Complex, Mixed, Central???

The more I learn, the more confused I get!

I found these definitions on ResMed's website that explains each type of SDB...

The difference between central, mixed and complex sleep apnea
CSA is a form of sleep-disordered breathing (SDB) caused by the temporary absence of a signal from the brain’s respiratory center. Without this signal, there is no effort to breathe. Mixed sleep apnea is fairly common and consists of both central and obstructive components. On the other hand, CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices.

from http://www.resmed.com/us/clinicians/abo ... clinicians
I found this information backed up on the National Institute of Health website, as well, at least in regards to the complex sleep apnea definition

Now, what I don't understand, is it says that Complex Sleep Apnea is mostly obstructive during the sleep study, with mostly centrals with treatment.

BUT

On my sleep study, I had mostly centrals and hypopneas, with only one obstructive and one mixed. So, does that mean I have something other than "regular" sleep apnea, or other than "regular" complex sleep apnea?

I'm not trying to diagnose myself, but I am looking ahead, and trying to be prepared (educated) for what may be yet to come. I am currently on bilevel, and the centrals are still quite high.

Given the definiton of CompSA, it seems that the only way to diagnose it is to compare the results of the baseline sleep study (i.e., the one without PAP treatment) to the results of the titration sleep study (i.e., the one with PAP treatment).

Which "sleep study" are you referring to?

I was referring to the initial phase of my sleep study, done without any treatment. I refer to the titration phase as such. During the titration study, I had nearly no issues, with a 0.2 AHI. However, my "at home" numbers have never been that good, and have rarely been less than 5.

.

I don't know about yours, but my sleep during the tests was anything but usual. So while I am sure the tests caught enough data about obstructive apnea (which, based on my understanding, only require a relaxed muscle state), I wonder about things that happen only when I sleep more deeply that I did in the lab.

In the 20 days since I have started recording and reviewing data from my machine, I have not seen any sign of such things. But then again, I have yet to sleep for more than an hour or two at a stretch.

So while my AHI levels match those recorded during the titration study, I am still holding my breath, so to speak, and waiting to see if the treatment is truly dealing with all of my sleep problems.

Don't let the definitions throw you too much. The definitions are meant to specify, not confuse.

The two words "sleep apnea" may be used to describe an event (as in, he just had an apnea during sleep, a sleep apnea) and the same two words can be used loosely to describe a condition (as in, he has sleep apnea). Similarly, phrases such as "obstructive sleep apnea" and "central sleep apnea" can be used to desribe events or be used to describe medical conditions.

Nearly every human has an occasional obstructive sleep apnea during the night, especially if the person has had a lot to eat or drink before bed and is exhausted and maybe has a cold and is on cold meds. That doesn't mean everyone has the condition (or syndrome) called "obstructive sleep apnea." Similarly, most humans have occasional harmless apneas during sleep that are central by definition, but that doesn't mean we all have the condition called "central sleep apnea."

That is confusing enough. Now add the various ways medical people describe combinations of events and combinations of conditions. That occasionally even causes disagreements between different camps of sleep experts, with some of them arguing that "complex sleep apnea" is a separate condition and others arguing it is not. Why is that? As best I can figure, it must be something like this:

During a titration sleep study, air pressue is applied which can end up, generally, with one of three results. (1) With most people, once obstruction of the airway is prevented during the study, all (or most) apneas cease. (2) With others, once obstruction of the airway is prevented, it becomes clear that the person is also suffering from a form of the condition "central sleep apnea," which has been unmasked, meaning there may be a neurological or cardiac problem that has been found, for example. (3) In yet other instances, though, central apneas appear that seem to be caused by the body adjusting to the pressure itself and by its no longer having obstructive apneas. Sometimes that stops by the end of the night, sometimes it persists for longer, other times that problem seems to go away after a few weeks of treating the obstructive apneas, and other times it seems to be a permanent problem with that person and the application of positive airway pressure at most any level. What that is called when it isn't called "central sleep apnea," and how that is dealt with, has been a source of some controversy, from what I have read. Machine manufacturers think everyone like that needs a special machine (read: expensive machine) designed for treating it. Others have not jumped onto that bandwagon just yet.

