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Posted: **Tue Dec 13, 2011 9:02 pm**

And one thing to remember is that if the centrals aren't causing problems (desats/arousals/etc.), they may not need to be a concern, since they aren't necessarily damaging in and of themselves the way obstructive apneas are.

As one site explains:

No clear guidelines are available on when or whether to treat central sleep apnea in the absence of symptoms, particularly when central sleep apnea is discovered after polysomnography (PSG) is performed for another reason. Clearly, when the symptoms are present, treatment is warranted. The decision to treat should be made on an individual basis.

Up to 20% of central sleep apnea cases have been suggested to resolve spontaneously. If the patient is not symptomatic, observation may be the only appropriate step. This may be the case in patients who have central sleep apnea during sleep-wake transition, patients without significant oxygen desaturation, or in those who experience central sleep apnea during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea.

If present, treatment of the underlying disorder often improves central sleep apnea.

-- http://emedicine.medscape.com/article/304967-treatment

So some might argue that the point is to treat obstructives first, then to worry about any residual centrals later, within reason, if no serious underlying cause, beyond OSA, is found.

An unpopular thought, perhaps, but something worth thinking about, to my mind.

Posted: **Wed Dec 14, 2011 2:14 am**

Riverlea wrote:No, the Doc didn't mention that at all. They want me to stay at the same pressures for another four to six weeks. The apneas are now recording entirely as centrals, but they (I also saw the Attending) aren't sure what sort of events the machine is actually reporting as centrals.

Remember that a CPAP machine can't definitively detect a central apnea without O2 sensor or EEG, and a chest effort belt. The "CA" indication in the machine data is useful, but not definitive.

You may get more info if you get the free SleepyHead software and look at the data. Please look at the link in my signature.

It would also be good to fill in your equipment in your profile. Look at the link in my signature.

Posted: **Wed Dec 14, 2011 3:57 am**

jnk wrote:Sometimes I try way too hard not to offend the lurker-docs, don't I?

Nah, you're doing it right. I'm just too accustomed to doin' what I want to do, in my own therapy. Set in my ways.

jnk wrote:If I had a cooperative doc, I would probably give him the opportunity to feel like he was giving me permission to do what I concluded was best for my own body;

Again, you are suggesting doing it right. And that's good.

jnk wrote: but, yes, I agree 100% with Rested Gal that, in my case, if he didn't agree with me, I, too, would still switch out of an auto mode, if centrals or mixed apneas were persisting.

Speaking of "doing it right".... THERE YA GO!!! Pssst, Riverlea, listen to jnk, not to me about how to go about "doing it right." Keep your doctor on your side and happy if you're happy with the doctor. Give your doctor a chance to "do it right."

Pugsy wrote:Your choice on how you wish to proceed. Rested Gal, Jnk and myself have a lot more hours on these machines than you do and we are quite comfortable experimenting with various pressures and machine modes. Not that we know it all, because we sure don't, we are just comfortable taking control of things ourselves.
I can see where it would be a big step for you to change what your doctor has advised. You are new to all this and there is a huge learning curve. Then you have to add the the complicating factor of those pesky centrals. Makes it doubly confusing. So just because we would do it doesn't mean you should do it unless you understand and are comfortable with it yourself.

Ditto to what both Pugsy and jnk have said.

And a big amen to this: "Not that we know it all, because we sure don't, we are just comfortable taking control of things ourselves."

And an especially big amen to this: "So just because we would do it doesn't mean you should do it unless you understand and are comfortable with it yourself."

Posted: **Wed Dec 14, 2011 3:00 pm**

I'm on the run today but would like to post a few general questions re: VPAP Auto versus bilevel.

Is there anyone out there who has gone from the auto to the bilevel, permanently? What are your reasons?

Does anyone using VPAP auto suspect that the pressure fluctuations themselves can cause wakefulness?

Why are people prescribed VPAP Auto in the first place, as opposed to bilevel?

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