Central Apneas and BiPAP S/T

Does anyone know how many central apneas a night you would have before a BiPAP machine should be considered?

Hawk256 wrote:... Does anyone know how many central apneas a night you would have before a BiPAP machine should be considered? ...

I assume you mean a BiPAP S/T unit. There is also a BiPAP Auto SV unit. The ASV (Auto Servo Ventilator) units are fairly new and are designed to specifically address sleep disorder breathing problems related to central sleep apnea. This includes:

• Primary CSA
• Cheyne-Stokes Respiration (CSR) Periodic Breathing
• CSA due to medical condition without CSR
• High altitude periodic breathing
• Other Periodic Breathing Issues
• CSA due to drug
• ComplexSAS (Complex Sleep Apnea Syndrome)

The following is one example of a synopsis of the diagnostic criteria:

https://online.epocrates.com/u/2936648/ ... s/Criteria

Primary CSA

Patient reports at least 1 of the following:

• Excessive daytime sleepiness
• Frequent arousals and awakenings during sleep or insomnia complaints
• Awakening short of breath.
• Polysomnography shows 5 or more central apneas per hour of sleep.
• The disorder is not better explained by another current sleep disorder, medical or neurologic disorder, medication use or substance use disorder.

I've also read that you must have more than one half of you apneas be central apneas. So, if you have obstructive sleep apnea, then if CPAP therapy resolves most obstructive apnea events, but more than one half of the remaining events are due to CSA and the number of those events exceeds 5 per hour, then you would qualify.

Hope that helps.

I am not going to say I have the answer to your question but I will relate my experience. I have been on a bipap since 98' and never had another lab test done until a few weeks ago. My machine started acting up on me so the doctor set up a new study as part of the process to allow me to get a prescription for a new machine.
The lab did a bipap only titration as that is what was on the order. I received a call a few days later to go back and do another night at the sleep lab as the data pointed to me having central sleep apnea and the bipap titration did not reach a succesful conclusion.
I went back and did a night with the ASV machine. That session was considered to be succesful and am now waiting for the machine to arrive.
I guess what I'm trying to say is, in my case, it wasn't a question of how many but the fact there were ANY episodes that caused my doctor to raise the alarm and switch machines.

CSA is a different animal that a bipap simply won't remedy.

What is the reason for your question? Are you afraid you're having central episodes at night? If you are I would see a doctor because a night at the lab would be the only way I would know how to find out for sure.

Fred D wrote:What is the reason for your question? Are you afraid you're having central episodes at night? If you are I would see a doctor because a night at the lab would be the only way I would know how to find out for sure.

I have central apneas that have been documented by a sleep study. It was not until I really started to understand what was happening with a central apnea that I became more concerned. The more I understand a central apnea, the more I think that central apneas are dangerous at any count. I have a CPAP machine and was wondering if the Dr. should have prescribed a BiPAP S/T unit for the central apneas.

I know what you mean. I had not heard of central sleep apnea until I got the call from the doctor telling me to go back for another study. I then started doing some research and discovered what you have. CSA should be treated with specialized equipment. If your lab study indicated you are experiencing these symptoms I'd revisit your doctor and discuss it.

This site has a ton of information and alot of good people willing to share it with you. Try and get a copy of your titration results if you do not already have one so you can go over it with your doctor. Find out if he knows you are having these central episodes and if he does; why he doesn't think you should have specialized equipment for it.

I can't say when my OSA changed over to CSA or why but I do know the bipap I have been using does not allow me to get the type of rest that is needed to function as well as one wants to. In fact, looking at the results of the first study when I did the bipap titration, the results show me having the most central episodes at the pressure (14/10) my present machine is set at. So is not only the bipap machine I have not doing much for me; it is set at the worse pressure. But wrong pressure is still better than no pressure so I will continue to use it until the ASV gets in which I found out yesterday will be a week from tomorrow. (the 26th)

I hope you can follow up and get something done to your satisfaction.

Fred

Hawk256 wrote:... I have central apneas that have been documented by a sleep study. It was not until I really started to understand what was happening with a central apnea that I became more concerned. The more I understand a central apnea, the more I think that central apneas are dangerous at any count. ...

First, let me hand you your towel and let you read this encouraging book cover:

Don't Panic!

Oh, wait! That's the wrong book!

Seriously, in general central apneas are no more dangerous than any other apnea. As with other apneas the danger has to do with frequency and duration more than that they happen. Almost everyone experiences a few central sleep apneas. The problem is when it becomes excessive. What's excessive. Well the medical / insurance community decided that apneas do not need to be addressed if they occur 5 or less times per hour.

So, how bad is your situation? Well, let me provide an excerpt from a recent sleep study, where the effort was to find the correct pressure for me on BiPAP. In part, it states:

There were 67 respiratory events consisting of 6 obstructive apneas, 1 mixed apnea, 39 central apneas, 21 hypopneas, and 8 RERA’s. The overall apnea-hypopnea index (AHI) was 30.5/hr. The respiratory disturbance index (RDI) including RERA’s was 34.1/hr. The SpO2 nadir was 73%. Snoring was largely eliminated at 10/5 cmH2O, but tech noted snoring at 17/9. At BiPAP of 17/9 cmH2O, AHI was 14.6/hr. and the SpO2 nadir was 86%.

So, during the sleep study - EVEN with BiPAP in place - for every obstructive apnea I experienced, I had SIX central apneas. Also, even at a higher pressure my O2 saturation level was only 86%. Repeated over and over, night after night, month after month, year after year, that level of O2 starvation does cause damage.

But if you have a handful throughout the night, then it is really normal.

Hawk256 wrote:... I have a CPAP machine and was wondering if the Dr. should have prescribed a BiPAP S/T unit for the central apneas.

It depends on the frequency. Additionally, doctors will often start with CPAP because as you regain your own normal energy many times the central apneas lessen.

I hope that by example, this helps explain how and why an S/T or ASV model will be prescribed.

Fred D wrote:... But wrong pressure is still better than no pressure so I will continue to use it until the ASV gets in which I found out yesterday will be a week from tomorrow. (the 26th) ...

Hey! Congratulations! That's great news.

Don't be surprised if you feel as if you are a newbie all over again with the ASV unit. They definitely "feel" quite different. I sometimes feel as if my ears should start to inflate any minute ... as the pressure ramps up on my unit when I fall asleep:



Hey! You've got to laugh at this stuff, or you'll go stark raving mad!

You are so right.... Gotta keep a sense of humor or you gonna go crazy.
I started to ask where you got my picture from but the face is to skinny, the hair's not white and......the ears are to small.

Fred