Central / mixed apnea

Ichabod · Post by **Ichabod** » Mon Dec 04, 2006 10:33 am

I know there is some of you who have central apnea knowledge. My sleep study showed an AHI of 39... If I am reading it correctly. It also states 27 central and 14 mixed. I was titrated at 10 and have been on CPAP since 11/13/06. I believe that I have learned through reading on these lists that C-PAP does nothing for central apnea (at least not my machine). My wife has told me that I am still grumpy... maybe even a bit more so than pre cpap. Being new to this, I do not know how knowledgable my Dr. is to apnea.

My question and reason for the above ramble is this. Is the central an issue with the number 27 that could be a cause for my grumpiness or should I just wait for my mood to get better?

Thanks,
Mike

Bella · Post by **Bella** » Mon Dec 04, 2006 11:05 am

Welcome Ichabod! I have to say I don't know much at all about your type of machine, but I gather that people do like the C-Flex.

I have Central Sleep Apnea - my AHI is quite higher at 128. I use a bilevel machine, not the single pressure CPAP. My (Synchrony S/T) Bipap is set so that I inhale at a pressure of 14 and exhale at a pressure of 4. If I do not take a spontaneous breath for a set time (I think it is 8 seconds), the machine will trigger a breath for me.

I have been on the Bipap for just over a year. I still have some bad days, but I did feel a great improvement at the start. I think I was one of the lucky ones.

Snoredog · Post by **Snoredog** » Mon Dec 04, 2006 11:58 am

I also have CA & Mixed apnea in addition to OSA. I find it to be more common than most people think. With it, you still feel like crap even after being on cpap therapy, but you feel much worse if you go off it that is for sure. It is very difficult to get cpap therapy to work successfully but it can be done if you thoroughly know your condition.

It takes good communication with your doctor, if the sleep doctor doesn't want to lay the cards on the table and provide you everything you need to treat the disorder it can be much more difficult and frustrating. Should that happen, tell the doctor you will go elsewhere.

I found my GP doctor whom I've been seeing for the past 20 years as my best advocate. He writes any script I need, orders up any PSG's or tests and shares with me completely all the results. There is none of this keep the patient in the dark crap. I have more of my medical history/records than he does, I take my medical folder in with me every visit.

I had 4 PSG's over the years, first one was split-night all others were retitration. I think the 2nd & 3rd could have been avoided had I had a more experienced tech doing the titration to begin with. They score the severity the same as obstructive, but I think they should be double the severity as compared to obstructive comparing how you feel the next day.

My suggestion:

1. Obtain the unsanitized PSG report from the lab from your doctor along with any titration pressure table. There should also be a titration table. This table can help you "dance" around the CA & MA events with pressure, it shows the events as they occur at a given pressure. CPAP can help and you don't need Resmed's ASV machine to do it.

2. Once you know your CA threshold you then have to limit your pressures below that. In my case that was 9.0cm. Note: I purchased every autopap on the market out of my own pocket, I can tell you the Remstar Auto is the best machine to have, despite its leaky tank, the M series would be preferred. The M series has some features the classic doesn't such as the AutoRamp. It seems when you use the AutoRamp it result in lower AHI (for me anyway).

3. Get EncorePro software & reader. This will allow you to monitor your results and after a while you can spot the pattern difference between obstructive and ca events.

4. Use a mask that has more dead space and a lower CO2 washout rate. A mask with a lower exhaust rate is what you want. I found just as the CSDB study indicated that retaining more of your CO2 can help lower the number of CA events seen. Avoid using interfaces like the Breeze, Swift etc. these interfaces have no deadspace and washout more CO2. I suggest you try the Somnotech Soyala, not because of its deadspace because the Activa has more, but because of its lower exhaust rate.

curtcurt46 · Post by **curtcurt46** » Tue Dec 05, 2006 10:40 am

Snoredog,
I have a couple of questions concerning folks with central and mixed apneas.
1. Are the centrals and mixed always brought on by an increase in cpap pressure?
2. Do folks have central apnea and no OSA?
3. In you case, why don't you use a machine intended for central apneas such as the remstar bipap ST or something similar?

