Medical Rationale for CPAP over APAP?

Titrator wrote: I wish that I could take every one of you into a sleep lab and let you watch a sleep test. Ted

Well, only for those who have already been through a sleep study. I would never recommend giving a tour to a newbie, before they've had the test. Would scare the you-know-whats out of them and they might reconsider.

Anonymous wrote:

Titrator wrote: I wish that I could take every one of you into a sleep lab and let you watch a sleep test. Ted

Well, only for those who have already been through a sleep study. I would never recommend giving a tour to a newbie, before they've had the test. Would scare the you-know-whats out of them and they might reconsider.

I would have loved to have a tour before my first study. I could have been a little more proactive when I arrived for the real thing. Things like... Don't you have any better masks than that?... or can you crank up the hummidity?... and why don't you use a heated hose?

Guest, Titrator, et al---please weigh in on my thoughts regarding holding one's breath versus true central apneas:

Central Apnea: a central or purely autonomous issue related to the respiratory drive

Holding the Breath: When in response to anxiety and/or sensory stimuli such as pressure or physical discomfort, responsive "breath holding" implies that the conscious mind versus an autonomous response orchestrates this particular event.

If the EEG reflects deep stages of sleep and the respiratory effort belt reflects a lack of respiratory effort, then these particular events are central in nature and not an issue of responsive breath holding. If this is true then what Titrator observed were likely pressure-induced central apneas versus a more conscious albeit reflexive breath holding.

Titrator, when you observed those events were deep stages of sleep seldom or often registered on the EEG? if seldom then I would think these could have been simple holding of the breath. If deep sleep was maintained then these had to be true pressure induced central apneas.

Thoughts? Ideas? Comments?

-SWS, if that's your definition, then there's got to be a new definition for what happened to me.

It might not be a "central apnea", but it wasn't a conscious breath holding. The best description I can give is that I "forgot to breathe".

Liam, turning blue.

The following excerpt is taken from the Insomnia Manual and Reference on TAS.

Peter J. Hauri of the Mayo Sleep Disorders Center wrote:Also included here are sleep onset central apneas, often associated with
hyperventilation before sleep in anxious patients, then resulting in central
apneas when the patient falls asleep and respiration becomes automatic.
These sleep onset centrals often awaken the sleeper. There is then frequent alternating between wake with hyperventilation and sleep with central apneas causing arousal, until more solid sleep is established

The above describes an anxiety-based central apnea that only happens during sleep onset and intervening periods of non-deep stages of sleep. I have read that sleep onset central apneas are common for patients on CPAP. Perhaps those are instances of CPAP-anxiety-related central apneas. Do these central apneas qualify as anxiety-based "breath holding" or are they true centrals?

Liam, this is not exactly what is happening with you, but perhaps we can draw some relevant understanding toward your own issue(s) as we explore this central apnea topic further. Interesting topic, none the less...

"hyperventilation before sleep" are the key words for my
situation. I put on the mask and do some regulated deep
breathing to get going in synch with the machine. Maybe if
I didn't hear the machine whining and switching gears, I
wouldn't be trying to "get going" breathing. Nights when I
breathe deeply and lay there awhile before falling asleep,
usually end up with one or two little tick marks on the graph
for central apnea. My Doctor says that my CO2 levels are
too low from hyper breathing. So my body doesn't need to
breathe, until the CO2 levels start to build up in the tissue.
My sleep tech said "We see those Sleep Onset Centrals a lot
-- just ignore them." In those cases it seems like anxiety
would play a major role for hyperventilation in your first sleep
study. When I have nights in which I drop right off to sleep,
without laying there breathing (you know like your head hits
the pillow and your zonked). In those nights I don't tend to
see those Central Apnea tick marks. As for what is happening
in the middle of the night with Central Apnea is hard for me to
say (since I am Sleeping!!). I do know that in the morning,
when I am basically just laying there with my eyes closed, I
do tend to get a cluster of Centrals. I was thinking that those
were occuring because I was "trying" to fall back asleep. My
RT said that if an arousal occurs before a Central, then the
Central should NOT be scored! Many of us have reported having
Centrals during the middle of the day. I know I do! I just
catch myself sitting there, just not breathing. So when I called
the Sleep Tech, she said "We see huge amounts of Centrals
in highly trained athletes." They don't breathe because they
have reduced their Oxygen need to such a low level. Apparently,
there was a presentation recently in Nature that it is a very valuable
thing for longevity to not breathe very often. Alligators breathe
only a couple of times per minute, and live a long time. Humans
breath more and live a shorter time. Dogs breathe more frequently
and only live 15 years. Rabbits breathe more frequently and live
ever shorter lives. I guess Dragonflies and Hummingbirds breathe
even more times per minute. So you really should study Yoga and
meditate such that you can breathe just a couple of times per minute,
so you can live a longer life. In other words, you have only so many
breathes when you are born, so you just really appreciate Centrals,
as they are extending your life!! As Rested Gal would say: "I'm
not a doctor, and YMMV".

meister wrote:My sleep tech said "We see those Sleep Onset Centrals a lot -- just ignore them."

