Normal duration range for apneas/hypopneas with CPAP?

[1210donna]

I'm dx'd with Mixed Apnea (largely centrals and hypopneas), and slim with no snoring and no struggle to breathe when having apneas/hypopneas. I'm on a Resmed S9 Autoset. Been on it since 2012. In 2013 I was dx'd with a connective tissue disorder and have autonomic neuropathy as part of that (40-70% with it have AN). This was not known when I was put on the Resmed S9 autoset. Although my AHI looks good on the Resmed S9, I recently became concerned because in spite of the low AHI there were days with hypopneas up to 130 secs that were not being stopped by the machine and a day with 23 centrals in one hour - combined non breathing of around 10 min in that hour. My pressure was set to 10 and the median was at 10 and the 95% was at 10. I got the pressure turned up to 12 and checked and now the median is at 11.66 and the 95% at 12. Guess pressure needs to be higher still.... Although the AHI is low, its still quite normal for my centrals and hypopneas to be up to 30 secs (I rarely have anything flagged as an obstructive). I know CPAP won't stop all events but shouldn't their duration at least be under 30 secs? What is the normal duration range for apneas/hypopneas with good working CPAP?
thanks

[Julie]

Hi, some more knowledgable people will follow here, but I'm curious about a couple of things... for one, centrals are not usually addressed by 'regular' Cpap (or auto), and a different machine is necessary, i.e. one that can register them to begin with, which a regular machine normally won't (though it will track hypopneas), and if you do have an Autoset, why is it set in Cpap mode rather than a range of pressure e.g. 8 to 12? I don't think it's possible to say how long a 'normal' event is for anyone as we're all different of course, and even our own events change in length over one night. Little suggestion btw, it's probably best to put all your queries in one thread so we can keep track of your 'picture', rather than going to many threads to follow the story.

[JDS74]

With a CPAP machine, centrals are reported but not treated.
Hypopneas should be treated by increasing pressure just like an obstructive apnea.

It's odd that no where along the line was an ASV titration done that would show whether or not your centrals could be effectively treated.

The AutoSet is a capable machine so maybe an adjustment of your oressures is in order.

Check with your sleep doctor to see if a new titration is in order or if some pressure adjustment might help.

[1210donna]

Hi, some more knowledgable people will follow here, but I'm curious about a couple of things... for one, centrals are not usually addressed by 'regular' Cpap (or auto), and a different machine is necessary, i.e. one that can register them to begin with, which a regular machine normally won't (though it will track hypopneas), and if you do have an Autoset, why is it set in Cpap mode rather than a range of pressure e.g. 8 to 12? I don't think it's possible to say how long a 'normal' event is for anyone as we're all different of course, and even our own events change in length over one night. Little suggestion btw, it's probably best to put all your queries in one thread so we can keep track of your 'picture', rather than going to many threads to follow the story.

Hi Julie, it is set to variable pressure... but during the centrals its not reaching max pressure at all... sometimes at 5, or 7 or 8, but not going up or getting near 10.
it does record centrals, but yes it doesn't do anything about them.
I was put on CPAP even though my study dx'd mixed apnea because I didn't have lung failure, heart failure, brain tumor, cervical spinal stenosis or any obvious sign of central apnea
but a year later I was dx'd with Vascular EDS, part of which is mild autonomic neuropathy and recently a further dx of autonomic neuropathy and told it was chemo damage on top of the EDS
so I have asked them to review the clusters of centrals not being addressed and put me on the right machine if that's what it takes.

[1210donna]

With a CPAP machine, centrals are reported but not treated.
Hypopneas should be treated by increasing pressure just like an obstructive apnea.

It's odd that no where along the line was an ASV titration done that would show whether or not your centrals could be effectively treated.

The AutoSet is a capable machine so maybe an adjustment of your oressures is in order.

Check with your sleep doctor to see if a new titration is in order or if some pressure adjustment might help.