That is my broad, oversimplified take as a patient trying to figure this stuff out. Hopefully others will correct me if I misstated anything above.

Simply put..."Complex Sleep Apnea" is OSA made worse by using CPAP/BIPAP. The addition of CPAP/BIPAP not only fails to treat your OSA but actually makes it worse. Thats why they created Auto SV and VPAP Adapt.

It is different than "Central Sleep Apnea" but is similar in some ways. For "complex" instead of less and less respiratory events when using CPAP, you get more and more despite increasing the pressure, often these are central apneas but they don't have to be centrals to be called Complex Sleep Apnea.

Very good explaination, jnk...thank you

Big Daddy RRT,RPSGT wrote:Simply put..."Complex Sleep Apnea" is OSA made worse by using CPAP/BIPAP. The addition of CPAP/BIPAP not only fails to treat your OSA but actually makes it worse. Thats why they created Auto SV and VPAP Adapt.

It is different than "Central Sleep Apnea" but is similar in some ways. For "complex" instead of less and less respiratory events when using CPAP, you get more and more despite increasing the pressure, often these are central apneas but they don't have to be centrals to be called Complex Sleep Apnea.

So basically, as long as my AHI is lower WITH treatment than it was WITHOUT treatment, I most likely would not be suffering from complex sleep apnea. Is that correct?

Here is one machine manufacturer's point of view on the subject, which differs somewhat from mine:

http://www.resmed.com/us/clinicians/abo ... clinicians

The way my opinion differs, is that I believe that some patients who meet that definition for complex sleep apnea can be treated successfully with CPAP or bilevel, if they are the patients whose complex sleep apnea resolves on its own after a few weeks of treating the obstructive apneas.

But I'm no doc, so my opinion doesn't matter. And there is no doubt that many patients like the ones described on that page benefit greatly from machines that do more than CPAP and bilevel machines do.

jnk wrote:Here is one machine manufacturer's point of view on the subject, which differs somewhat from mine:

http://www.resmed.com/us/clinicians/abo ... clinicians

That's the same information that I had in my opening post, I believe. Any wonder I got confused?

jbn3boys wrote:

jnk wrote:Here is one machine manufacturer's point of view on the subject, which differs somewhat from mine:

http://www.resmed.com/us/clinicians/abo ... clinicians

That's the same information that I had in my opening post, I believe. Any wonder I got confused?

Sorry. I was only trying to cover my butt where my opinion differs slightly from ResMed's.

Machine manufacturers have their take. Certain groups of doctors have their take. Patients have their take.

Bottom line for me is that someone has symptoms and don't feel so good, so a doc has to make up some data to convince insurance to let the doc try to help the person. Insurance wants the doc to start with the cheapest option. Manufacturers want the doc to quickly move on to the more expensive option. The patient just wants to feel better and to have the most convenient and comfortable machine possible. So a little dance has to take place, taking into consideration all those points of view. The patient's role is to be vocal about how he or she feels so that if one machine doesn't do the trick, other kinds of machines can be tried.

My opinion as a patient is that I want to start with, and give a full chance to, the most comfortable and convenient machine before moving on to a machine that might be less convenient and less comfortable. So I would give CPAP and bilevel a chance for several weeks. That being said, if I didn't feel well on one type of machine, I would cooperate fully with my doctor in finding a way to quality for a different kind of machine, such as one designed to treat complex apnea, if I met that definition. My understanding of that definition is someone diagnosed obstructive sleep apnea based on the diagnostic PSG who then meets the definition for central sleep apnea during titration and continues to do so, not responding well to CPAP or bilevel, feeling worse on PAP instead of better. Maybe they would feel better on a machine designed for CSA, maybe not. But whether they feel better or not, to my mind, has little to do with what name is given to what they are going through. Call it CSA. Call it OSA. Call it CompSA. Call it whatever. You either try another machine or you don't.