Snoredog · Post by **Snoredog** » Tue Dec 05, 2006 1:21 pm

[quote="curtcurt46"]Snoredog,
I have a couple of questions concerning folks with central and mixed apneas.
1. Are the centrals and mixed always brought on by an increase in cpap pressure?
2. Do folks have central apnea and no OSA?
3. In you case, why don't you use a machine intended for central apneas such as the remstar bipap ST or something similar?

curtcurt46 · Post by **curtcurt46** » Tue Dec 05, 2006 1:50 pm

Thanks,
I heard there may be some advanced technology CPAP/ventilation devise that might come close to helping with central apneas coming out in the near future.

Do you monitor you 02 levels as that should be an indication of the effectiveness of the current therapy?

With the leaps in technology we see daily you would think there may be an effective treatment for central apneas coming soon.

Snoredog · Post by **Snoredog** » Tue Dec 05, 2006 2:01 pm

[quote="curtcurt46"]Thanks,
I heard there may be some advanced technology CPAP/ventilation devise that might come close to helping with central apneas coming out in the near future.

Do you monitor you 02 levels as that should be an indication of the effectiveness of the current therapy?

With the leaps in technology we see daily you would think there may be an effective treatment for central apneas coming soon.

Bella · Post by **Bella** » Tue Dec 05, 2006 2:03 pm

There is a new machine that is aimed at controlling centrals better. There is a wonderful thread here about it under the subject heading:
Resmed VPAP Adapt SV - for Central Sleep Apnea. (I don't know how to paste the link).

By the way, I have pure central apnea - no obstructive.

Wulfman · Post by **Wulfman** » Tue Dec 05, 2006 2:30 pm

Bella wrote:There is a new machine that is aimed at controlling centrals better. There is a wonderful thread here about it under the subject heading:
Resmed VPAP Adapt SV - for Central Sleep Apnea. (I don't know how to paste the link).

By the way, I have pure central apnea - no obstructive.

Do you mean this one, Bella?

viewtopic.php?t=11458

Den

Bella · Post by **Bella** » Wed Dec 06, 2006 6:18 am

Wulfman wrote:
Bella wrote:There is a new machine that is aimed at controlling centrals better. There is a wonderful thread here about it under the subject heading:
Resmed VPAP Adapt SV - for Central Sleep Apnea. (I don't know how to paste the link).

By the way, I have pure central apnea - no obstructive.
Do you mean this one, Bella?

viewtopic.php?t=11458

Den

Ichabod · Post by **Ichabod** » Wed Dec 06, 2006 7:14 am

Snoredog,
How do you feel about the CO2 capabilities of the Comfortgel compared to the Soyala? I am going to call Apria this morning. I am up against a clock for insurance. If I believe what I have read about Apria, this could take some time. If they can't provide the Soyala quick enough, I know they have the Comfortgel.

Your thoughts?

Mike

Guest · Post by **Guest** » Wed Dec 06, 2006 12:18 pm

[quote="Snoredog"][quote="curtcurt46"]Thanks,
I heard there may be some advanced technology CPAP/ventilation devise that might come close to helping with central apneas coming out in the near future.

Do you monitor you 02 levels as that should be an indication of the effectiveness of the current therapy?

With the leaps in technology we see daily you would think there may be an effective treatment for central apneas coming soon.

_________________
/quote]

The only thing I've read about was CO2 manipulation in that CSDB Harvard Study. I seem to agree that may be the better way to go, by retaining more CO2 it can trigger those chemoreceptors that trigger respiratory drive. I have been using the Somnotech Soyala which has a much higher CO2 retention rate and have been sleeping and feeling much better. I've had my worst night of sleep using the Swift which I'd put on the opposite end of the CO2 retention scale.

I wish I had one of those non-vented blue elbows to try. The first time I tried reducing the vent rate I started to hyperventilate but if you stay with it that seems to go away after a few minutes.

_________________

/quote]

Does this mean that it could help my central sleep apnea if I "manipulate" my CO2? I can't afford the new machine and the program that "loans" me the one I have is already one generation behind. I am so much better than I was a year ago, but some days are still pretty bad. I'm in the market for a new ff mask and was going to opt for the F&P 432 or the Ultra Mirage.

Central / mixed apnea

Central / mixed apnea

CSA