Central Sleep Apnea

[meusion]

Hi
I am new to this forum. I have just been diagnosed with obstructive sleep apnea. I was trying the mask and found that my sleep has been much worse, called the sleep clinic and they said that I also have central sleep apnea. I can't find any in depth information on this except for information that is pretty scary, such as most people with central sleep apnea are usually severely ill or have heart conditions! I am feeling really worried. Does anybody have any experience with central sleep apnea or any information that may be helpful?
Thanks,
Heather

[1wacy]

Heather...
I have central apnea plus obstructive sleep apnea.As for your question,no we are not severely ill.Before I started with therapy I was sleepy just about 24/7.Now I wake up and ready to go for all day.What a differance sleep therapy makes.The main thing is to stick with it.You will have bad days and hope for the best many more GOOD DAYS!!!
I have added referances from Mayo Clinic on Central's.Hope this will help you.

Wes

http://www.mayoclinic.com/health/centra ... ea/DS00995

[meusion]

Thanks for the info. I am all new to this sleep apnea stuff and like I said have been having difficulty with the CPAP mask and getting adequate sleep. I am hoping that I will soon adjust to the mask but in the meantime I am exhausted. I even had to take the day off of work because I was so tired I couldn't even stay awake.
Heather

[Julie]

Hi, a lot of newbies to Cpap have a hard time until they get lucky and find this forum (honestly , because there are so many knowledgable people here (present company excluded!), but I'd like to ask which mask you're using, because early on most of us have to go through various masks until we find the right one, the one that fits properly (comfortable and doesn't leak around the edges) and does its job. Many of us find that either before Cpap, or after starting, we breathe to some extent through our mouths when sleeping, and there are different types of masks that are more effective in dealing with it, so the Cpap air can go down, rather than out. Plus it would help to know what pressure(s) your machine was set at, as sometimes there are misunderstandings about prescribed pressure vs 'ramp' pressure, i.e. the ramp pressure is often set too low to make breathing comfortable, until it reaches the desired pressure, so the majority of us don't use the feature after a few nights. There's a lot more of course, and I hope you can find the answers to make you feel better with your equipment.

[rested gal]

Heather, here are some discussions you might find interesting. Especially the posts by christinequilts:

Links to Central Apnea discussions
viewtopic.php?p=22702

[meusion]

Hi,
Thanks for all your replies. I am on my second mask, it is a phillips respironics fulllife mask, full face. I tried a nasal pillow when at the sleep lab and felt like I couldn't breathe at all. The pressure is set at 10.3 but it is on auto set so it may still be adjusting. I have a heated humidifier. The machine is a resmed. I had another really bad night of sleep last night. I am so exhausted. I keep waking up and then having to get used to the mask all over again. I am really really frustrated.
Thanks,
Heather

[JohnBFisher]

... I have just been diagnosed with obstructive sleep apnea. I was trying the mask and found that my sleep has been much worse, called the sleep clinic and they said that I also have central sleep apnea. I can't find any in depth information on this except for information that is pretty scary, such as most people with central sleep apnea are usually severely ill or have heart conditions! I am feeling really worried. Does anybody have any experience with central sleep apnea or any information that may be helpful?

Heather, the links from Rested Gal should provide a good bit of reading for you. In addition, I would suggest the following reading:

http://en.wikipedia.org/wiki/Sleep_apnea

In particular:

In central sleep apnea, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation will drop to a lower than normal level (Hypoxaemia) and the concentration of carbon dioxide will build to a higher than normal level (hypercapnia). In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body. ... Fortunately, central sleep apnea is more often a chronic condition that causes much milder effects than sudden death. The exact effects of the condition will depend on how severe the apnea is, and the individual characteristics of the person having the apnea.

First, let me note that some central sleep apnea is perfectly normal, especially as you fall asleep. It's not normal for it to be constand and frequent. So, knowing the numbers from the sleep study is important.

Why do all the websites list "Cheyne-Stokes Respiration (or CSR)" as the cause of central sleep apnea? Well, in a large percentage of the cases where Central Sleep Apnea (CSA) exists, the patient suffers from heart problems. As a result, people tend to generalize. That appears to be why the author of the Wikipedia article equates Central Sleep Apnea with Cheyne-Stokes Respiration. They are not equal.

