Anyone able to help me get my centrals down?

[FoodPouches]

After about 6 weeks on the Respironics System One Auto BiPAP, I have been feeling a little better, but still not great, and I’m having a lot of trouble getting improvement from this point. I’ve been on a new base pressure of 10 cm IPAP and 8 cm EPAP for over a week now, and the only apneas on my sleep data have been clear airway apneas and hypopneas.

At my follow up, my sleep doctor said that these could possibly be central apneas based on the limited data from my diagnostic study, but he is most concerned that my AHI is below 5. And it is, it is consistently around 3.0 and split between clear airways and hypopneas, with zero obstructive apneas during the night. But I am still not where I want to be.

The numbers are not what concern me. What concerns me is that I still wake up around 10 times per night short of breath and often with numb fingers from low O2 levels. I have read that the Auto BiPAP does not react to central apneas, so I am at a loss as to how I might handle this in order to have improvement. I’m not sure that a pressure change would do the trick (the lower pressure I was on before made my AHI and energy worse, and at any higher pressure, I get aerophagia).

If the best indicator is how you feel, and do not feel myself yet, how may I get these centrals and hypopneas to go away so that I may stay asleep?

(Leak is almost entirely a flat line, and there is 0 large leak)

If anyone can offer any advice, I would really appreciate it.

Thanks everyone.

[OutaSync]

Can you ask your doctor to prescibe an overnight oximetry test to determine how low your oxygen is actually going, despite BiPap?

[Mr Bill]

Ask your DME if they will send you home with a pulse oximeter. My DME let me know he has both pulse oximeters and autotitrating BIPAP's that he will loan out overnight (the former for free, the latter for a small fee) if I know of friends that wonder if they have a problem.

[FoodPouches]

Can you ask your doctor to prescibe an overnight oximetry test to determine how low your oxygen is actually going, despite BiPap?

Yes, I think I will ask him about that, because I know it was mentioned at my followup, but nothing ever came of it.

In the meantime, I know I am still not getting quite the oxygen I need at times during my sleep. The Auto BiPAP is not quite doing what it's supposed to do, and I feel that it is because of central apneas. I wonder if there is anything I can do about this?

OutaSync, I notice that you using a machine for complex apnea. I know that my AHI is not in a range that would legitimately qualify me (at least insurance wise) as a person with central or complex apnea. But I wonder if a machine similar to that is something I might consider?

Thanks!

[JDS74]

Foodpouches:

What you are describing could be severe cental apneas. Your machine records the data needed to make a clear diagnosis.
You should get a copy of Encore Pro and look at the waveform data.

I have complex apnea and the waveform data shows central apneas that last about 30 seconds at times.

You should also follow up on the suggestion of getting a recording pulseoximeter so you can correlate your actual blood oxygen level with the CA' s you see on your Encore Viewer report and on the Encore Pro wave form report.

It is correct that the System One machine only reports on CA's ( what they refer to as clear airway apneas ) and can't definitely tell you that they are centrals. With the waveform report, you can certainly see what is going on.

To switch to an adaptive servo ventilation machine and have the insurance company at the table most likely will require another sleep study in which they do a titration for the ASV machine.

If you are comfortable with the Respironics machine, then having the titration done at a sleep lab with Respironics equipment may be the way to go. If you aren't, then a lab that uses ResMed equipment might be a choice.
You should decide up front which type of machine you want and use that type for the titration. Titrating on one and getting a different one adds complications to what is going on.

One last suggestion: When you wake up at night, gasping, can you turn off the CPAP and then turn it back on right away?
If you do so, then there will be a break in the data that you can use to look at what was going on just before you woke up.
By turn off and then back on, I mean only a period of 4-5 seconds, just enough to show up on the reports. Encore Viewer won't give detail by Encore Pro certinly will.

[DreamDiver]

Foodpouches:

What you are describing could be severe cental apneas. Your machine records the data needed to make a clear diagnosis.
You should get a copy of Encore Pro and look at the waveform data.

This is not technically true. ResMed's S9 calls them 'centrals', but they are technically clear-airway apneas that may be showing up due entirely to the use of CPAP. Respironics calls them 'clear-airway apneas' - not centrals. A mild case of compsas may be indicated, but this can only be diagnosed in a sleep lab. Our S9's do not measure eeg, nor do the measure thoracic or abdominal effort, so a truer measure of central apnea is not available, and may not even truly be indicative. More study is necessary.

If you want to buy a servo ventillator, you'll still need to be titrated because SV titration is a little trickier than standard titration. Yes, you can do it at home, but your prescription needs to have all the necessary settings. Your doc probably isn't going to be happy signing a prescription for SV without a titration.

Minimum buy-in: the cost of a titration, doctor's visit and the SV machine itself, because your insurance may not pay for it if your apneas do not indicate need according to their crummy, outdated actuarial tables. I personally would like to try SV myself, but my insurance isn't good enough to get me to a doc that can actually diagnose something out of the ordinary. He told me he's a clinician - not a diagnostician - straight from his own mouth. I'm not sure the somnology 'profession' has caught up with whatever our type of apnea is yet.

Consider: Ask about whether a notable number of alpha intrusions were seen in your delta (NR3) sleep. (Very brief periods of waking during very deep sleep.) If so, your problem may be neurological, but not entirely or exactly related to centrals. That could account for the muscle pain, numbness and constant wakings. There may be more appropriate options than SV.

Are you still having trouble with Aerophagia?
What is your AHI average for the past week?

[FoodPouches]

Consider: Ask about whether a notable number of alpha intrusions were seen in your delta (NR3) sleep. (Very brief periods of waking during very deep sleep.) If so, your problem may be neurological, but not entirely or exactly related to centrals. That could account for the muscle pain, numbness and constant wakings. There may be more appropriate options than SV.

This is an interesting thought. On the vast majority of nights, my sleep data is virtually absent of any apneas during what I assume is delta sleep. I'm referring to the data at the beginning of the night because I believe that's when I get to the deep sleep (NR3) stages. It is the rest of the night that contains the clear airways and hypopneas which come in at a fairly consistent rate. Could you tell me what is the significance of this?

Are you still having trouble with Aerophagia?
What is your AHI average for the past week?

I still experience a lot of aerophagia if I put the machine on Auto BiPAP with base pressures of 10 cm IPAP and 8 cm EPAP.
I do not experience as much aerophagia if I put the machine on straight BiPAP at 10 cm IPAP and 5 cm EPAP. I experience it, or at least it only bothers or wakes me toward the last third of the night.
I experience zero or very little aerophagia if I set the machine to Auto BiPAP with base pressures of 9.5 IPAP and 7.5 EPAP, but then I wake up often to shortness of breath and occasional numbness in fingers.

The last two settings mentioned are based on limited amount of nights data. The first setting is what the doctor set me to. The second setting, the straight BiPAP setting is what I have been using the past many nights, and I feel that's what I do best on with this machine, but I'm not certain.

My AHI average for the past week is 3.1 I would say that more than half of this is clear airway apneas and the rest are hypopneas. About 1 obstructive per night regardless of setting.

On Monday, I will hear from my doctor about what the next step is. If my insurance will permit another sleep study, then I will attempt that. If not, based on my doctor's assessment, I may bite the bullet on the SV. I am not sure. This is a little frustrating and confusing.

I appreciate the the input and advice
Thanks