Central Apnea

[John Galt]

I've seen several posts in which the writer states that if they raise their pressure too much, they get more Central Apneas. How can you tell if you are having Centrals? I haven't seen a way to measure Centrals. I'm interested because I have raised my pressure higher than suggested by my sleep study, and this has significantly lowered my AHI.

[rested gal]

With your machine, you'd see "NR" tick marks start showing up on the Encore Pro (or Encore Viewer) Daily Details graph.

NR means "Non-responsive", as in... 3 small increases in pressure didn't make an improvement in an apnea-like lack of airflow from you.

If 3 small pressure increases don't produce an improvement response in the airflow, the Respironics machine figures, "Hmm, throat might already be open, so that might be a central apnea...more pressure isn't gonna change that, so I'll quit trying more pressure until the flow gets better on its own." It then marks the event as "Non-responsive." NR. Doesn't mean it WAS a central. Just that it might have been.

I don't know this for a fact, but it's my hunch that most (not all..."most") people can take a LOT of pressure before they'd have a few centrals, if any. Also, I don't think a few scattered random centrals are something to get very concerned about anyway.

Links to Central Apnea discussions
viewtopic.php?p=22702

[Snooze_Blues]

... I don't think a few scattered random centrals are something to get very concerned about anyway.

Hi Rested Gal (and all),

Let me take this opportunity to introduce myself and ask a question related to the quoted excerpt from your post.

I've been lurking here, reading, getting familiar with all the terms, and learning a lot. I had a sleep study done a few weeks back and have been trying to understand what it all means before I surrender to "the force" (my sleep Dr., sleep lab, and DME provider).

Yesterday, I received a copy of the summary of my sleep study. I was a bit shocked and not sure how concerned I should be. I expected to see all the stuff I've been reading about and routine statements regarding the 6 cm pressure I was told overcame my OSA incidents. What I found was a diagnosis of Complex Sleep Apnea with as many as 68 Central Apneas per hour, with a few (7) type 1 (don't know what that type is) hypopneas thrown in to the mix for an AHI of 29 per hour ON CPAP!

Uhhhh... is this bad? It sure sounds bad to me, but I'm new at this and still in apnea kindergarden. It certainly doesn't sound good, but may possibly be ugly since there is a note that while CPAP is being prescribed, the Dr. "suspects" that I will eventually require an ASV device (adaptive servo ventilation).

I looked up that device and it sure is fancy. And around $4,000! Yikes! I hope insurance will cover that puppy should it be deemed medically necessary!

Oh, my question re: your quote: How many central apneas "are something to get very concerned about anyway"?

[RosemaryB]

... I don't think a few scattered random centrals are something to get very concerned about anyway.

Hi Rested Gal (and all),

Let me take this opportunity to introduce myself and ask a question related to the quoted excerpt from your post.

I've been lurking here, reading, getting familiar with all the terms, and learning a lot. I had a sleep study done a few weeks back and have been trying to understand what it all means before I surrender to "the force" (my sleep Dr., sleep lab, and DME provider).

Yesterday, I received a copy of the summary of my sleep study. I was a bit shocked and not sure how concerned I should be. I expected to see all the stuff I've been reading about and routine statements regarding the 6 cm pressure I was told overcame my OSA incidents. What I found was a diagnosis of Complex Sleep Apnea with as many as 68 Central Apneas per hour, with a few (7) type 1 (don't know what that type is) hypopneas thrown in to the mix for an AHI of 29 per hour ON CPAP!

Uhhhh... is this bad? It sure sounds bad to me, but I'm new at this and still in apnea kindergarden. It certainly doesn't sound good, but may possibly be ugly since there is a note that while CPAP is being prescribed, the Dr. "suspects" that I will eventually require an ASV device (adaptive servo ventilation).

I looked up that device and it sure is fancy. And around $4,000! Yikes! I hope insurance will cover that puppy should it be deemed medically necessary!

Oh, my question re: your quote: How many central apneas "are something to get very concerned about anyway"?

I will let those who know about ASV's and centrals answer you about those. However, with the diagnosis/prescription of cpap, the way it works is that you have to fail on cpap before they will be able to justify the more expensive machine . So, they are giving you a cpap to take home even though it doesn't take care of many of the events .

