Seems Like I have Central Sleep Apnea - Switch to Bipap Worth it?

[Dog Slobber]

The OP is reading his OSCAR (see his Aug 6th Oscar), no where on this report does it mention "central apnea". It does however mention "clear airway apneas".

Is OSCAR misleading us? I don't think so.

As a matter of fact, OSCAR is misleading you.

When SleepyHead was first written, it was written for Respironic machines. Respironics has always called "Centrals", "Clear Airways" in their CPAP machines. Then when SleepyHead started supporting ResMeds, the name "Clear Airways", stayed.

ResMed simply doesn't use the term Clear Airways.

Then when SleepyHead forked to become OSCAR, the code still hasn't been changed.

So yes, OSCAR is indeed misleading you. Not deliberately, but changing the term to Centrals hasn't been a priority.

Did the OSCAR authors decide to change the EDF file header from "central apnea" to "clear airway apnea"?

No they didn't. Why would they? Clear Airway doesn't exist in ResMed created EDFs. Why are you suggesting they do?

[palerider]

Having a few "centrals" as reported by a home treatment machine

Home machines do NOT report "centrals". They identify clear airway events. Clear airway events may or may not be "centrals" apneas.

(resmed algorithm lumps these two types of events together, BECAUSE the home therapy machine is unable to distinguish between a pathological central apnea and a 10 second cessation of breathing that might occur when a person rolls over in their sleep, or talks in their sleep, or a whole bunch of other things the are NOT pathological )

Well, you're wrong.

"clear airway" is a term MADE UP by Philips Respironics, they're the only ones that use that term. The rest of the sleep medicine world calls them "centrals"

[palerider]

it took me awhile to get used to those open-airway apneas being called "centrals" myself.

The OP is reading his OSCAR (see his Aug 6th Oscar), no where on this report does it mention "central apnea". It does however mention "clear airway apneas".

Is OSCAR misleading us? I don't think so. Did the OSCAR authors decide to change the EDF file header from "central apnea" to "clear airway apnea"?

No, Mark Watkins wrote sleepyhead originally for Philips Respironics machines, and since they used that phraseology, that's what the software uses. He never fixed it for other machines, and it wasn't on the top of the list of things to fix when Oscar forked off of the dead sleephead code.

It's on the list of things to fix.

Give up, you're (as so often happens) wrong, and making a fool out of yourself.

[ozij]

I actually think the term "Clear Airway" apnea is a good operational description / definition of what the machine is reporting. i.e, this is an -a-pnea Icessation of breathing) not caused by an airway obstruction. The machine does not sense flow, hence "apnea", but - based on the way its algorithm works, identifies the airway as being clear.

We only know more about this type of apnea when we see the context in which these breathing stops appear in the chart.

[dataq1]

It's on the list of things to fix.
Give up, you're (as so often happens) wrong, and making a fool out of yourself.

Regardless of who "made up" the term Clear Airway Apnea it is a damn good description of the event. (cessation of breathing without detectable airway obstruction)

Central Apnea as described by Resmed (for home machines): " central sleep apneas, “central” because your apneas are caused by a dysfunction in the central nervous system, not a physical obstruction." [ from Resmed's blog site referenced above]

As home machines are unable to determine if a clear airway apnea is caused by central nervous system dysfunction, it is appropriate to use the term that best describes the event.
- Nothing to "fix" here

The more important thing here is NOT the language usage, but if the CPAP user should seek to rule out nervous system dysfunction (as opposed to just assuming that all clear airway apneas are SWJ)

[palerider]

It's on the list of things to fix.
Give up, you're (as so often happens) wrong, and making a fool out of yourself.

typical mindless garbage.

As usual, you're full of crap.

[jimbud]

It's on the list of things to fix.
Give up, you're (as so often happens) wrong, and making a fool out of yourself.

typical mindless garbage.

As usual, you're full of crap.

Dungheap#2 ?

JPB

[lazarus]

I actually think the term "Clear Airway" apnea is a good operational description / definition of what the machine is reporting. i.e, this is an -a-pnea Icessation of breathing) not caused by an airway obstruction. The machine does not sense flow, hence "apnea", but - based on the way its algorithm works, identifies the airway as being clear.

We only know more about this type of apnea when we see the context in which these breathing stops appear in the chart.

Well said. I fully agree that "clear airway apnea" (1) is more accurate, (2) shows more humility regarding what a home treatment machine can actually report, and (3) may be the best choice for OSCAR.

But once the ad/marketing people at ResMed had done their thing, I acquiesced that a two-syllable word would likely win out in the vernacular in the long run.

I therefore choose personally not to correct OPs who speak of home-reported "centrals" and "bipaps," when that simply reflects the usage of what they've read elsewhere. If I know what they mean and get the intent of the question, I am willing to sacrifice some technical accuracy for friendly, helpful discourse.

the CPAP user should seek to rule out nervous system dysfunction

No. A user who just started PAP a few months ago should not needlessly be told to worry about nervous system dysfunction. They need to become well-settled into optimized PAP. Full stop. Emergent centrals may well dissipate over time.

And it isn't strictly the percentage that matters when the number of clear airway events is still relatively low and a person may not be fully used to sleeping with a mask.

Alarmist rhetoric about a need to rule out brain damage is a much stronger indication of some nervous system dysfunction on the part of the alarmist than on the part of the PAP patient having a few centrals as his or her brain and body adapt to PAP.

