central sleep apnea - what does it take to make a diagnosis?

Since we're discussing Centrals I thought I'd just throw this tidbit of info in here.
I posted this elsewhere but it was not a discussion on Centrals but pressure adjustment.

I visited my MD with data in hand. It was my first visit since starting xPAP.

I have an APAP machine. (Disclaimer: This is just my Doc's opinion just as it applies to me...)

Using the data & My Encore AHI/Pressure chart I noticed that as pressure went up my Hypopneas went DOWN but my OSA (label) went up. They actually intersected at 9 cm , coincidentially where I was titrated.

So my OSA was going up as my machine responded by raising pressure but my Hypop's were dropping at the same time. My Doc's explanation was that the OSA's were really Centrals since my Hypops were dropping with increased pressure. He reasoned that if the OSA measurement were truly Obstructions then my Hypop's would also go up because I would have restrictions pre-OSA. However my Hypop's were dropping so the events labeled OSA by the software were Centrals because I wasn't obstructed but wasn't taking a breath.

Sorry for the rambling - Hope I made sense. This may not apply to you but it certainly made sense upon seing my data. It explains why my "OSA" would kick up as the pressure increased on my APAP to clear the OSA's.

What comes first: Chicken or the egg? This seems like an interesting way to analyze potential Centrals. Of course the only way to know for sure is in the sleep lab.

I fyou are having what is labeled OSA's by your software as pressure rises but your Hypop's are falling - that "could be" an indication that those OSA'a are rewally Centrals being triggered by the pressure.

I thought you might find this info of some value.

Best,

Tom

The nice person from CPAP for Seniors explained that "CPAP failure" meant, specifically, failure during a sleep study to resolve OSA with CPAP, and there would have to be a sleep study showing that a respiration assistive device (dual level pap, bipap, different names for the same thing) actually resolved the apneas before such a machine would be paid for even if the diagnosis was mixed apnea.

Noncompliance because of discomfort did not constitute an indication for a bi-level pap.

I have a friend who reports that she freqently wakes as I stop breathing at night and she pokes me so that I will take a breath. She says she des not hear me snore, just that I stop breathing for a significant amount of time - she is probably already awake, just not roused and my non-breathing rouses her.

Very kind of your friend to notice.

We all need more friends like that.

Tom

II got a clarification from "CPAP for Seiniors". If you have OSA, failure means that you have to have Apnea that is not reduced with CPAP and which a study shows is reduced with BiPAP. Compliance/comfort are not justifications. (I presume that some apneas are OK, but if, say, you started at a rate of 15 and were reduced to 5 with CPAP, and Respriatory assist could get you to 0, that would probably be justification).

This is not quite what is written in the regulations (failure is not strictly defined), but my guess is that they know what is needed to get the machine paid for by Medicare.

Yes, a doctor could write me a prescription for a Respiratory Assistance Device (Medicare's terminology) and I could buy one, but I'd have to pay for it out of pocket - not part of it, but all of it. It would mean probably three months of no money for things like groceries and such to pay it off. I'm on a fixed income, unable to work. I can't even putter around the house effectively anymore. I probably could afford a CPAP, they are pretty cheap now for cash, and I could afford an autopap even. But there is a big price jump from those to the assistive devices with the back up timers.

Yes, a good part of the prescriptions are pain meds. It is even possible that they interact with the Sonata.

I had already planned on having a discussion with my sleep doc about this. However, I wanted to get a read from the people here regarding this, because, well, this in my first interaction with this doctor and so far I am not horribly impressed. There are lots of good sleep docs out there, I'm sure, but there are also bad ones.

In any case, it sounds like a call that could go either way depending on the number and degree of the CSA events. Sounds like I should read the study myself, discuss it with my doctor, and proceed from there. I always have the option of a second opinion if I find the doctor unbelievable.