Central Apneas - Question

In my original split-night study I had 2 Central apneas during my baseline portion (before CPAP). Is this cause for concern or are there typically a few central apneas per night that occur normally?

Does this mean I need BiPAP?

I'm still awating results of my full-night titration study and hope to have them early next week.

Thanks,

--Andy

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration

ColoZZZ wrote:In my original split-night study I had 2 Central apneas during my baseline portion (before CPAP). Is this cause for concern or are there typically a few central apneas per night that occur normally?

Does this mean I need BiPAP?

I'm still awating results of my full-night titration study and hope to have them early next week.

Thanks,

--Andy

Having a few centrals is common. If you had some, I'd want to know what they do when cpap pressure is applied.

Sometimes they resolve themselves other times not. If they don't, you probably have a pressure found where they increase in frequency. If so you avoid going higher than that pressure. If you are using a autopap you set the Maximum pressure to that found pressure so the machine doesn't misread and go higher causing even more to trigger.

I make it a point to talk to the PSG tech, I ask about the centrals and the arousals seen, he usually goes over it with me and points out the pressure that ended the test, in my case that is usually a central. He then tells me the pressure to use to avoid those centrals and obtain the best sleep.

I sleep better with an autopap due to its lower pressure.

A bipap machine will not treat central apnea. The S/T models can offer some relief by providing backup ventilation should you go too long before taking another breath. But none treat centrals directly.

[quote="Snoredog"]

A bipap machine will not treat central apnea. The S/T models can offer some relief by providing backup ventilation should you go too long before taking another breath. But none treat centrals directly.

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[quote]

Snoredog - why do you saty that a Bipap will not reat central apnea? By "treat" do you mean prevent it from happening? Just curious.

Thanks Snoredog for the info. So to recap,

1) I shouldn't be too alarmed about a couple of Central apneas during 145 min. of regular sleep - its normal,

2) I need to get the results of my titration study to see if there were Central apneas and determine whether they commenced when a particular pressure was reached,

3) If there were centrals that began at a certain pressure, make sure not to set the upper limit above that pressure (IF I can get an APAP),

4) BiPAP does not treat central apnea,

5) APAP may be a better therapy due to its ability to reduce pressure when less is needed.

Please let me know if I've got this wrong. What does "S/T" stand for?

I am SO READY to get started with this therapy I'm thinking of hitting Craig's List and buying ANY machine until I can get the prescription and DME to set me up! I feel like every day is another wasted day of my life...

(especially after just sitting through a management meeting! )

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, DME, Prescription, APAP

ColoZZZ wrote:Thanks Snoredog for the info. So to recap,

1) I shouldn't be too alarmed about a couple of Central apneas during 145 min. of regular sleep - its normal,

2) I need to get the results of my titration study to see if there were Central apneas and determine whether they commenced when a particular pressure was reached,

3) If there were centrals that began at a certain pressure, make sure not to set the upper limit above that pressure (IF I can get an APAP),

4) BiPAP does not treat central apnea,

5) APAP may be a better therapy due to its ability to reduce pressure when less is needed.

Please let me know if I've got this wrong. What does "S/T" stand for?

I am SO READY to get started with this therapy I'm thinking of hitting Craig's List and buying ANY machine until I can get the prescription and DME to set me up! I feel like every day is another wasted day of my life...

(especially after just sitting through a management meeting! )

Looks like you have a pretty good grasp on it.

The S/T in the bipap is Spontaneous or Timed back-up modes. It is how the unit cycles between IPAP and EPAP pressure, they can operate in Spontaneous mode where the patient determines the unit cycle, Spontaneous/Timed mode where if the patient fails to trigger inspiration then the machine can switch to IPAP cycle based upon a preset interval determined by the patent's breaths per minute (BPM). This cycling or switch can sometimes trigger the patient to breathe.

ColoZZZ wrote:1) I shouldn't be too alarmed about a couple of Central apneas during 145 min. of regular sleep - its normal,

Right.

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

ColoZZZ wrote:2) I need to get the results of my titration study to see if there were Central apneas and determine whether they commenced when a particular pressure was reached,

It's always good to have a copy of full reports from both the diagnostic and titration sleep study. I'm not a doctor, but as I understand it...as for worrying about where centrals appeared in the titration (if they did at all) there is a lot more to consider than just "where/at what pressure(s)." I've read sleep techs discussing transient centrals that can appear in some people just from the change to a new pressure during the titration...temporary centrals that subside as the body adjusts to breathing at the next pressure. Seeing some centrals popping up at a certain pressure during a titration might not mean that's going to happen later when using that pressure. Sleep techs often speak of just giving it some time at that pressure to see if the centrals subside.

ColoZZZ wrote:3) If there were centrals that began at a certain pressure, make sure not to set the upper limit above that pressure (IF I can get an APAP),

Again...not necessarily. Could have been transient, temporary centrals during the titration. Especially if it was a split night sleep study rather than two full nights of one diagnostic night and one titration night, the titration might have been a tad rushed...possibly moving the pressures up faster than would have happened in a full night titration. Depending on the sleep tech handling the titration and the sleep lab's titration protocols, the move up to "next pressure to try" might have been rushed even in a full night titration. There's an art, along with the science, of doing a good titration in a sleep lab, imho.

ColoZZZ wrote:4) BiPAP does not treat central apnea,

BiPAP S/T is more often prescribed for serious central apnea. Spontaneous -- as long as you're breathing at a normal rate, it goes along with your breathing..your inhale/exhale. Timed -- a rate is set to make the machine not keep waiting for you to take a breath if a central apnea has put your breathing into an overly long pause. The switch to "inhale/exhale" happens if you don't meet a timed rate of x number of breaths per minute and don't initiate an inhale spontaneously (on your own.) The theory being that the nudges of pressure changing from exhale to inhale will "remind" the brain/body to breathe spontaneously again.

More recent very specialized machines -- "ASV" (adaptive servo ventilation) machines like the Respironics BiPAP autoSV / "HeartPAP" and BiPAP autoSV 2 or ResMed VPAP Adapt SV might be even more effective for treating severe central sleep apnea.

ColoZZZ wrote:5) APAP may be a better therapy due to its ability to reduce pressure when less is needed.

For the typical Obstructive Sleep Apnea that most people have, an autopap usually does a fine job. If it turns out that a single straight pressure suits a person better, an autopap can always be set to operate as straight cpap.

ColoZZZ wrote:I am SO READY to get started with this therapy I'm thinking of hitting Craig's List and buying ANY machine until I can get the prescription and DME to set me up! I feel like every day is another wasted day of my life...

(especially after just sitting through a management meeting! )

LOL!!! Can't say I blame you for wanting to get started with treatment! Getting a machine on your own isn't a bad idea at all. heheh. Never hurts to have two machines. It's nice to have a backup sitting there ready, "just in case."