Central Apnea-Is It Normal To Stop Breathing More Than 30 Minutes At a Time?

GearChange · Post by **GearChange** » Thu May 26, 2022 5:34 am

dataq1 wrote: ↑
Wed May 25, 2022 6:31 pm

Tidal Volume is managed by Philips Respironics ASV for the purpose of managing Central Sleep Apnea.
ResMed ASV maintains a constant Minute Volume to manage Central Sleep Apnea.
http://www.apneaboard.com/wiki/index.ph ... _The_Guide

My understanding of your May 24 Oscar report, specifically between~ 0607 and ~0625, the patient initiated (triggered) about 4-6 breaths out of what might have been an expected 100-150 breaths. However, the ASV took charge and supplied the missing breaths.

So, technically YOU stopped the normal breath cycling, but because the ASV made up the difference so that your system would still maintain oxygenation..... so you wouldn't die.

Is that normal, you not initiating the respiration cycle at that frequency?
IMO, No, it is not normal, and that is why your treatment/therapy requires ASV.

Precisely, thank you.
Most sleep therapists and RTs do not fully understand the seriousness of Central Apnea and end up prescribing inappropriate or ineffective treatment, such as putting the patient on regular CPAP therapy which in turn exasperates the patient's central apnea.
Most often this ignorance towards Central apnea is because CSA patients make up a small percentage of the apneac population or sometimes simply because the patient's insurance does not cover ASV treatment.
Another point that I have been making here is the fact that even when Central Apnea is correctly diagnosed and a ASV system is prescribed (currently and as far as I can tell, only Philips and Resmed offer ASV systems for home use), professionals still need complete data sets from each sleeping session, in order to continue with intelligent and effective therapy.
For example, my Philips Respironics ASV logs details of machine triggered breaths, down to timestamps for each event (see below).

It is NOT normal for anyone to stop breathing for such long periods of time while asleep and thus besides Phrenic Nerve Stimulation Surgery, ASV ventilation therapy is the only known form of therapy for to this group.

lazarus · Post by **lazarus** » Thu May 26, 2022 9:23 am

GearChange wrote: ↑
Thu May 26, 2022 5:34 am
ignorance towards Central apnea

This is rampant in forums, especially the mistaken belief that all centrals are idiopathic rather than often being the result of serious conditions that it may be very important to address with direct treatment instead of considering it somehow a success to use ASV merely to hide symptoms. Hiding a problem is not the same thing as actually addressing it. That is why smart docs don't just count up the centrals, apply some formula, and then send everyone on their way with ASV before thorough exploration. ASV often is an indication of giving up the search and assuming nothing can be done beyond treating the symptom. Sometimes that's all that can be done. But it is never the first thing to do.

GearChange wrote: ↑
Thu May 26, 2022 5:34 am
CPAP therapy which in turn exasperates the patient's central apnea.

In misguided hands (let the reader use discernment), it is possible to do that exact same thing with an ASV. The only difference is that ASV is a more powerful tool so it is possible to do create even more problems with it than with more standard forms of PAP. ASV, as great as it is for those who need it, isn't automatic-magic. It may even be possible to be clumsy enough in applying it that it could, for example, cause a patient to learn not to spontaneously trigger breaths for inordinate amounts of time and instead to allow the machine to initiate breaths that the patient's body might have triggered a fraction of a second later.

GearChange wrote: ↑
Thu May 26, 2022 5:34 am
professionals still need complete data sets . . . in order to continue with intelligent and effective therapy

On this point, we agree. ASV is not a toy to experiment with in a gee-wiz-ain't-this-cool sort of way. It takes a pro overseeing the approach with intelligence, not a dial-winging patient, in most instances, in my opinion.

And that is why it is also my opinion that you may inadvertently be doing damage to this forum with your posts that some may use to form misguided opinions on their own about ASV and CSA. Your claim in your signature that you have extensive experience may be read as an attempt to make yourself an authority about something that I believe no one (at this particular forum, anyway) considers you actually to be an authority on. But hey, I'm no authority, either--just a patient trying to be helpful to fellow patients.

If you need help, please say so. If you want to theorize about how ASV could be used, it might be better to limit those thoughts by sharing them with your own doctor instead of posting them on forums. I KNOW you don't want anyone to get hurt by what you say.

This is not a personal attack, just a critique. I don't doubt your motives. I'd gladly buy you a beer. However, you may inadvertently be misleading some in a way you never intended. I thought I should say so instead of biting my tongue.