While this is just stupid, it seems to be the way it works with the insurance. I believe the thing to do will be a) not to struggle to make it work and b) take it back and let them know it's not working sooner rather than later. That way you can get the machine you need. I'm not sure how soon it can be, maybe someone here will know. It may be quicker just to go along with them and take back the cpap and then get on with the right machine than to try and go around them, due to all the red tape of most of these systems.

Maybe you won't have to physically deliver the cpap before they give you the right machine. At least that way some of your apneas will be taken care of while you are waiting for them to approve it.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, AHI

[ozij]

This is from Resmed, about Complex Sleep Apnea

http://www.resmed.com/en-au/clinicians/ ... 011213.pdf

http://www.resmed.com/en-au/assets/docu ... 0933r1.pdf

[Guest]

what other health conditions do you have?

[Snooze_Blues]

what other health conditions do you have?

Nothing I'd consider serious... but that's me. Why do you ask? Are there certain conditions that predispose me/us to CSA events? (IOW I'll pony up some more info if it seems relevant).

RosemayB, Thanks for those suggestions.

ozij, Thanks for those links. I read the 1st, but will have to save the 2nd big one for tomorrow after a few thousand more CSA's.

[rested gal]

Oh, my question re: your quote: How many central apneas "are something to get very concerned about anyway"?

Snooze, it's past time for me to say, "I'm not a doctor or anything at all in the health care field." LOL!!!

I really don't know. When I talk about "a few" (centrals), and "scattered", and "random" I'm thinking of averaging maybe 2 or 3 an hour.

Sounds like you have a very good doctor who is well aware of Complex Sleep Disordered Breathing, which is a whole other ballgame from what I was talking about. CSDB (or CompSAS - complex sleep apnea syndrome - as it's also called) as I understand it is noticed during a cpap titration by the sleep disordered breathing being made worse, instead of better, by cpap and bipap. Titration often bringing on centrals, and more centrals. Lots of them.

You don't have something ugly. If you have CSDB, you just have something that takes a different kind of machine to correct. Different machine than the usual cpap, autopap, bipap.

If I were diagnosed with CSDB, the adapt servo machine I'd want is this one:

Respironics BiPAP Auto SV.

Personally, I'd not want the resmed VPAP III Adapt SV machine because of how finicky the settings are.

Of course, if one or the other ASV machine didn't suit me, I'd want to try the other.

[Guest 2]

I have come to the conclusion that my wife , who has been on APAP for over six months, must have Complex Sleep Apnea because her AHI is never below 5 irregardless of what pressure is used. Her 90% pressure always goes to the highest pressure on the machine with apneas and hypopneas increasing as the pressure increases during the night.

Her sleep test titrated pressure was 6 but that was like no treatment at all. To make a long story short, her best pressure results are 10 - 12 but even then her AHI is most ofen near 10.

She has been 100% compliant, wears a chin strap, tapes her mouth, has done everything according to everything on this forum, yet it appears APAP is not working for her.

Is there any help available here concerning Complex Sleep Apnea besides simply the need of VPAP?

[Guest]

Sounds like you have a very good doctor who is well aware of Complex Sleep Disordered Breathing, which is a whole other ballgame from what I was talking about.

I was thinking the same thing, but it's a bit unnerving receiving so much supplemental information on the sleep study summary when everything was proceeding as though only Obstructive SA was present. Still, I can see where telling me wouldn't really speed the process of determining how I respond to CPAP over an adjustment period, which potentially could drop the Central Sleep Apnea numbers and leave me with primarily Obstructive SA... I suppose. Probably wishful thinking, though.

Neither the doctor, nor the nurse at the sleep lab, have any idea if I have any idea of, or interest in in knowing, what sleep apnea actually is, let alone the differences between obstructive and central and all the detailed and confusing measures and stuff they work with every day, but probably only care to discuss upon prompting.

I'm not going there for med school, after all, but I've never balked at asking questions and trying to participate in my own health care. That's why I've been trying to educate myself here and elsewhere before I resume the next step they've recommended for me, namely, obtaining and using a CPAP.

You don't have something ugly. If you have CSDB, you just have something that takes a different kind of machine to correct. Different machine than the usual cpap, autopap, bipap.

The ugly I was thinking about was the $4K price tag for the VPAP machine. Good lord! That is more than I could get selling one of my cars and my motorcycle, both! Those masks might also fit into the ugly category, now that I think about it.

