Complex Apnea

[Bwolf]

I had a follow-up sleep study done while using a CPAP and they found out that my Apnea was "complex" and the tech said I would need a different kind of machine....I explained that I have used both a regular CPAP, and an Auto-CPAP.....other than a BI-PAP what other types of machines are there? The tech said its not very common and would be more expensive but wanted the doctor to explain it all to me.....does anyone have any ideas? Thanks, Baron

[JDS74]

I had a follow-up sleep study done while using a CPAP and they found out that my Apnea was "complex" and the tech said I would need a different kind of machine....I explained that I have used both a regular CPAP, and an Auto-CPAP.....other than a BI-PAP what other types of machines are there? The tech said its not very common and would be more expensive but wanted the doctor to explain it all to me.....does anyone have any ideas? Thanks, Baron

Baron:
The machine type being referred to is an Auto Servo Ventilator machine (ASV). Both ResMed and Respironics make them and there may be others.

The machine basically operates as an auto adjusting BiPap machine until you have a detected central apnea. Then it kicks in as a ventilator type machine and forces a breath. It has another mode in which it monitors your breathing rate and kicks in if your rate falls below the minimum the machine is set for.

If you would click on the User Control Panel and select your equipment and then select "TEXT" for the display type, it would be helpful for others wanting to make helpful comments. At the same time, it would also be helpful if you would open your original post and edit to add the comment "ASV" in the subject line. That way others with more knowledge than I on ASV type therapy could chime in.

[Pugsy]

ASV machines.

In Respironics line this one https://www.cpap.com/productpage/respir ... avaps.html

In ResMed line this one http://www.resmed.com/us/products/s9_vp ... c=patients

[Bwolf]

Thanks to both of you....I'll make the changes to my post as you suggest.

[Bwolf]

I had a follow-up sleep study done while using a CPAP and they found out that my Apnea was "complex" and the tech said I would need a different kind of machine....I explained that I have used both a regular CPAP, and an Auto-CPAP.....other than a BI-PAP what other types of machines are there? The tech said its not very common and would be more expensive but wanted the doctor to explain it all to me.....does anyone have any ideas? Thanks, Baron

[JohnBFisher]

... That way others with more knowledge than I on ASV type therapy could chime in. ...

You did a good job with the explanation.

Bwolf, we can add a lot more information as you go along with it. And it will take some advice on how to live with it. If people think the respiratory therapists are clueless about living with xPAP, they have *no* clue on living with an ASV machine. What do I mean by that? Well, when you use a CPAP or BiLevel machine, the pressure is fairly steady and leaks in the mask are nothing - in comparison to an ASV machine. You see, when the ASV machine kicks in as a ventilator, it ramps the pressure up toward 25 to 30cm H2O (depends on your specific prescription). But at that level there is not a mask in the world that stays on without leaking. Getting a mask to work at those pressures is "interesting". But by using mask liners and other tricks, you'll learn how to avoid those problems.

And the sleep tech was right. The machines cost a LOT. Hang on to your hat (be seated) when you hear the price. But I would pay almost ANYTHING for that good night of sleep. And my ASV machine is *WONDERFUL*. I sleep like a baby with it. I don't / can not / sleep without it.

[Paper_Nanny]

And the sleep tech was right. The machines cost a LOT.

My insurance company didn't have a problem with covering my ASV, so although the cost is a lot more, for me, that was a moot point.

It does take a bit to get used to the way the ASV works and this is a great place for getting ideas and suggestions on how to make the therapy work for you. For almost everyone, it really is a matter of being committed to your therapy and committed to finding ways to deal with any problems that come up.

That said, you could be one of the lucky ones who doesn't have much trouble adjusting to the ASV. I was in that category. I had a few minor problems getting used to it, but those were easily remedied. It has turned out that the ASV may not be the best machine for me to be using, but that is a separate issue.

Read a lot and ask questions if you have any problems. And best wishes!

Deborah

[Bwolf]

Thank you to everyone for your replies....the insurance is currently doing a pre-authorization for the machine...so we will wait and see.

