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Greetings Chris! Thank you for taking the time to clarify your situation. Since you have little or no support, I will offer what I would do in your shoes. This is not medical advice. Rather, think of it as what an experienced individual would do in a similar situation.

You wondered:

cjc wrote:... The item on my sleep study (attached below) that is throwing me is the Centrals/hr value of 9. When I was on APAP my AHI dropped to a lowest value of 6.5 but an average of about 11. This was significantly different to the 2.6 I was seeing on the Adapt unit. Can anyone tell me if I am on the right track in assuming that I have enough Centrals to warrant sending the VPAP Auto back and getting the Adapt ? ...

The short answer is "Yes!". With mixed apneas and the fact that you have few apneas while in REM sleep, it seems to indicate that you have Complex Sleep Apnea. Normally, if the issue is just obstructive sleep apnea the AHI during REM sleep is higher. Of course, you have very little time in REM sleep. It's likely that your apneas are keeping you from reaching REM sleep most of the time.

So here are the things I see in your report:

• You don't have a lot of spontaneous arousals.
• You don't have any periodic limb movements (PLM).
• You have a low AHI in REM sleep.
• Your time to REM sleep is VERY long.
• You have over 5 central apneas per hour.
• The number of mixed and central apneas is greater than the number of obstructive apneas.

While it is possible that CPAP or even a BiLevel machine would solve your sleep problems, it is not all that likely. In your shoes, I would go with the ASV unit.

Hope that helps.

FWIW... I agree with JohnBFisher and that is why I mentioned Dr Krakow's ideas.

I am in a similar situation with the VPAP auto that I use. Technically I probably may not need it because on APAP I was doing quite well at least on paper. The VPAP allows me to feel better and that is all that matters to me. I think you know my story.

You might do just fine on a VPAP Auto...but you also might not and we don't have a crystal ball to know for sure. If it were me and I could afford it...I would go with the higher end machine...because I know for sure that IF I needed it...then the machine would do what I needed and no "what ifs".

John, Pugsy,

Thank you both so much. Your comments are pretty much exactly what I needed to help me figure out what I need to do. I think that I will indeed return the VPAP Auto and go with the Adapt based on my new understanding of the data and to avoid the "What if" scenario.

You two are both gold and this forum is lucky to have such experienced individuals helping other people with their sleep apnoea journeys

I'm using the adpat and the pressures are high to fall asleep on. I'm not sure if it's better with the phillips machine, but I don't know if my insurance will cover anything else. I still keep up waking up with the mask off for some reason on 5/15 min and max ps. there aren't a lot of settings that you can change on this machine it seems like you have on phillips in the clinician menu

apnea2142 wrote:I'm using the adpat and the pressures are high to fall asleep on. I'm not sure if it's better with the phillips machine, but I don't know if my insurance will cover anything else. I still keep up waking up with the mask off for some reason on 5/15 min and max ps. there aren't a lot of settings that you can change on this machine it seems like you have on phillips in the clinician menu

Repeat after me .. "It's time to schedule an appointment with my doctor ...". Believe it or not, we'll continue to say the same thing. Remember, we do not provide medical advice on this forum. Instead, we provide advice based on our experience. And right now our experience says you need to work with your doctor to be certain your therapy meets your needs.

'Nuff Said!

Pugsy wrote:There is a doctor here in the US that is promoting ASV use for not only people with central sleep apnea.

Smart doctor. You have only one life to live, so why not live well. Get ther S9 Adapt, and live well.

what are your sleep doctors doing for you? most of the ones I saw did not know anything about the machine settings or even sleep apnea and they don't seem to know how to treat sleep apnea.
my O2 just plummetted on my sleep studies and I didn't know why and the cpap machine just didn't work. I tried auto cpap and woke up in a bad fog on the 10-15 setting, couldn't think all day.
theophylline seems interesting, it also is supposed to increase oxygen to the heart and stimulate respiration but can be toxic in higher doses. I don't know if taking a few days did anything for my sleep apnea but I'm not sure
I just wish I could have one night where I wake up clear headed and without my heart pounding or bad fog the whole day

apnea2142 wrote:what are your sleep doctors doing for you? most of the ones I saw did not know anything about the machine settings or even sleep apnea and they don't seem to know how to treat sleep apnea.
my O2 just plummetted on my sleep studies and I didn't know why and the cpap machine just didn't work. I tried auto cpap and woke up in a bad fog on the 10-15 setting, couldn't think all day.
theophylline seems interesting, it also is supposed to increase oxygen to the heart and stimulate respiration but can be toxic in higher doses. I don't know if taking a few days did anything for my sleep apnea but I'm not sure
I just wish I could have one night where I wake up clear headed and without my heart pounding or bad fog the whole day

Not that I'm an expert by any means but were you able to get any O2 readouts whilst using the APAP ?

I know that I had the same foggy head for the first week but didn't have the headaches or daytime sleepiness and pretty much put it down to my brain chemicals needing to recalibrate. From what I have read, the "Fight or Flight" response from your body when it detects you are essentially choking releases alot of adrenaline which desensitises area's of the brain to essential neural chemicals such as serotonin, dopamine and noradrenaline hence the high prevalence of depression amongst Sleep Apnoea patients. I got past that foggy head feeling after about a week or two.

cjc wrote:... Not that I'm an expert by any means but were you able to get any O2 readouts whilst using the APAP ?

I know that I had the same foggy head for the first week but didn't have the headaches or daytime sleepiness and pretty much put it down to my brain chemicals needing to recalibrate. From what I have read, the "Fight or Flight" response from your body when it detects you are essentially chocking releases alot of adrenaline which desensitises area's of the brain to essential neural chemicals such as serotonin, dopamine and noradrenaline hence the high prevalence of depression amongst Sleep Apnoea patients. I got past that foggy head feeling after about a week or two.

I concur. Theophylline is NOT a good choice. "apnea2142" needs to work with their doctor to be certain that the therapy is effective. As you note, the constant barrage of adrenaline will not be addressed by any medicine. The best way to solve that is to solve the apneas. In this case, the best approach is to remove the apneas through the EFFECTIVE use of an ASV unit.

"apnea2142", I repeat, you need to work with your doctor to be certain that the therapy is effective. If your doctor is not doing so, hunt for one that will help you attain effective sleep. You keep asking questions that only a doctor can or should answer.

I have mostly centrals and I love my Adapt. If it's an option for you, I sure would go with it.