The bad was what seems to me to be a more difficult to treat sleep disorder, but I think you are saying that one disorder isn't necessarily worse that another as long as there's a machine available, and affordable, that can fix it. Which is actually comforting on some level. I'm not a hypochondriac, but I can get spun up over stuff like this, especially when I first encounter it, and over think, or perhaps more appropriately in this instance, over fear things.

Still, in the back of my mind, I wonder if my brain is going to throw in the towel one night, and my wife will wake up to Mr. Snooze Blues in a deep, rich, cyan blue hue. Ewe!

Ok. Ok. Relax. Deep breathe. I just need some sleep... yeah... that's it. I just need some sleep...

If I were diagnosed with CSDB, the adapt servo machine I'd want is this one:

Respironics BiPAP Auto SV.

Personally, I'd not want the resmed VPAP III Adapt SV machine because of how finicky the settings are.

Of course, if one or the other ASV machine didn't suit me, I'd want to try the other.

Thanks for the reco. I may have a choice, but then again, who knows? The DME provider I am to work with can obtain both brands, although this high dollar machine may fall under some special requisition policy, depending on margins and business considerations. That may be a different can of worms. I was thinking the Respironics looked pretty good, too, and might be a better choice if only because everything associated with Resmed seems to cost a lot more, including replacement parts, accessories, etc. that I might have to, or want to, spring for myself.

I do appreciate the replies. It is definitely comforting to have found this site and not feel like I'm in this thing virtually alone. I suppose I now have virtual conferees.

I've really dragged my feet hooking up with the DME folks. Part of my normal denial and procrastination process on the one hand, but I've also been trying to prepare my wife for what I now refer to playfully as "the stranger soon to be in our bedroom each night" (the alien that will soon be sharing our bed and attached to my face). I want her to be good and tired of me talking about it so that the actual arrival and usage will be a relief for her, if only to get me to shut-up.

That's my strategy anyway. I am a bit more worried about her reaction to it than my own. I believe I will have good compliance, but the proof is in the pudding, of course. We've only been married since 2001, so it seems like we are still newly weds, sometimes. Those masks aren't exactly honeymoon friendly, if you know what i mean.

[dllfo]

So far, it seems I am the only one on here with the Respironics BiPAP Auto SV.

It is great. A little noisy at times, but it keeps me alive. It has several alarms that are annoying. If I get up to answer nature's call at 2am, turning it back on has a beep. Turning the heated humidifier has another beep. Annoying. but when you realize it will save your life, it is worth it.

EDIT: I read your comment again..about your "brain throwing in the towel".
My brain does that every night. NJC and a local Pulmonary doctor found out
my pulse ox can go into the 50s and my brain does not know it.

My SV breathes for me every night. I computed my SV breathes
for me between 120 to 250 times a night for me, so your brain can relax if
they put you on the Respironics SV and I would imagine the Resmed would
do just fine as well.
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, humidifier, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, humidifier, auto

[Snooze_Blues]

So far, it seems I am the only one on here with the Respironics BiPAP Auto SV.

Questions for dllfo, the adaptive servo ventilator pioneer:

1. Does the Respironics BiPAP Auto SV have a straight CPAP mode like most of the auto PAP's (APAP's) have?

2. Is the insurance equipment code the same for the Resp BiPAP Auto SV as it is for an APAP or CPAP? I can't imagine it is, but stranger things happen in the world of insurance.

3. How long have you had that thing?

4. Did your insurance cover the cost?

5. Did you have another machine before that one? If so, how long, what machine, and did insurance pay for it as well?

[Sherri_Baby]

Snooze...

I have the ResMed version, the VPAP Adapt SV, and have been on it for almost a year. These machines do actually have a CPAP "mode", but if you take the machine out of ASV mode, you lose your therapy. Standard CPAP therapy doesn't work for Centrals, thus the need for the ASV machine.

I'm not familiar with the Respironics version, because I've never used it. It came out after the Adapt, and I've been told that it works differently. My friend Peke, over at sleepapnea.org, was told that she couldn't have the Respironics machine because it wouldn't do what she needed it to do, and her doctor put her on the Adapt as well. Not trying to steer you away from it or anything like that, just trying to let you know that the two machines are different, and apparently used for different things.