When I was first put onto CPAP I got follow ups with the supplier after a month then after another month... they were looking at the AHI and disregarded the centrals as I didn't have lung/heart failure, didn't have a brain tumor or cervical spine injury so presumed I had nothing series enough to cause 'true centrals' and the AHI was improving so it fitted the view that the machine was doing a great job, and it does, except for nights with clusters of centrals (ie 3.5min of not breathing in 9 min of sleep). But maybe in the two months they checked how it was going these weren't happening, who knows.

[1210donna]

With a CPAP machine, centrals are reported but not treated.
Hypopneas should be treated by increasing pressure just like an obstructive apnea.

It's odd that no where along the line was an ASV titration done that would show whether or not your centrals could be effectively treated.

The AutoSet is a capable machine so maybe an adjustment of your oressures is in order.

Check with your sleep doctor to see if a new titration is in order or if some pressure adjustment might help.

And, no, never had a titration study... everyone just happy with the AHI... had the machine since Mar 2012... finally getting a titration study this Oct... but only because I now have suspected narcolepsy and cataplexy on top of my apnea so said can we please check my sleep stages with the machine... (during sleep study had no stage 4 sleep and 25% reduced REM but it was never retested...just presumed it would have self corrected with a better AHI).

[Todzo]

Is the EDS you mention in your tag line Excessive Daytime Sleepiness or Ehlers–Danlos Syndrome?

[1210donna]

Is the EDS you mention in your tag line Excessive Daytime Sleepiness or Ehlers–Danlos Syndrome?

Sorry about that, Ehlers Danlos Syndrome (type 4)

[Todzo]

Is the EDS you mention in your tag line Excessive Daytime Sleepiness or Ehlers–Danlos Syndrome?

Sorry about that, Ehlers Danlos Syndrome (type 4)

So you have a most rare type of a rare disease - and apparently - that makes it difficult for you doctor to get you what you really need.

I would seek some kind of medical advocacy (ombudsman, lawyer, not for profit group ...).

May we all find our way away from the paper monster!

Todzo

[1210donna]

yeah Todzo... seems it works like this... EDS is a connective tissue disorder.... connective tissue protects nerves throughout the body including the autonomic nerves involved in breathing and those in the brain involved in info processing... but also all muscles including those involved in respiration, ... and estrogen preserves and replenishes collagen (connective tissue)... I went through chemo (damages tissue throughout the body and set off preexisting autonomic neuropathy) then went onto estrogen blockers (for ER+ breast cancer) and all EDS chaos went whacko from there. My EDS specialist said, don't expect to find people like you in the text books... aiaiai... but so far I gather that I'm having similar stuff to those with MS in the autonomic dept and there's a study that found the same collagen disorder in Muscular Dystrophy as occurs in EDS (where people have episodes of muscle fatigue/CFS)... so guess that's an outline... expect 'stuff'. groan. at least now I'm on VPAP. it has turned around the I:E ratio so finally in the right direction now with longer expiration than inspirations and NO apneas

[Todzo]

yeah Todzo... seems it works like this... EDS is a connective tissue disorder.... connective tissue protects nerves throughout the body including the autonomic nerves involved in breathing and those in the brain involved in info processing... but also all muscles including those involved in respiration, ... and estrogen preserves and replenishes collagen (connective tissue)... I went through chemo (damages tissue throughout the body and set off preexisting autonomic neuropathy) then went onto estrogen blockers (for ER+ breast cancer) and all EDS chaos went whacko from there. My EDS specialist said, don't expect to find people like you in the text books... aiaiai... but so far I gather that I'm having similar stuff to those with MS in the autonomic dept and there's a study that found the same collagen disorder in Muscular Dystrophy as occurs in EDS (where people have episodes of muscle fatigue/CFS)... so guess that's an outline... expect 'stuff'. groan. at least now I'm on VPAP. it has turned around the I:E ratio so finally in the right direction now with longer expiration than inspirations and NO apneas

The VPAP is good news!!

I hope, for the sake of all of us, that medicine makes its way out of the barbaric age.

I be praying for you and yours for wisdom. I need it too!

May we find a way!

Todzo