Central Apnea Question

[ignorantone]

Did a sleep study in 2010 that indicated I have severe Apnea with and AHI index of 38. Low central apneas though. Tried the machine and failed to be compliant.
Did another sleep study in 2012 and the centrals increased. With this last study, they put me on the ResMed S9 vpap, which I liked. My problem again was compliant. Couldn't find a mask that didn't leak and medicare only allow about 2 tried. My question is, do the centrals increase in time if one is not using therapy?

[SleepWellCPAP]

Hello ignorantone,

The question about centrals increasing over time is really an excellent one. The interesting thing about central apnea is that it can be brought about by the application of pressure, ie complex sleep apnea. I wonder if in 2012 you needed more pressure to ablate the apneas and thereby produced more centrals. There are posters on here that would probably know that answer much better than I, but my guess is yes. And the next sequence of events involved the bilevel with an inspiratory pressure a fair amount higher than expiratory.

With high pressures, it is difficult as one would expect, to keep the mask from leaking. The fact that you say "medicare only allowed 2", is very strange as it's usually the provider and/or manufacturer that sets the limit on mask fit guarantees. My suggestion in this case would be to continue to try other masks until you find one that works for you. I personally have swapped over a dozen masks on some patients until I found one that worked. Some sleep labs by the way, will let you try their demo masks. Hopefully you will find something that contains the pressure you need.

Hope that helps.

Jim

[JohnBFisher]

Did a sleep study in 2010 that indicated I have severe Apnea with and AHI index of 38. Low central apneas though. Tried the machine and failed to be compliant.
Did another sleep study in 2012 and the centrals increased. With this last study, they put me on the ResMed S9 vpap, which I liked. My problem again was compliant. Couldn't find a mask that didn't leak and medicare only allow about 2 tried. My question is, do the centrals increase in time if one is not using therapy?

Hmmm... I would disagree with your nickname .. It's a reasonable question.

Second, yup ... I'm going to say it ... You really ought to keep with the program. Obstructive and central sleep apnea (especially the latter) is connected with Sudden Death Syndrome. And that's not just me saying that. Researchers are finding a clear connection:

http://scholar.google.com/scholar?hl=en ... h+syndrome

Third, if you had an S9 VPAP Adapt, then it's little wonder the mask leaked. (That machine and one like it from Respironics can really swing the pressure... But it's doing that to help sustain your breathing when you stop). You can use mask liners to help reduce the leaks and quiet them when they do occur.

Fourth, more importantly, you will feel a LOT better if you are able to get a good night of sleep. You will be surprised at how much difference it can make.

Finally, to answer your question, you will probably see an increase in the number of central apneas as you age. Remember, it's not normal to stop breathing. This indicates there is some basic problem with your brain stem. That's not bad in itself. But when you stop breathing every night you only make the situation worse .. and the central apneas will tend to increase. Though there is no cure (and it's not immediately life threatening), there is something you can do to reduce further damage ... start to use and stay complaint with the xPAP device that's prescribed.

Hope that helps answer the question.

[Acroflyer]

Hello ignorantone,

The question about centrals increasing over time is really an excellent one. The interesting thing about central apnea is that it can be brought about by the application of pressure, ie complex sleep apnea. I wonder if in 2012 you needed more pressure to ablate the apneas and thereby produced more centrals. There are posters on here that would probably know that answer much better than I, but my guess is yes. And the next sequence of events involved the bilevel with an inspiratory pressure a fair amount higher than expiratory.

With high pressures, it is difficult as one would expect, to keep the mask from leaking. The fact that you say "medicare only allowed 2", is very strange as it's usually the provider and/or manufacturer that sets the limit on mask fit guarantees. My suggestion in this case would be to continue to try other masks until you find one that works for you. I personally have swapped over a dozen masks on some patients until I found one that worked. Some sleep labs by the way, will let you try their demo masks. Hopefully you will find something that contains the pressure you need.

Hope that helps.

Jim

My experience and professional opinions I read or heard lends credence to the idea that the more pressure we need to treat obstructive apnoeas and hypopneas, the more centrals or clear airway apneas we're likely to experience. The explanation is that the brain transmits a message to breathe when our carbon dioxide (co2) level is at a certain point. Air at an artifically high presure (caused by a machine that forces air down our throat at a much higher rate than normal) lessens the Co2 in our system. The brain has sufficient oxygen or hasn''t reached the co2 threshold where it needs to transmit a message to breathe. Thus, no breathing but no airway obstruction. Our machine reports a central or clear airway obstruction.

Do we need the air or not when those macine reports a clear airway or central obtstuctions/s? I look at my respiration rate after the centrals. There's a problem if my breathing signifficantyl increases after the centrals because that would indicate my system is starved for oxygen. Mine doesn't. If it did, I would invenstigat the possibility that I may need ASV or a machine designed to treat complex sleep apnea which is a combination of obstructive and central apneas.