CSR is not the only cause of CSA. Anything that interferes with the normal signalling of the autonomic nervous system tends to cause CSA. For example, perhaps the second most common (just based on my reading) cause is the application of xPAP therapy! Yup. Most people have no problem breathing against the increased pressure. But for a small percentage of people, the increased pressure triggers central sleep apnea. Depending on how it presents, it might also be termed mixed, or a complex apnea (also known as Complex Sleep Apnea Syndrome). The reasons this occurs is not well understood. Typically the best method to treat this is to switch to BiPAP (BiLevel Positive Airway Pressure), which increases the pressure when you inhale and decreases it when you exhale.

And in a much smaller percentage of the patients, there are problems with the autonomic nervous system or the connection between the autonomic nervous system and the repiratory muscles. You can read more about the control of the respiratory system at:

http://en.wikipedia.org/wiki/Respiratory_system#Control

So, someone with a problem with their brain stem due to some injury (a traumatic brain injury) or a progressive neurological disease (such as Parkinsons, MSA, or OPCA) may start to have problems with Central Sleep Apnea. Of if someone has problems with the musculature for breathing (or the interface between the autonomic nervous system and the muscles) they may develop issues with Central Sleep Apnea issues. Those might include muscular dystrophies, MS, ALS, and the like.

But if you are otherwise healthy, then if the central sleep apnea numbers are low, you might not have any big issue with it. If they are fairly high (I think the rule of thumb is over 20 per night), then you might need to work with your sleep specialist to see what can be done. As I noted, sometimes switching to BiPAP is all that is needed.

Regardless of the central sleep apnea, if you continue to have problems, I would suggest taking with the Respiratory Therapist at the DME. If that person is unhelpful, bo back to see your sleep specialist. If your machine can provide data about your sleep, then get the software to SEE what is happening. Sometimes that can lead to a better therapy that helps you sleep better.

Plus also remember, that it can take a while to get accustomed to the CPAP mask. So, for some people after a few weeks they find they are sleeping better. Hang in there, but DO take a proactive approach to try to get better sleep.

Hope that helps.

[kteague]

Having the specifics of your report(s) can help you see which parts of the available reading actually apply to your situation. Ask for copies of your report(s) that include the details, not just the summary page. That will help you formulate questions where now there is mostly a vague sense of not knowing.

While you do want to be certain your treatment is effective (per machine data), poor sleep during the adjustment phase is common. You may feel clearer if you ask your doctor questions like... Is my prescribed treatment any different than for those who have obstructive sleep apnea? How is my treatment addressing my central apneas? What is the plan to monitor my treatment for effectiveness in treating the centrals?

Best wishes as you move forward.

Kathy

[Muse-Inc]

Heather, if you have a high enough percentage of centrals then a different machine might be required before you feel good again. Now that 'said,' to get that machine, you have to 'fail' with a CPAP machine meaning with reasonable time you get little or no benefit. Keep in touch and report your progress or lack thereof with your sleep doc or whoever got you started so they can take appropriate action.

If you list every single detail that is an issue with the mask, I'm sure someone will be able to make suggestions that will help. Gotta tackle this 1 problem at a time.

I wish you very best in finding successful treatment...this apnea journey is challenging, moreso for some of us.

[timbalionguy]

*Possible red flags here!*

You start xPAP therapy, and you immediately felt worse. Let us assume for the moment your mask fits correctly, and you have an acceptable leak rate. (If this is not the case, disregard the rest of this post and fix these items first!) You are using a full face mask, so that eliminates mouth breathing for the moment.

You contact the sleep lab, and they tell you, matter-of-factly "Oh, by the way, you have central sleep apnea as well". If, for whatever reason, your therapy is bringing on a bunch of pressure induced centrals, this is something your doctor (not your respiratory therapist) should be concerned about.

First of all, fill out your equipment profile, so we all know what your machine and mask is. Use descriptions rather than pictures when you do this. (It is on your user control panel).

From what I can read here, it sounds like you already have a data capable machine. While most machines do not record central apneas per se, they do record something that might be centrals. If you have a high rate of these, you need to have some big adjustments made in your therapy (like switching to a BiPAP machine of some sort). You need to either 1.) read your data yourself with the appropriate software. People here can help you interpret what it means (and teach you how), or 2.) Have your doctor (not RT) read the data. The sooner you find out if you are having a lot of pressure-induced centrals, the sooner your therapy will be effective.

As has been mentioned, a few bad nights when starting out is fairly common. But if you are considerably more tired all the time, and it is not improving, you need to talk to your doctor about this right away.