How Do You Know if Central Apneas are Resolved

[skjansen]

Let me start by saying that though I have been on CPAP since November of 2004, I still do not think I am getting the best treatment I can. I frequently wake up unrefreshed. My Sleep Center has infuriated me on several occassions so I have not been back for awhile. They have however opened an office near my home and I am hopeful that I can get an appointment soon with a different RT than I was having to deal with before.

In saying all of that let me give you some background. I am using the ResMed S7 Elite with a UMFFM. My pressure is currently set at 13. My sleep study diagnostics were as follows:

6 OSA
25 Central Apneas
31 Mixed Apneas
15 Obstructive Hyponeas
AHI 39
Lowest oxygen 89%

They then put me on a CPAP machine (by the way this was all done in one night) and here are the results:

12 Central Apneas
1 Obstructive Hyponea
AHI 3
Oxygen 97%
Pressure was 11

Now 2 1/2 years later I am still tired. Not like I was mind you, but still tired. Thanks to all of you I have finally learned how to get my daily results (my Sleep Center does not want their patients to know this). Unfortunately I have not been writing down the daily results but my AHI has been in a range from around 4.2 all the way up to 7.2. Last night it was 6.8 and my leakage was 0.32l/s. Resmed says anything under 0.4L/s is acceptable. By the way, for those of you who remember my post from last week about this, I had my decimals in the wrong place. My pressure is 13.

So, after all of that, here are my questions.

(1) I am considering taking my pressure up to 14 to see if I can lower my AHI. Would you give this a try if it were you?

(2) I have ordered a new mask. Though my leakage appears to be in the acceptable range according to ResMed I have definitely found that my AHI goes up when my leakage goes up. Right now to keep my leakage down I have to tighten my mask to the point where it is very uncomfortable and almost leaves bruise marks on my eyes. I have ordered the new Quattro, but do you have a full mask you would recommend?

(3) How do you know if the Central Apneas are resolved? My CPAP does not appear to break down the CA. I know all of my CA's happen when I sleep on my back. Should I try to not sleep on my back. If so, do you have any recommendations on how to avoid that?

(4) I am seriously considering asking for another sleep study. If I am having CA's and my current treatment is not resolving the problem, I would like to try the new ResMed unit that best addresses CA's. Have any of you tried it? I believe it is called a VPAP.

I know this is alot to digest, but I am confused and really want to do everything I can to get the best treatment. Please help if you can.
Thanks a bunch.

[Sherri_Baby]

They then put me on a CPAP machine (by the way this was all done in one night) and here are the results:

12 Central Apneas
1 Obstructive Hyponea
AHI 3
Oxygen 97%
Pressure was 11

CPAP has not fixed your centrals...they're still there.

(1) I am considering taking my pressure up to 14 to see if I can lower my AHI. Would you give this a try if it were you?

If you raise your pressure, the possibility exists that you will make your centrals worse. In some people, increased pressure (and just CPAP therapy in general!) CAUSES central apneas, it doesn't improve them.

(3) How do you know if the Central Apneas are resolved? My CPAP does not appear to break down the CA. I know all of my CA's happen when I sleep on my back. Should I try to not sleep on my back. If so, do you have any recommendations on how to avoid that?

If the Centrals were resolved, you would be feeling better. When I have Centrals, I KNOW it....I wake up feeling like I've been hit by a mack truck, and then backed over a few times! They are by far worse than obstructives, as far as I'm concerned. If I fall asleep without my mask, I will inevitably wake up feeling this way.

(4) I am seriously considering asking for another sleep study. If I am having CA's and my current treatment is not resolving the problem, I would like to try the new ResMed unit that best addresses CA's. Have any of you tried it? I believe it is called a VPAP.

YES, YES, YES!! By the way....did I say "YES!!" ? I don't know what the magic fairy dust is in the Adapt, but whatever it is, it works, and I've stopped questioning it. I don't care why or how it works, it just DOES. I LOVE my Adapt. Its called the ResMed VPap Adapt SV.... CALL YOUR DOCTOR, request another sleep study, and specifically request the Adapt. Tell him you think you're still having Centrals, and you KNOW that that's what the Adapt was specifically designed for.

Good luck.... hope that helps....