I am concerned however as to why I have central apena...my doctor said that centrol apena is usually only found in people who either: abuse drugs, are extremely overweight, have other complicated medical conditions like HIV, etc.....I don't use drugs, am not overweight, and regularly test negative for other serious medical issues.....am I just an odd case?

[JohnBFisher]

Thank you to everyone for your replies....the insurance is currently doing a pre-authorization for the machine...so we will wait and see.

I am concerned however as to why I have central apena...my doctor said that centrol apena is usually only found in people who either: abuse drugs, are extremely overweight, have other complicated medical conditions like HIV, etc.....I don't use drugs, am not overweight, and regularly test negative for other serious medical issues.....am I just an odd case?

Bwolf, just remember that in any graduating class of doctors that one half of them do not finish in the top half! And I fear this is a perfect example. Complex Sleep Apnea Syndrome (CompSAS), is a well known and well documented situation, where the respiratory systems fails to trigger as it should with increased pressure. This is not something new. It is not something unique. And it MUST be addressed as you would address obstructive apneas. Failure to do so *IS* very detrimental to your health. This is not a "MIGHT BE" situation. This is a "DEFINITE" situation.

If, during the sleep study, you exhibited signs of complex sleep apnea, then your doctor should work to resolve the issue. If he fails to do so, go find another doctor who will do so.

Why? Well, I had an idiot doctor, who told me that I could not have central sleep apnea, because it is so rare. (Not that I did not have central apneas. I did during ALL of my sleep studies. I've had increasing problems during the wake/sleep transition - reaching a point where my BiPAP would shut off because I stopped breathing for more than a minute at a time!!) He was just convinced that if it was rare, then I could not have it. Idiot!

I should have paid a LOT more attention to my own symptoms. Since I did not, I developed uncontrolled high blood pressure (even with medication). I also struggled with HORRIBLE headaches. I used Ibuprofen to tackle the headaches. And the high blood pressure and Ibuprofen combined to permanently damage my kidneys. Gee, thanks Doc!

Just because they have a "Doctor" as part of their title does NOT mean that they are competent! If you are having problems with sleep - PAY ATTENTION !!! If the doctor will not, find another who will.

http://www.resmed.com/us/clinicians/abo ... apnea.html

Hope that helps.

[archangle]

my BiPAP would shut off because I stopped breathing for more than a minute at a time!!

It shuts off if you stop breathing for a minute?

Geez, what horrible device was that? I've heard of shutoff due to big leaks, but to shut off due to a long apnea!!!

[archangle]

Be sure you have a competent doctor who really looks at your sleep study PLUS waveforms before prescribing an ASV machine. Some people panic when they hear "central apnea."

My CPAP machine will occasionally show "central apneas," but when I go look at the waveform, the length of the event is short, and I'm actually still breathing somewhat during the apnea. A dumb doctor might see "x" central apneas per hour and panic.

I'm also suspicious about whether short central apneas mean anything. If your blood O2 level is high enough, maybe your breathing reflex may simply shut down for a short time until your O2/CO2 levels reach a level for you to breathe again.

I do realize that you you can have truly dangerous central apneas. Just be sure to really look at the results before you let someone inflict you with an ASV machine.

[JohnBFisher]

my BiPAP would shut off because I stopped breathing for more than a minute at a time!!

It shuts off if you stop breathing for a minute?

Geez, what horrible device was that? I've heard of shutoff due to big leaks, but to shut off due to a long apnea!!!

This was a BiPAP only unit (at the time) and I had the "Auto Off" feature enabled. The assumption the engineers probably made was that if the user was not connected (no change to inspiration pressure), then the user must have taken the mask off. Thus, after one minute it would turn itself off. Now, I don't know about you, but even if a central apnea is normal during the wake/sleep transition, then one that lasts more than one minute during that transition is NOT normal. Though I have a scattering of central apneas throughout the night, the wake/sleep transition is the most difficult for me.