If I go to a cooking forum that discusses the proper techniques in the use of kitchen knives, I don't expect to find threads on how best to juggle butcher knives in a side-show attraction.

Hey, just me. One man's opinion. And please take it in the spirit with which it is intended.

Sleep well.

GearChange · Post by **GearChange** » Thu May 26, 2022 10:37 am

lazarus wrote: ↑
Thu May 26, 2022 9:23 am

GearChange wrote: ↑
Thu May 26, 2022 5:34 am
ignorance towards Central apnea
This is rampant in forums

Hey, just me. One man's opinion. And please take it in the spirit with which it is intended.

Sleep well.

Yup, that makes 2 points that we can agree on.

lazarus · Post by **lazarus** » Thu May 26, 2022 10:58 am

And perhaps a third would be that anyone who finds it necessary to say "I have extensive experience" in a forum signature (in any forum) may be someone of whom to be especially wary, since it may be a red flag indicating a desire to assert one's own "reputation"?

Just a thought. Up to you.

Glad we were able to agree on a few things, though, either way.

GearChange · Post by **GearChange** » Thu May 26, 2022 11:37 am

GearChange wrote: ↑
Fri May 20, 2022 6:45 pm
So I am putting this out there in case there's a live CSA person on a ASV machine, who has had a similar experience and is as curious as I am about this strange phenomenon.

To conclude this post while taking into account relevant commentaries, here are my thoughts on this topic;
First and foremost, I clearly stated why I am making this post in the first line of my OP, so that there would be no ambiguities, however some commentators may have missed that point.
I wanted to know if there are other CSA patients on ASV therapy here who have noted what I have, in their charts. It appears however that there have been none so far .

That being said, I had also been in consultation with my own specialist (and yes she is a MD), and had been fully briefed by her, prior to making the OP.
Here are her thoughts for those who care to know:

1-My ASV PAP therapy is doing exactly what it has been designed to do, providing ventilatory support when I am not doing it involuntarily.
2-CSA is a relatively new field (in medical terms anyway) and for the past decade or so since it was first officially isolated as a "condition", there has not been a whole lot of published research on CSA and its characteristics.
3-ASV therapy is even newer than CSA. In fact it is so new in medical terms that not a whole lot of professionals are even properly trained on its use.
4-There have been some scant studies that link CSA to a variety of causes, however since some subjects have been eliminated for these causes, they are labeled as "idiopathic". Much more studies are needed in this area alone.
5-There has not been any study (that she knows of and I am sure someone will correct her on this) on the exact length of breathing cessation by different CSA patients, "presumably" because such study would require large numbers of subjects, equipment and teams involved which would make this venture quite complex and very expensive.
6-There have however been studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea by these patients , however there are some studies that show a reduction or total elimination of CSA, when OSA subjects stop CPAP therapy. There are however no indications (or group studies that she knows of) which can show the long term use of ASV therapy by CSA patients can result in patients not breathing for long periods of time, as per in #5 ( and as the last commentator alluded to).....and besides, I can go back to my early days of therapy and find the same long periods of not breathing in my Philips charts because of course my Resmed charts do not show this information.

I am therefore cleared to continue with my therapy, unless I choose to stop ASV therapy, an option that I am not prepared to exercise just yet.

I have also modified my signature because at least one commentator felt uncomfortable with it and suggested that some people may take it literally and exercise what I post here, despite the fact that my signature also specifically warns against such action without clearing it with their own medical team.

lazarus · Post by **lazarus** » Thu May 26, 2022 12:05 pm

GearChange wrote: ↑
Thu May 26, 2022 11:37 am
. . . studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea . . .

I am aware of NO study which suggests long-term use of CPAP by OSA patients contributes to the development of CSA, idiopathic or otherwise.

Solving a plumbing problem never causes an electrical one. However, NOT solving a plumbing problem can eventually knock out the electricity throughout the entire house/body in a very dangerous way.

In my case, once my serious OSA was resolved with PAP, all my centrals eventually disappeared. It is OSA itself that can cause centrals over time for some who are moderate-to-severe, if they have a tendency toward breathing dysregulation. Allowing the entire body to heal by using optimized CPAP all night every night can help underlying issues that can otherwise cause CSA. So, although both conditions can be related, I believe it to be in the very opposite way that you seem to suggest.

I am glad to know you are in close consultation with a sleep doc, if that's what she is, though. If I needed ASV, I would want a sleep doc with some experience in neurology or cardiology, or some some similar discipline, in the loop and preferably that it be a doc/RRT team with some hands-on experience with ASV--because: PAP can unmask; ASV can mask. However, for those who, after thorough investigation, are found to have no known treatable, solvable conditions appearing to contribute to the central apnea problems and who continue to have disturbed sleep from an inordinate amount of true centrals, I am very, very glad ASV exists for them. A real game-changer for that population, no doubt!