That's easy to SAY, but when I'm already hyper focused on my breathing because of mask and machine, it wakes me up to notice that I'm not breathing.

Plus, when the CO2 starts building up, I DON'T start breathing naturally, until I'm feeling like I'm short on air, by which point my psyche can't buy that the mask is not at fault, and the only way I can FEEL like I'm solving the problem is to breath around the mask (pull it off if I'm in the FF mask, breath through mouth if I'm in the Swift, etc). It may ACTUALLY solve the problem to start breathing through the mask again, but psychologically it doesn't feel like it.

Liam, usually the 5th in "4 out of 5 patients"...

I had no idea my brief comment would unlesh such a debate! This forum is fun!!

Vicki, reading detailed posts instead of sleeping.

SWS I think you’re very close to getting it. From what I have seen in studies if you give them the 15 minutes to settle down on the new pressure and the centrals go away it’s not a true pressure induced Apnea. It’s when you let them settle down and they do it over and over again then its pressure. There is no settling down from your lungs being over filled .WOW this thread has really come a long way. You can get Deep Sleep Centrals that are not pressure related in REM also. Anything is possible in REM and it’s just ignored. Sometimes you will see a single central in there for no reason at all.


Liam if you feel better on your AUTO then it’s the right treatment for you. If it treats your apnea and all its symptoms who cares .You feel better and your able to stay on a form of CPAP all night long that’s what counts right there.

Everyone is different that’s for sure. It takes awhile of hit and miss until we find our way of doing CPAP or BIPAP. The Auto’s are great to treat generic OSA that’s all that matters. Do what you have to do to treat your apnea and get some Sleep. If it fixes 75% of your apnea that’s better then none if you failed on everything else. I would bet its fixing more like 90% of it though. If you realy want to know how you do on an Auto
The best way is to have a sleep study in the lab on your Auto CPAP. An auto down load is not going to be able to tell you the True story . It has no EEG.

You are correct in the best way, but not all of us can spend $3000
everytime we want to try something else. For example, maybe I
start using a Dental Device, or maybe I stop using Ambien ... and
I want to see what effect that has. What is the "2nd best" way??
I am willing to buy most of the sensors which the Sleep Lab has
if I can find out where to order them. I am interested in a sensor
like the chest belt, which records if you are on your back or right or
left side. Thanks.

Meister the best sensor is you. How you feel and maybe an oximeter at most . If you feel good the doctor says your doing ok such as your Blood pressure is down , if you snored your not snoreing anymore things like that then your good to go for the most part.

Go off of the the epworth scale if you pass then your doing pretty good.

http://www.silentpartners.org/sleep/pat ... pworth.htm

You really don't need a sleep test or all of its equipment just use your better judgment on how you feel.

An oximeter measure blood oxygen levels right.? How much do they cost and where do I get one? If they are inexpensive, seems that would be a great way to see how one is doing.

Same mask -- same PAP -- same settings -- same bed -- different
weather!! -- maybe some nights mask leaks more than other nights,
but I had three WOW fabulous nights and 20 not so good nights, and
7 HORRIBLE nights in one month. So is the treatment working well?
So what do you want to change? I am just looking for consistent,
night after night, reproducible results. So do I up the minimum
pressure or lower the maxium pressure on the Auto? Do I change masks?
Do I change to a BiPap? Do I change meds? Yes, I have heater
humidifier with heated hose. I have seen it work and not work. This
is not such simple stuff for all of us. Right, LIAM?

http://www.med-worldwide.com/product17251.html

Oxygen desats usually are well correlated with morning headaches,
and can lead to internal organ damage over time.

Meister, I don t think that one can ever expect a consistent night after night result. There are too many things involved.I ve been tryin to get my AHI under 10 but I seem to have 1 cluster of apneas every nite that last about an hour. They usually include a few centrals. I ve tried everything but my AHI goes between 8 and 14. So don t expect perfection, especially if you have a severe case of osa like myself. All I know is I feel better than before. Way better. Just keep at it. Maybe you will find the best pressure, mask, meds etc for you.