central apneas

[granti55]

Why are 99% of my apneas showing up as central apneas on my recently purchased S9 autoset when I download my data card? I am using ResScan 3.14.

Thanks Grant

[rested gal]

What is a typical overnight AHI for you? What's the AHI breakdown for one night?

[granti55]

[quote="rested gal"]What is a typical overnight AHI for you? What's the AHI breakdown for one night?[/quote]
it has been a AHI of 1-4 with the S9 and with my S8 elite it is 4-7, but on the S9 the events all show up as central apneas. Grant

[rested gal]

What is a typical overnight AHI for you? What's the AHI breakdown for one night?

it has been a AHI of 1-4 with the S9 and with my S8 elite it is 4-7, but on the S9 the events all show up as central apneas. Grant

I don't have an answer for why all your events with the S9 are showing up as centrals...perhaps that's what they are. The older S8 machines didn't attempt to identify centrals. But an AHI of 1 - 4 is so nice and low, I wouldn't worry about exactly "what" the events are that add up to make an AHI of 1, or 2, or anything under 5.0.

People tend to think a few central apneas are worse things to have than a few obstructive apneas. There's something about "OMG, my brain didn't send a timely signal to breathe!" that sounds scarier than, "OMG, my throat slammed shut so that I can't breathe!!" No matter which event it is...central or obstructive...with either one we don't get air until the brain gets around to sending a signal to do something.

I'm not saying you're panicking about centrals, Grant. Not at all. You're simply curious about what shows up on your reports, and I probably would be too. The S8 and S9 machines identify (thus, report) things so differently from each other, comparing what an S8 reported with what an S9 reports is a little bit (call it a slice... ) of apples and oranges. I guess I'd just shrug if I couldn't find an answer (maybe someone else knows) and think, "Good, my AHI is nice and low, whatever the events actually are, and the few centrals are likely normal ones."

[bkdraft]

My sleep study showed NO Centrals, all obstructive, my S9 is 99% centrals. Started out at AHI around 9-10 but after month its has dropped to average of 3-4. Still mostly all centrals with a obstructive every now and then.

[Bright Choice]

Why are 99% of my apneas showing up as central apneas on my recently purchased S9 autoset when I download my data card? I am using ResScan 3.14.

Thanks Grant

Same thing happened to me ... Short story, first doc said not to worry, everyone has some. Got second opinion with psg and titrations (3 nights) this week. End result is rx for ASV with diagnosis of ca and OSA.
For me, I am glad I did not ignore them.

Good luck!

[bkdraft]

Guess I should have added that when the centrals showed up they set me up with a 02 concentrator, thats when my AHI got down to acceptable levels.

[granti55]

Thanks guys my 02 never drops below 91

Grant

[JohnBFisher]

... Same thing happened to me ... Short story, first doc said not to worry, everyone has some. Got second opinion with psg and titrations (3 nights) this week. End result is rx for ASV with diagnosis of ca and OSA. ... For me, I am glad I did not ignore them. ...

While your first doctor was right that everyone has SOME, you should not have an elevated AHI due to Central Apneas. If that's the case, they should be addressed (via oxygen and/or ASV). Untreated, those central apneas can be as devastating as obstructive apneas. Trust me, I know. Due to untreated central apneas I had *HORRIBLE* headaches every day. It caused my blood pressure to be uncontrollable. (No matter the medication I took, it was high). And to combat the headaches, I used Ibuprofen. Unfortunately the combination of Ibuprofen and high blood pressure causes kidney damage. While it is not severe, it now must be monitored carefully.

I did get the centrals addressed, but it took me breaking down in tears trying to get my doctor to explain that I was desperate for sleep and BiPAP just was NOT getting the job done.

So, good for you sticking to it and getting your issue addressed.

[Bright Choice]

... Same thing happened to me ... Short story, first doc said not to worry, everyone has some. Got second opinion with psg and titrations (3 nights) this week. End result is rx for ASV with diagnosis of ca and OSA. ... For me, I am glad I did not ignore them. ...

While your first doctor was right that everyone has SOME, you should not have an elevated AHI due to Central Apneas. If that's the case, they should be addressed (via oxygen and/or ASV). Untreated, those central apneas can be as devastating as obstructive apneas. Trust me, I know. Due to untreated central apneas I had *HORRIBLE* headaches every day. It caused my blood pressure to be uncontrollable. (No matter the medication I took, it was high). And to combat the headaches, I used Ibuprofen. Unfortunately the combination of Ibuprofen and high blood pressure causes kidney damage. While it is not severe, it now must be monitored carefully.

I did get the centrals addressed, but it took me breaking down in tears trying to get my doctor to explain that I was desperate for sleep and BiPAP just was NOT getting the job done.

So, good for you sticking to it and getting your issue addressed.

This is so new to me. New diagnosis is CompSA (complex sleep apnea). This is what the Resmed site says:
http://www.resmed.com/us/clinicians/abo ... clinicians
CompSA is characterized by the following:

•The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared
•CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour
•With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA

My experience on cpap and apap (S9) was good, not great. I still had a lot of daytime sleepyness and fatigue but more importantly, a lot of desats during the night that I couldn't figure out. Now, new doctor, new diagnosis, new machine - hopefully it will work as well for me as for others here.