Thanks for putting up with me in your thread.

I wish you well.

GearChange · Post by **GearChange** » Thu May 26, 2022 12:43 pm

lazarus wrote: ↑
Thu May 26, 2022 12:05 pm

GearChange wrote: ↑
Thu May 26, 2022 11:37 am
. . . studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea . . .
I am aware of NO study which suggests long-term use of CPAP by OSA patients contributes to the development of CSA, idiopathic or otherwise.

Thanks for putting up with me in your thread.

I wish you well.

You could have just googled this one. It is called "Treatment-emergent central sleep apnea"
Here's a link:
https://www.uptodate.com/contents/treat ... leep-apnea

lazarus · Post by **lazarus** » Thu May 26, 2022 1:11 pm

GearChange wrote: ↑
Thu May 26, 2022 12:43 pm

lazarus wrote: ↑
Thu May 26, 2022 12:05 pm

GearChange wrote: ↑
Thu May 26, 2022 11:37 am
. . . studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea . . .
I am aware of NO study which suggests long-term use of CPAP by OSA patients contributes to the development of CSA, idiopathic or otherwise.

Thanks for putting up with me in your thread.

I wish you well.
You could have just googled this one. It is called "Treatment-emergent central sleep apnea"
Here's a link:
https://www.uptodate.com/contents/treat ... leep-apnea

That proves the exact opposite of what you think it does. Getting the OSA out of the way reveals, or unmasks, CSA.
That has less than zero to do with "long term use of CPAP therapy by Obstructive Apnea patients (OSA) [contributing] to the development of Central Apnea." It is something that can happen initially with PAP, not as a result of long-term use. It often resolves if pressure-related. It may not resolve if the centrals are caused by an underlying comorbidity (heart/brain/nerves/drugs/etc.) that needs treatment.

ChicagoGranny · Post by **ChicagoGranny** » Thu May 26, 2022 1:15 pm

GearChange wrote: ↑
Thu May 26, 2022 11:37 am
There have however been studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea by these patients ,

Do you have links to evidence on "long-term?" The link you provided refers to a study that talks about TECSA upon initiation of CPAP and after 30 days to several months. I don't consider several months to be long-term. https://www.uptodate.com/contents/treat ... abstract/8

GearChange · Post by **GearChange** » Thu May 26, 2022 1:18 pm

lazarus wrote: ↑
Thu May 26, 2022 1:11 pm

GearChange wrote: ↑
Thu May 26, 2022 12:43 pm

lazarus wrote: ↑
Thu May 26, 2022 12:05 pm

GearChange wrote: ↑
Thu May 26, 2022 11:37 am
. . . studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea . . .
I am aware of NO study which suggests long-term use of CPAP by OSA patients contributes to the development of CSA, idiopathic or otherwise.

Thanks for putting up with me in your thread.

I wish you well.
You could have just googled this one. It is called "Treatment-emergent central sleep apnea"
Here's a link:
https://www.uptodate.com/contents/treat ... leep-apnea
That proves the exact opposite of what you think it does. Getting the OSA out of the way reveals, or unmasks, CSA.
That has less than zero to do with "long term use of CPAP therapy by Obstructive Apnea patients (OSA)

"....Treatment-emergent central sleep apnea (CSA), previously referred to as complex sleep apnea, is detected in approximately 5 to 15 percent of patients who undergo positive airway pressure (PAP) titration for obstructive sleep apnea (OSA). Treatment-emergent CSA is defined as the persistence or emergence of central apneas and hypopneas during the initiation of PAP therapy without a backup respiratory rate for obstructive OSA, despite significant resolution of obstructive respiratory events...."

Mayo clinic explains it easier:

".....Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for their sleep apnea treatment. This condition is known as treatment-emergent central sleep apnea and is a combination of obstructive and central sleep apneas...."

But whatever you say dude. We are way off topic again.

lazarus · Post by **lazarus** » Thu May 26, 2022 1:45 pm

GearChange wrote: ↑
Thu May 26, 2022 1:18 pm

lazarus wrote: ↑
Thu May 26, 2022 1:11 pm

GearChange wrote: ↑
Thu May 26, 2022 12:43 pm

lazarus wrote: ↑
Thu May 26, 2022 12:05 pm

GearChange wrote: ↑
Thu May 26, 2022 11:37 am
. . . studies done which suggest that long term use of CPAP therapy by Obstructive Apnea patients (OSA) , tends to contribute to the development of Central Apnea . . .
I am aware of NO study which suggests long-term use of CPAP by OSA patients contributes to the development of CSA, idiopathic or otherwise.