If you don't feel well, you try things. Using a different machine is one thing to try.

But if I had a lot of significant centrals, I would personally be asking my doc to try to figure out why. It is my meds? Is it something else? My doc and I might not ever figure it out, but I would want to try to figure it out, just in case it told me and my doc something significant about my health.

I am actually pretty far over my head with all of that. I am just saying what my thought process would be for me personally.

jnk wrote: The patient just wants to feel better and to have the most convenient and comfortable machine possible.

AMEN.

jnk wrote:My opinion as a patient is that I want to start with, and give a full chance to, the most comfortable and convenient machine before moving on to a machine that might be less convenient and less comfortable. So I would give CPAP and bilevel a chance for several weeks.

And that's exactly where I'm at...two weeks into bilevel. I'm sure it's still too soon to know for sure if it's working, but I'll be sending my reports in tomorrow.

jnk wrote: That being said, if I didn't feel well on one type of machine, I would cooperate fully with my doctor in finding a way to quality for a different kind of machine, such as one designed to treat complex apnea, if I met that definition.

emphasis added
And THAT is why I am so confused!

jnk wrote: My understanding of that definition is someone diagnosed obstructive sleep apnea based on the diagnostic PSG who then meets the definition for central sleep apnea during titration...

and that's where it just doesn't match my study. I did have obstructive during my diagnostic portion of my PSG, but I had many, many more centrals during the diagnostic PSG. Once they slapped a mask on me (titration PSG), I had nearly zero episodes of any kind. Yet they still increased my level several times, and ultimately tried me on bilevel during that same night. I guess they must have seen events coming, and increased pressure before the incident was "bad" enough to be scored. That's my only thought. Anyway, I am still having significantly high AHI's, with a high percentage of them being centrals. I really don't know what that means. Maybe I won't until my doctor can address it. And maybe it would be different if I had a different doctor. Maybe I'll never know. But I will keep searching for a treatment that allows me to feel rested.

As I said, I'm not so much trying to diagnose myself, I'm just trying to understand the different terms/diagnoses/treatments, so that I am well-informed whatever may come next.

I do appreciate your input, jnk! Thank you!

jbn3boys wrote: . . . I do appreciate your input, jnk! Thank you!

You are very welcome.

If you are giving me the green light for me to continue to spew my personal opinions, there is one more thing I would add:

If it wasn't clear to me that my primary problem was central sleep apnea, but I still felt bad while using one manufacturer's bilevel, I would probably want to try the other manufacturer's bilevel before I tried a machine designed specifically for centrals.

But, hey, that's just me.

jbn3boys wrote:So basically, as long as my AHI is lower WITH treatment than it was WITHOUT treatment, I most likely would not be suffering from complex sleep apnea. Is that correct?

Yes basically, however if the lower AHI is still unacceptable and includes a lot of new central apneas then it might still be considered complex but BiPAP would probably be the next step.

JNK is right that the additional central apneas of some patients with complex OSA may resolve on their own. So a trial of CPAP might be ok if the AHI is not too high. The CPAP data is essential if your gonna try this because patients give up quickly if they feel little or no relief for all their trouble with CPAP. If fact one of the biggest problems with compliance is that patient see trying CPAP at home as the final step (I tried CPAP for a couple of weeks and it doesn't work for me) rather than the first step in treament so getting at least a little improvement right away is very important.

Big Daddy RRT,RPSGT wrote: . . . one of the biggest problems with compliance is that patient see trying CPAP at home as the final step (I tried CPAP for a couple of weeks and it doesn't work for me) rather than the first step in treament so getting at least a little improvement right away is very important.

Good point. Very true.