[Guest]

Sherri:

Thanks for your response. My hesitation in returning to my Sleep Doc is last time I saw her she basically told me that I was a fat slob that was not even trying to lose weight. Keep in mind this was when I was on Jenny Craig AND exercising 1 hour a day. I also am not a fat slob, not even close, but she sat there on her skinny a** preaching to me. Made me so mad. I have gained about 10 pounds since my last appointment and attribute that to the Remeron they put me on to help with insomnia. I really need to go back but I hate them so much. I guess I need to put that behind me and be an advocate for myself until I get the very best treatment I can.

Thanks again.

[Wulfman]

Let me start by saying that though I have been on CPAP since November of 2004, I still do not think I am getting the best treatment I can. I frequently wake up unrefreshed. My Sleep Center has infuriated me on several occassions so I have not been back for awhile. They have however opened an office near my home and I am hopeful that I can get an appointment soon with a different RT than I was having to deal with before.

In saying all of that let me give you some background. I am using the ResMed S7 Elite with a UMFFM. My pressure is currently set at 13. My sleep study diagnostics were as follows:

6 OSA
25 Central Apneas
31 Mixed Apneas
15 Obstructive Hyponeas
AHI 39
Lowest oxygen 89%

They then put me on a CPAP machine (by the way this was all done in one night) and here are the results:

12 Central Apneas
1 Obstructive Hyponea
AHI 3
Oxygen 97%
Pressure was 11

Now 2 1/2 years later I am still tired. Not like I was mind you, but still tired. Thanks to all of you I have finally learned how to get my daily results (my Sleep Center does not want their patients to know this). Unfortunately I have not been writing down the daily results but my AHI has been in a range from around 4.2 all the way up to 7.2. Last night it was 6.8 and my leakage was 0.32l/s. Resmed says anything under 0.4L/s is acceptable. By the way, for those of you who remember my post from last week about this, I had my decimals in the wrong place. My pressure is 13.

So, after all of that, here are my questions.

(1) I am considering taking my pressure up to 14 to see if I can lower my AHI. Would you give this a try if it were you?

(2) I have ordered a new mask. Though my leakage appears to be in the acceptable range according to ResMed I have definitely found that my AHI goes up when my leakage goes up. Right now to keep my leakage down I have to tighten my mask to the point where it is very uncomfortable and almost leaves bruise marks on my eyes. I have ordered the new Quattro, but do you have a full mask you would recommend?

(3) How do you know if the Central Apneas are resolved? My CPAP does not appear to break down the CA. I know all of my CA's happen when I sleep on my back. Should I try to not sleep on my back. If so, do you have any recommendations on how to avoid that?

(4) I am seriously considering asking for another sleep study. If I am having CA's and my current treatment is not resolving the problem, I would like to try the new ResMed unit that best addresses CA's. Have any of you tried it? I believe it is called a VPAP.

I know this is alot to digest, but I am confused and really want to do everything I can to get the best treatment. Please help if you can.
Thanks a bunch.

With this new information you've provided, increasing pressure MIGHT make things worse......unless you change your sleeping position. Any apneas are typically worse while sleeping on one's back.
There are various types of "wedge" pillows available which would help keep you on your side. There's always the old "tennis balls tied to the back of the nightshirt" remedy, too. The wedge pillow thing sounds more comfortable.

Tightening up the UMFF can make the leakage worse. I run a pressure of 12 and on a good night, my leakage stats are below 40. The seals need to be curled in so they can expand a bit with the internal air pressure to form the seal to the face. If it's too tight, it can crush that seal and cause more leakage. There IS a fine balance between too tight and too lose......sometimes it takes a bit to find it. I have my forehead support in the vertical position and with virtually no tension on the upper straps. In fact, you could probably insert a piece of cardboard between my forehead and the forehead support. Any/all of the tension is on the lower straps.
(Note: I never watched the ResMed fitting video.....I came up with this method on my own.)

Snoredog is very knowledgeable on Centrals, so he may throw in his $.04 worth here, too.

Best wishes,

Den

[Guest]

Do centrals show up as AIs on a machine?

[blarg]

Short answer is "depends".