So, pay attention to the advice of johnbfisher. It is nothing to fool around with.

[avi123]

Thanks John Fisher.

[máirtín]

Guess I should have added that when the centrals showed up they set me up with a 02 concentrator, thats when my AHI got down to acceptable levels.

When is O2 therapy indicated?
I have mixed SA that is mostly central. I have been using the VPAP for about three weeks (after a year with straight CPAP that was a complete failure). My AHI is way down but I still wake up feeling like I need oxygen. All of the PSG's indicated my O2 never dropped below 90%.
Are some people more sensitive to relatively small drops in oxygen than others?

[rested gal]

This is so new to me. New diagnosis is CompSA (complex sleep apnea). This is what the Resmed site says:
http://www.resmed.com/us/clinicians/abo ... clinicians
CompSA is characterized by the following:

•The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared
•CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour
•With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA

My experience on cpap and apap (S9) was good, not great. I still had a lot of daytime sleepyness and fatigue but more importantly, a lot of desats during the night that I couldn't figure out. Now, new doctor, new diagnosis, new machine - hopefully it will work as well for me as for others here.

Bright Choice, I truly hope your new machine (an ASV) will help you feel better.
What have you noticed about what it is doing for you, so far?

Were you able to get the full Polysomnograph report following your sleep study and titration in Albuquerque?
It would be great if you could scan and post all the report pages. If you have difficulty doing that and want to mail me a copy, I'd be glad to work on that if you wish. Seeing your study report could be a great learning experience for others.

What did the doctor say showed up in your titration that indicated a diagnosis of CompSA (Complex Sleep Apnea)?

What did he say about the persistent desats you had been having at the higher altitudes where you live?

Did you have a chance to ask Dr. K (or anyone at his Maimonides sleep lab) the two questions NotMuffy was interested in hearing the answers to?

Say, BC, while you're out there, can you ask a question for me

viewtopic.php?p=591438#p591438

Maimonides is big on titrating out everything, including some things that aren't even there (long story).

Anyway, while RERAs are an event that are already quite subtle, they carry it one step further and score RERSCAs (Respiratory Effort-Related Sub-Cortical Arousals). These events do NOT have associated EEG changes.

So my question is, "What specifically are the criteria for scoring RERSCAs?"

Further, that value adds to a parameter called "Research RDI">

Whose Research Definition does that refer to?

[granti55]

If 90% of my total apneas were Central I would then be worried but less so if the AHIs were below 5, as RG posted. As I understand it, I should be worried if my Centrals were above 50% of my total apneas b/c my AHIs are way above 5. See here:



Two weeks ago I changed from cpap to apap (S9 Autoset), but I don't think that this APAP is gentle on Central Apneas. It keeps raising pressure to treat Obstructive and Snore but doing so it creates more Central Apneas. See here that the S9 Autoset raised the pressure b/c of OA but kept it that hi during the next CA:



In the following case the S9 Autoset raised the pressure to its max allowed of 13 cmH2O which btw was not hi enough to treat the three OA completely. It's possible that those OA were not 10 sec long:



So, while the S9 Autoset is cruising at hi pressure setting it is not ready to deal with forthcoming CAs.

In the following ResScan graphs the S9 Autoset started to raise the pressure when it encountered the 32 sec OA (on the left), to 11 cmH2O. Next, this pressure was unchanged for the 23 sec CA. At the 17 sec OA it raised the pressure to the max allowed of 13 cmH2O and held it till the 42 sec OA, affecting the 17 sec and the 24 sec Central apneas.



Grant, since both of us are using the S9 Autoset, I would listen to John Fisher and pay attention to our Centrals.


p.s.s.

1) In the meantime I have settled on a mask with almost zero leak.

2) I have noticed some cardiac components embedded in my flow charts which I need to investigate.

thanks for the info. Grant

[JohnBFisher]

Remember, if the total AHI (including centrals) is 5 or less, then it's considered normal. Also remember that these machines, while much smarter, can not truly tell if the event is a central apnea. For example, if you transition from wakefulness to sleep (or from sleep to wakefulness), then central apneas are perfectly normal and are NOT counted in an AHI value. These machines can not tell if that is the case. Of you might awaken enough to turn over in your sleep. During that movement, it's not unusual for us to hold our breath for a little while. The machine records a CA event, but apnea? Nope. That's why I prefer to call these Clear Airway events. There was not obstruction, but no guarantee they were central apneas. Additionally, it is possible to have an obstruction that occurs at the same time as a central apnea. The machine would mark that as an obstructive apnea, whereas a polysonmograph would score it as a central apnea.

Think of these machines as providing windsock data ... helpful, but not definitive.

Of course, having cautioned that, I also note that if the central apneas are severe enough that they interfere with sleep they MUST be addressed, since they also have all the same bad side effects on your body. So, if your AHI remains elevated and over 50% of them are noted as central, then you should discuss it with your doctor. And keep on doing so. I don't want to see anyone else suffer the same adverse health issues (kidney damage and diabetes) as I have suffered.

Hope that helps.