Thanks for putting up with me in your thread.

I wish you well.
You could have just googled this one. It is called "Treatment-emergent central sleep apnea"
Here's a link:
https://www.uptodate.com/contents/treat ... leep-apnea
That proves the exact opposite of what you think it does. Getting the OSA out of the way reveals, or unmasks, CSA.
That has less than zero to do with "long term use of CPAP therapy by Obstructive Apnea patients (OSA)
"....Treatment-emergent central sleep apnea (CSA), previously referred to as complex sleep apnea, is detected in approximately 5 to 15 percent of patients who undergo positive airway pressure (PAP) titration for obstructive sleep apnea (OSA). Treatment-emergent CSA is defined as the persistence or emergence of central apneas and hypopneas during the initiation of PAP therapy without a backup respiratory rate for obstructive OSA, despite significant resolution of obstructive respiratory events...."

Oukay...whatever you say dude.

Titration. That means the very first night on PAP.

lazarus · Post by **lazarus** » Thu May 26, 2022 1:50 pm

GearChange wrote: ↑
Thu May 26, 2022 1:18 pm
We are way off topic again.

That happens when people have to correct misinformation/disinformation. But I apologize for it nonetheless. Won't happen again. I'll let it pass in your threads in the future, since I won't open them. But if in someone else's thread . . . Good day to you.

GearChange · Post by **GearChange** » Thu May 26, 2022 2:04 pm

lazarus wrote: ↑
Thu May 26, 2022 1:45 pm

GearChange wrote: ↑
Thu May 26, 2022 1:18 pm

lazarus wrote: ↑
Thu May 26, 2022 1:11 pm

GearChange wrote: ↑
Thu May 26, 2022 12:43 pm

lazarus wrote: ↑
Thu May 26, 2022 12:05 pm

I am aware of NO study which suggests long-term use of CPAP by OSA patients contributes to the development of CSA, idiopathic or otherwise.

Thanks for putting up with me in your thread.

I wish you well.
You could have just googled this one. It is called "Treatment-emergent central sleep apnea"
Here's a link:
https://www.uptodate.com/contents/treat ... leep-apnea
That proves the exact opposite of what you think it does. Getting the OSA out of the way reveals, or unmasks, CSA.
That has less than zero to do with "long term use of CPAP therapy by Obstructive Apnea patients (OSA)
Titration. That means the very first night on PAP.
I think I made a mistake responding to your post and linking that particular study because now we are way off topic and discussing an issue that has nothing to do with this thread.
However treatment emergent central apnea (either at the onset of treatment for OSA or later in OSA CPAP therapy) has been the subject of many studies, however you clearly stated that you knew of NO such study ... yet you seem to have suddenly developed an expertise in the field since I told you that you could have just googled the subject ...but the point is that I really don't care as It has nothing to do with my post and whether some TECSA happen at the beginning of CPAP titration and some later in therapy, is of no relevance or interest to me.

Thank you for your input though.

Julie · Post by **Julie** » Thu May 26, 2022 7:02 pm

You all have very erudite writing and ideas. Good for you, but has ANYone gone back and seen what Pugsy said? She is THE expert on all this stuff here and almost everyone else's (relatively) recent input just doesn't take what she says into account, therefore wasting even more time etc. than is needed. Show off all you want, but she knows her stuff cold, so why not pay more attention to what she's said and less to your own ideas? Now you can all pile on here for a change... have fun!

dataq1 · Post by **dataq1** » Thu May 26, 2022 10:24 pm

Julie wrote: ↑
Thu May 26, 2022 7:02 pm
You all have very erudite writing and ideas. Good for you, but has ANYone gone back and seen what Pugsy said? She is THE expert on all this stuff here and almost everyone else's (relatively) recent input just doesn't take what she says into account, therefore wasting even more time etc. than is needed. Show off all you want, but she knows her stuff cold, so why not pay more attention to what she's said and less to your own ideas? Now you can all pile on here for a change... have fun!

I've been following this thread but I can not find "what Pugsy said" in this thread.
Could you please link to what you are referring ?

Central Apnea-Is It Normal To Stop Breathing More Than 30 Minutes At a Time?

Re: Central Apnea-Is It Normal To Stop Breathing More Than 30 Minutes At a Time?

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