a cousin who had to have her apneas treated by a ventilator, The machine that she ended up with was an ASV machine that would self-trigger a blast of air if she failed to breath on her own for a prescribed period of time. This machine keeps track of how many times (a night) the machine has to take over and "force" her to breath. This machine helped her handle her centrals.

Subsequently (after many "migraine-like head aches" she was diagnosed with a brain tumor. So she underwent surgery to remove the tumor and the headaches, and other symptoms went away. She still continued to use the ASV machine, however apparently her need for the machine triggering has vanished. Her doctors surmise that the tumor was impacting her brain's breathing centers, and recommended that she could discontinue the forced ventilation when ever she was comfortable to do so.

The point is that we are all unique, and our bodies don't always follow the "rule of thumb".

She is now 34 years old and has two small children ( headaches enough !) Thank goodness that she is an advocate for her own health care and actively sought the best guidance.

Wishing your son the best.

[wobblycrayon]

Thanks Wondering1, so glad about your cousins happy ending!