If you're not breathing, the machine can generally tell, but the hard part is whether it realizes it's a central or thinks it's obstructive. The best auto on the market for telling the difference is the P&B 420e, and they only claim 60% success. Many autos will then jack up the pressure (since you had an apnea) which generally makes the centrals worse. Just depends on the algorithm.

So yes, they'll show up as an apnea, but the question is if you know what's really going on or not.

[Guest]

So if you jack up the pressure and you start having more AI's instead of less, it's a decent bet they are centrals?

[Wulfman]

skjansen,

Please check your PMs (private messages)....far, upper, right-hand corner.

Den

[Wulfman]

So if you jack up the pressure and you start having more AI's instead of less, it's a decent bet they are centrals?

On the reporting software (like Encore Pro), they MAY show up as "clusters" of apneas, too.

Den

[gasp]

(3) How do you know if the Central Apneas are resolved? My CPAP does not appear to break down the CA. I know all of my CA's happen when I sleep on my back. Should I try to not sleep on my back. If so, do you have any recommendations on how to avoid that?

I sleep on an adjustable bed to help me not sleep on my back or if I do to reduce OSA. When I lie flat, my slack jaw and relaxed throat muscles close my airway. When I sleep up at an angle, my jaw and throat fall down instead of back. The foot of the bed comes up for support; otherwise I'd slip down to the end of the bed I have retrained myself to sleep on my side, but occasionally find myself on my back. The bed angle helps. Let me know if you're interested in buying one and I'll let you know what features I was looking for and where I bought it.

When I travel I take a foam wedge with me but find it a bit uncomfortable as I have to pile extra pillows under my legs to keep from fighting during the night to stay up on the wedge.
http://www.relaxtheback.com/contourslee ... 31-6389766

[Guest]

On the reporting software (like Encore Pro), they MAY show up as "clusters" of apneas, too.

I had some clusters show up one night...but it was on a night when I had the pressure lower than normal..searching for the holy grail of pressure...., so I suspect it was just obstructive apnea when I got on my back.

[Snoredog]

you really have no accurate way of knowing if your central apnea has been fully resolved unless you use a 420e machine.

The 420e is about the only conventional autopap on the market that can effectively differentiate Central apnea from obstructive. It does so by detecting an open airway and listening for cardiac oscillations via its pneumotach sensor.

Only problem with that detection modal is some studies show that only about 60% of central apnea seen has an associated open airway, the rest may be a closed airway variety (meaning no cardiac oscillations can be heard). So that means that even the 420e can only detect about 60% of them even on a good day or 6 out of 10, of those with an open airway where cardiac oscillations are seen it is 100% effective in differentiating them.

This means the central can also be of a mixed apnea variety where the central apnea transitions from one with an open airway and no air flow into a obstructive apnea event with a closed airway during the same event, hence the term "mixed" apnea.

Most autopaps on the market will fail to see this type of event and score the event as obstructive. If it does that, it will also increase pressure in response making the condition even worse. For them to be seen by the Remstar, it has to see 3 events in a row before it will log a NR event. For some of us that have this type of condition, having 3 consequtive CA's in a row is rare, the machine will respond as if they were obstructive many more times than it will log them as NR. All you have to do to see this happen is switch from the Remstar to the 420e and watch your AHI drop by 5 to 8 points overnight.

Using some reverse logic, when I use my M series Auto, I know any residual AHI I see left on the Therapy LCD display is central activity not obstructive. LOL, could be why they pulled EncorePro 1.8, it does not compute

[skjansen]

So, then I assume the only way to determine if you are truly still having centrals is to have another sleep study. Is that correct?

[Snoredog]

So, then I assume the only way to determine if you are truly still having centrals is to have another sleep study. Is that correct?

yep, or use a 420e, they will show up on its Silverling reports as seen below in the 2nd line from the top:


Look at your PSG hypnogram, it should show you where every CA you have takes you back to a wake state. Have only 3 of those per night and you are most likely going to be aroused or awaken 3 times per night, have 5 of them, you are awaken 5 times per night. Still tired? With use of the right pressure and machine you can sometimes completely get rid of them.

[Snoredog]

So, then I assume the only way to determine if you are truly still having centrals is to have another sleep study. Is that correct?

yep, accurately.