Numbes tell it all provided we interpret them correctly. Learn your numbers and how to post themn if you'r uncertain about how to interpret them.

[ignorantone]

Thanks people! You are so helpful. Sleeping is difficult for me without a mask, let along getting used to one. I take, alternating every night so I won't get addicted, Ambien, Ativan, Tylenol PM, Melatonin. Frustrating but I think a lot of women have sleep problems, with or without Apnea. Again, thanks all and would love to hear from even more of you.

[sleepstar]

Can you do a trial again? New masks are coming out all the time. Different ones may be available now. Unfortunately mask fit is the hardest part. Trial and error really.

[Grand-PAP]

Thanks people! Again, thanks all and would love to hear from even more of you.

Hi NOT ignorantone,

I agree with JBF, you have chosen an inappropriate name. Your questions are not ignorant and definitely important.

FIRST, I would suggest that you go to the CONTROL PANEL tab at the top of the screen, then Click PROFILE (complete the profile) and finally click EDIT EQUIPMENT and register your equipment. If you, in fact, have a S9 VPAP "ADAPT" it will NOT be in the drop-down list, so you will need to add it to the Additional Comments Field.

Especially since you indicated a prior problem with COMPLIANCE, you will find this forum to be a huge benefit to help resolve your problems and to allow you to be compliant, but more importantly enable you to get the maximum benefit from your therapy!

if you had an S9 VPAP Adapt

NEXT, JBF's comment is critical. In your post, you indicated, "ResMed S9 vpap." VPAP is ResMed's trade name for a BiPAP machine. HOWEVER, it is not necessarily the S9 VPAP ADAPT. The ADAPT is the machine that is specifically designed to treat Central Apneas and Complex Sleep Apnea. That was the purpose for my above comment suggesting that you register your profile and equipment. That will provide members the information to assist us in responding to your future posts. AGAIN, if it is an ADAPT, you will need to add it in the Additional Comments field.

Now to your question regarding leaks. If you have done much research on this forum, you're already aware that a successful mask selection is personal -- what works for one may or may not work for another. However, forgetting COMPLIANCE, attaining successful therapy is important enough for you to experiment until you find a mask that works for YOU!

The ResMed Mirage Quattro Full-face mask (NOT FX, to begin with) is a major go-to mask. It is one you definitely should consider. If so, I would recommend . . .

1. That you check the following: Taming the Mirage Quattro http://tinyurl.com/2ft3lh8

2. Purchase a Mirage Quattro Full-face mask liner from: http://www.padacheek.com.

FINALLY, my personal observations regarding CAs. Seventeen months ago, my Doc prescribed a S9 Elite (Straight CPAP machine). Even with CPAP therapy, I had AHI of 10 or more with CA index of 6 or 7 each night. My CPAP pressure was 10cm H2o. It took three or four EXTREMELY difficult months to get a PR System One autoSV machine (Respironics machine for CA Therapy). For the past 223 nights, with ASV therapy, my AHI has been .79 and virtually ALL EVENTS have been Hypopneas. I have perhaps one CA per week, on average. PLUS my inspiration pressure is 12.5cm H2o. So, my point is . . .

Yes, increased pressures, might in fact, cause CAs; however, with the ASV unit specifically responding to CA and Complex events, even with increased pressure, one can have improved CA results.

So, STICK WITH YOUR THERAPY!! Register and come back OFTEN with your results and questions. You'll find the forum filled with people who have traveled the same road as you and they are MORE than willing to help you avoid the pitfalls!!

Sleep Well! Best of luck with your therapy!

[Pugsy]

Couldn't find a mask that didn't leak and medicare only allow about 2 tried.

It isn't Medicare limiting the masks to 2. It's the DME's own in house mask swapping policy.
Medicare pays for 1 period during that first time period before they will pay for another.
The mask manufacturers themselves actually offer a 30 day trial/swap period for their masks and a DME that has your interest at heart will let you try any number of masks utilizing the manufacturer's 30 day trial and they have a bit more paperwork to do but this allows a patient to really try any number of masks in an effort to find one that suits you.
The DME has decided to only allow 2 because they don't want to do any extra work.
Not all DMEs are this way....shop around and ask what their policy is. Try to find a DME that actually has a policy like the mask manufacturers have offered.
My own DME had their own in house rules too but their rules were fairly generous...during the first 60 days I could try any number of masks free. I could have tried a new one every week if I wanted to. Insurance only gets billed for the first one...the rest of them the DME utilizes the manufacturer's policy. A little more paperwork for them to do but end result is the patient can try every mask they have available if they need to within that 60 days.

[ignorantone]

Hi Grand Pap!

Thank you so much for your comments. I have had 3 sleep studies over the past 3 years and because I am on Medicare, I have been unable to be compliant all 3 times and they take away my machine after 90 days. I am trying to get an appt. for a 4th sleep study. Problem has been masks fitting properly. Nose pillows don't work because I do breath thru my mouth at times. I am just very very frustrated with the whole process but know I need help.