Furthermore, it is when troubleshooting a truly significant number of centrals that THEN ruling out serious medical conditions should be fully explored before just jumping to ASV to hide the symptoms. It is only when nothing treatable is found that THEN it makes sense to give up on finding a cause and simply do what's necessary for the best sleep, which may or may not involve use of ASV.

In my opinion, OP ain't there yet. If concerns remain, a consultation with a sleep doc may be in order, sure. Hopefully, though, that won't be based on 'some guy on the Internet at cpaptalk.com told me that I have strong indications of brain/nervous-system dysfunction.'

That's the sort of thing that can give forums a bad name.

(Or, at least, a worse name.)

[dataq1]

I fully agree that "clear airway apnea" (1) is more accurate, (2) shows more humility regarding what a home treatment machine can actually report, and (3) may be the best choice for OSCAR.

Glad we are in agreement there

But once the ad/marketing people at ResMed had done their thing, I acquiesced that a two-syllable word would likely win out in the vernacular in the long run.

I Don't know what you are referring to. Are you saying that Resmed marketing decided to refer to clear airway events as central events, knowing full well that the word central refers to the central nervous system?

the CPAP user should seek to rule out nervous system dysfunction

So I see what you did here. What I said was the question is IF the cpapuser should seek to rule out......

And frankly that's the job of his professional medical specialist. And I wasn't taking about the OP as his question has already been addressed. It was more generically ANY cpap user, who seriously suspects that their clear airway events may caused pathologically (ie, brain dysfunction) owes it to themselves to seek professional guidance. (rather than relying on some nameless "guy on the internet" who says "forgetaboutit" ).

As you might have guessed, I am an advocate for seeking "professional medical advice" , just as the forum disclaimer says:

[lazarus]

There was no "if" in your earlier-stated position:

. . . 80% of his AHI is assignable to "clear airway apneas", he owes it to himself to find the root cause (hopefully to rule out any brain dysfunction or hypocapnia causation). . .

But I'll be more careful quoting you in the future. Or not quote you at all.

And I believe you misunderstand the idea behind the word "central." There are perfectly valid reasons for the nervous system not to send a message to breathe that have absolutely nothing to do with dysfunction or damage or disease. Would those be marked as pathologically significant in a sleep study? No, they would be ignored. But it is nevertheless still scientifically valid to refer to them as "central" outside the context of a PSG and in the context of home treatment, since it was not accompanied by evidence of obstruction.

Just because one term is less exact than another does not make it a lie, a conspiracy, or an attempt to mislead. The area is very gray, anyway, since an event can start out as a mere pause in breathing but then end up as obstructive from the lack of air movement in the airway. Some people close their airway when turning over; others don't.

All home-treatment labeling is inexact, but still valid for trending and for algorithm-response decisions by the machine--which is what treatment reports are all about after all, not about diagnosing central nervous system dysfunction.

In summary: Many centrals are natural and normal. Others are flagged as significant in PSG. They all involve the central nervous system not sending the signal to breathe, though. So it isn't a prevaracation to call the harmless ones centrals too.

[Pugsy]

Get back on topic please and in case anyone has forgotten what the original post and question was....
it wasn't fighting over the symantics of centrals vs clear airway nomenclature. Go reread the first post.
Further off topic crap will be removed.
You guys/gals have beat this dead horse to death more times than I can count.

Now if you want to start a thread of your own and continue with the "discussion" then go for it but take it out of this thread.

Thank you

[ozij]

For the OP:
You have no reason to assume you have "Central Sleep Apnea" based on your OSCAR numbers.
The percentage of CA's to total AHI as reported by a PAP machine is a not a correct basis for any kind of diagnosis of how you breathe when you sleep.
The central nervous system controls our breathing.
We can have a perfectly functioning central nervous system and yet stop breathing for ten seconds or more when we are awake.

[dataq1]

For the OP:
The central nervous system controls our breathing.
We can have a perfectly functioning central nervous system and yet stop breathing for ten seconds or more when we are awake.

Absolutely… when you say “awake”.
The OP seems to believe that these clear airway events are occurring while asleep. He seems to want to know how to control these events during sleep.

[palerider]

I actually think the term "Clear Airway" apnea is a good operational description / definition of what the machine is reporting. i.e, this is an -a-pnea Icessation of breathing) not caused by an airway obstruction. The machine does not sense flow, hence "apnea", but - based on the way its algorithm works, identifies the airway as being clear.

We only know more about this type of apnea when we see the context in which these breathing stops appear in the chart.

Well said. I fully agree that "clear airway apnea" (1) is more accurate,

Central sleep apnea is defined as:
"Central sleep apnea (CSA) is characterized by a lack of drive to breathe during sleep,"

It does not say *WHY* there is a lack of drive to breathe, that is not part of the definition of central sleep apnea. Centrals can have many causes. -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/

Resmed is correct in their definition.

[palerider]

Get back on topic please and in case anyone has forgotten what the original post and question was....
it wasn't fighting over the symantics of centrals vs clear airway nomenclature. Go reread the first post.
Further off topic crap will be removed.
You guys/gals have beat this dead horse to death more times than I can count.

Now if you want to start a thread of your own and continue with the "discussion" then go for it but take it out of this thread.

Thank you

In all fairness, the OP's question was answered rather succinctly right at the start.