Central or Complex Apnea is not necessarily a monster or anything like that... its just different. There are much FEWER of us out there, and its just much less common than your standard OSA. We're special, and require a different method of treatment, that's all...

As for insurance, my insurance company paid for the machine, no questions asked. As long as your doctor justifies its use as "medically necessary for treatment", you shouldn't have any problems at all.

[dllfo]

1. Does the Respironics BiPAP Auto SV have a straight CPAP mode like most of the auto PAP's (APAP's) have? YES. YOU CAN SET THE EPAP, IPAP MIN AND IPAP MAX AT THE SAME PRESSURE TO GET CPAP.

2. Is the insurance equipment code the same for the Resp BiPAP Auto SV as it is for an APAP or CPAP? I can't imagine it is, but stranger things happen in the world of insurance. I AM NOT SURE. MY PULMONOLOGIST AND THE NATIONAL JEWISH HOSPITAL WRITE UP WERE SUBMITTED AND MEDICARE SAID FINE. BIGGEST PROBLEM IS FINDING SOMEONE WHO CARRIES IT. I CALLED AROUND SACRAMENTO AND NO ONE HAD IT. I FINALLY WORKED A DEAL WITH APRIA AND GOT IT.

3. How long have you had that thing? I HAVE BEEN ON IT ABOUT TEN WEEKS.
I REALLY BELIEVE IT SAVED MY LIFE AT LEAST ONCE. MY BRAIN DOES NOT RECOGNIZE LOW OXYGEN LEVELS AND WOULD PROBABLY LET ME DIE. EVEN WITH A PULSE OX IN THE HIGH 50S-LOW 60S MY BRAIN DID NOT RECOGNIZE THE PROBLEM. SO THE SV IS REAL IMPORTANT FOR MY WELL BEING.

4. Did your insurance cover the cost? YES.

5. Did you have another machine before that one? If so, how long, what machine, and did insurance pay for it as well? I HAD THE RESPIRONICS BIPAP AUTO FOR ABOUT 16 MONTHS. IT WAS GREAT, BUT I KNEW IT WAS NOT DOING THE JOB TOWARDS THE END. I WAS GASPING FOR AIR WHILE ON THE MACHINE. I HAVE ALSO BEEN ON OXYGEN FOR SOME TIME, NOW I USE IT AS REQUIRED. I ALSO HAVE HELIOX FOR VCD...USUALLY BROUGHT ON BY GERD. I WORKED OUT A DEAL WHERE I USED THE OXYGEN AND HELIOX WHILE ON THE SV. I DID NOT DO IT FOR TOO LONG, BUT IT IS POSSIBLE AND I STAY AT MY OXYGEN AND HELIOX TITRATION OF 2LPM.

I LOVE THE MACHINE, BUT I WISH RESPIRONICS WOULD PUT EDUCATIONAL INFO ON THEIR WEBSITE. OR SUPPLY DVDS FOR US.

MEDICARE PAYS ABOUT $450 A MONTH FOR 13 MONTHS, THEN THE SV IS MINE I GUESS. MY ONLY CONCERN ABOUT IT IS THE HIGH PRESSURES IT USES.

THE PRESCRIPTION WAS THE THING. Apria said they were going to have to have some kind of meeting to determine their liability. I told them their liability was a lot higher if they had a prescription from my doctor and they did not fill it. They concurred and it came within a few days. I gave Apria a written waiver about the pressures, since I am the one changing them. I work with my doctor on that.

Hope I answered your questions....

[Snooze_Blues]

Hope I answered your questions....

Yes, thanks. Sounds like they developed these servo ventilation units just in time to help you survive despite several serious issues.

Let me throw in one more question...

Did the Encore Pro software come with your machine or did it cost extra? I'm assuming you have it, but maybe you don't.

I can't figure out if an individual can actually buy Encore Pro these days. It doesn't seem to be listed for sale any longer on cpap.com, or other sites I've visited. Everyone seems to be pushing the EncoreViewer software now and it looks to have a lot less features and capabilities, although it's likely more layperson friendly (simpler to install and use). But it doesn't look like EncoreViewer is listed in the SV offering on cpap.com, only Encore Pro, so hopefully, I could get myself a copy of Encore Pro somehow.

I appreciate the responses.

I'm probably getting a bit ahead of myself since I've been told I'll first be placed on a simple CPAP device, but will probably need an "adaptive servo ventilation" device eventually.