APAP and Central Apnea

[eklter]

Hello everyone.

I've been searching online about but haven't found anything addressing these questions. Why does APAP helps with central apnea? I understand that APAP machines intervene during obstructive apnea and some can detect central apnea episodes (clear airway). However, do the machines also try to alleviate these breathing pauses of neurological origin?

Thanks.

[Pugsy]

Generally speaking cpap or apap machines aren't normally prescribed for central apnea issues because they can't breathe for you and that is what a person needs when they have a central apnea. There is simply no air moving because there is no effort to breathe.

Often for insurance purposes the insurance company will require the person to try cpap/apap because sometimes those machines will work. It's not a common thing but insurance will require a person to try cpap/apap before moving on to a different machine. Why do they require it? Because sometimes it works and the insurance company would rather pay for cpap/apap because those machines cost a lot less than the machines that can deal with centrals.

A lot depends on what is causing the central apneas and how many a person is having as well. It gets a bit complicated but just a couple of months ago I saw a woman have her centrals go away with fixed cpap. I would have swore it wouldn't work but it did and she had a truckload of centrals.

If you are using insurance.....there's a good chance they are going to have a person jump through all the hoops they can find to avoid paying for the high dollar machine.....and on a rare occasion cpap can work.

[palerider]

Why does APAP helps with central apnea?

It doesn't. APAPs don't do anything when they detect a central apnea.

[Respirator99]

Why does APAP helps with central apnea?

It doesn't. APAPs don't do anything when they detect a central apnea.

That's true. However it's not unknown to see people with central apnea show a significant improvement on apap. Exactly what the mechanism is, I don't know. (I could speculate, but I have no evidence). But as Pugsy says, sometimes it just works.

[southerndoc]

High pressures can cause central apneic episodes. APAPs that are pushing high pressures (15-20) can cause them (treatment emergent central sleep apnea).

[palerider]

High pressures can cause central apneic episodes. APAPs that are pushing high pressures (15-20) can cause them (treatment emergent central sleep apnea).

It must be said that that is rare.

Not mentioning that it only affects approximately 15% of patients leads other people to be unreasonably 'scared' of 'higher pressures'.

[southerndoc]

Why would someone be scared of a higher pressure? That's ridiculous.

Yes, it's not common, but I would hardly say it's rare.

[palerider]

Why would someone be scared of a higher pressure? That's ridiculous.

Why? because they don't know any better, and they see people saying "high pressures can cause central apnea!" without any knowledge of the situation and ramifications.

Yes, it's not common, but I would hardly say it's rare.

What percentage does 'not common' turn into 'rare'?

[southerndoc]

As a physician, certainly <1%.

[eklter]

My mom's AHI is consistently below 1 using an AirSense 10 Autoset prescribed by the doctor after she was diagnosed with central apnea. Sleep studies were never conclusive for me, but I got the same machine anyways because I felt clear symptoms of breathing problems when sleeping. Three months later and my AHI is around 3 average. My sleep quality also improved noticeably. As per Oscar, Clear Airway and Hypopneas are the two largest portions of my episodes.

So it looks like we are among those infrequent cases where APAP helps with central apnea. Would it be worth trying an ASV?

Purple = Clear Airway, Blue = Hypoapnea, Magenta = Obstructive

[attachment=0]AHI Overview.JPG[/attachment]

[Pugsy]

Would it be worth trying an ASV?

You got 2 or 3 grand sitting around with no where to go that you want to spend??

You aren't having enough centrals to earn a central sleep apnea diagnosis showing on this report.
You would need at least 5 to 10 centrals per hour average pretty much every night to get a doctor to even take a look and consider if you need ASV or not....and insurance sure won't pay for that high dollar machine without someone having a lot more centrals than you are seeing.

Not to mention that maybe some of those centrals flagged are false positives and not real asleep flagged centrals.
Go here and watch all the videos so you can learn to distinguish arousal/awake central flagged events from asleep flagged centrals.
http://freecpapadvice.com/sleepyhead-free-software
Bear in mind it is normal to have a few centrals here and there and it doesn't necessarily mean a person has central sleep apnea. Like it is normal to have what is called a sleep onset central apnea and it's no big deal unless someone has so many that they keep bouncing a person out of sleep or they are causing desats.

Are you waking often during the night? If so then that increases the chances of having a sleep onset central apnea when transitioning back to sleep with multiple awakenings. When that happens the problem isn't so much the centrals as it is the awakenings themselves.

Did you ever have a sleep study to see exactly what kind of apneas you might be having or did you decided to self diagnose and got a machine to try and this is what you see?

[eklter]

Thanks for the videos. I'll sure watch them.

I had an at-home study that detected "some" apnea and then another in the clinic the didn't detect enough issues for a diagnosis. However, for years I had been waking very out of breath, sweaty, with racing heart, having claustrophobic dreams..., etc. The sleep onset CA that you describe closely resembles what I experienced. When these problems started long ago I'd keep jumping back awake in a startle when falling asleep, which made sleep difficult or caused a night of insomnia. Usually I moved on the bed every 2 minutes more or less while making odd snapping sounds with my throat. CPAP seemed like the last recourse because I for sure didn't want to sleep with a hose attached to my face. But ended up convinced to give it a try. To my surprise, even the very first night I slept better without crazy dreams or waking gasping for air.

A professional diagnosis would be valuable, but I'm hesitant to spend all that money again for nothing.