Replies to This Discussion

Permalink Reply by RockRpsgt on October 8, 2009 at 12:32am

I believe that what Duane was trying to say was that a diagnosis of central apnea without a titration is very deceiving. In most cases CSA can't truly be seen unil the OSA has been corrected. The reason for this is due to the fact that OSA will disguise itself as centrals. In Jan's case at this point I would be more worried about the 186 obstructive events than I would about the 20 central events that were probably caused by the OSA arousals. Just my opinion though.

I recently had a pt that had over 200 mixed events in his first 2 hours of sleep. It was ugly! I cleared up hhis obstructions at a pressure of 12cm H2o. I got him into the first rem he had probably had in years. After this rem he rattled off central events like machine gun fire. I lowered and raised, and lowered and raised until I thought he was going to fail CPAP. At a pressure of 17cm H2o all events stopped and he entered a rem rebound that lasted for 3 hours. CPAP can cure CSA. Just not all of the time.

Duane McDade said:

I hate to do this but, Oh my GOD! Does anybody know what Central Apnea is! I will speak middle class American here....Central Apnea is where your auto pilot shuts off while you sleep. The circuit in your brain that keeps you breathing while you sleep "shorts out" and you dont breathe. Your o2 level goes down and the people in the "you're gonna Die Room" wake you up so you breathe. The fact that you have been told you have Obstructive and Central Sleep Apnea is strange, Was your diagnosis done by a Machine? If so get a second Opinion.

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Permalink Reply by RockRpsgt on October 8, 2009 at 12:38am

http://www.ncbi.nlm.nih.gov/pubmed/18363194?ordinalpos=10&itool...

Sanner B, Schäfer T.
Medizinische Klinik am Bethesda Krankenhaus Wuppertal. Bernd.Sanner@bethesda-wuppertal.de

Central sleep apnea (CSA) is characterized by a lack of drive to inspire for at least 10 sec. In the CSA-syndrome accompanying arousals and desaturations of the arterial blood cause sleep disturbances and sympathetic nerve activations which lead to excessive daytime sleepiness and increase the risk for cardiovascular morbidity. There are six manifestations of CSA: a rare primary or idiopathic form, often in hypocapnic patients with an increased hypercapnic ventilatory drive; Cheyne-Stokes respiration, characterised by periodic CSA and a crescendo/decrescendo breathing pattern, often in patients with severe cardiac or neurological diseases; high altitude-induced periodic breathing (above 4000 m), CSA due to medical or neurological conditions; CSA due to drug or substance use; and primary sleep apnea of infancy. Besides the consequent treatment of the underlying medical conditions therapeutic options include the use of drugs, e. g. acetacolamide or oxygen, as well as non-invasive ventilation, e. g. continuous positive airway pressure (CPAP) or adaptive servo-ventilation.

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Permalink Reply by Jan on October 8, 2009 at 6:57am

Thanks-- I just go back from a night at the sleep lab for the titration study. I expect I will have some results in the next day or two. We used two different masks full mask and one that just went into my nostrils. I rejected one (the regular nose mask). I can see that the challenge is going to be finding one that is comfortable....The full mask was actually digging into my eye at some point. Something tells me that this is going to be a journey,but hopefully one with a happy ending

Rock Hinkle said:

I believe that what Duane was trying to say was that a diagnosis of central apnea without a titration is very deceiving. In most cases CSA can't truly be seen unil the OSA has been corrected. The reason for this is due to the fact that OSA will disguise itself as centrals. In Jan's case at this point I would be more worried about the 186 obstructive events than I would about the 20 central events that were probably caused by the OSA arousals. Just my opinion though.
I recently had a pt that had over 200 mixed events in his first 2 hours of sleep. It was ugly! I cleared up hhis obstructions at a pressure of 12cm H2o. I got him into the first rem he had probably had in years. After this rem he rattled off central events like machine gun fire. I lowered and raised, and lowered and raised until I thought he was going to fail CPAP. At a pressure of 17cm H2o all events stopped and he entered a rem rebound that lasted for 3 hours. CPAP can cure CSA. Just not all of the time.
Duane McDade said:

I hate to do this but, Oh my GOD! Does anybody know what Central Apnea is! I will speak middle class American here....Central Apnea is where your auto pilot shuts off while you sleep. The circuit in your brain that keeps you breathing while you sleep "shorts out" and you dont breathe. Your o2 level goes down and the people in the "you're gonna Die Room" wake you up so you breathe. The fact that you have been told you have Obstructive and Central Sleep Apnea is strange, Was your diagnosis done by a Machine? If so get a second Opinion.

• ▶ Reply

Permalink Reply by Vicki E Jones on October 8, 2009 at 12:53pm

Depends what is causing the CSA, though. I was on CPAP for 4 years with the CSA being ignored, because the sleep doctor I had 4 years ago assumed that my CSA must be due to my long-standing OSA. CPAP titration was done with oral appliance and nasal pillows. It still showed Central events, but he made that assumption and ignored it. Then again, the SV machines were not yet on the market, correct?

When my old CPAP machine started to act up this past spring, insurance said I had to have an overnight CPAP titration before Blue Cross would approve a new machine. That study (April) clearly showed CSA, at least 20 or 21 events an hour, even with oral appliance and CPAP. Fortunately, the sleep center now has a sleep neurologist for the first time in 4 years. I started with a sleep neurologist 4 years ago, but she soon took early retirement and had turned me over to the pulmonary guy that made the assumption that my OSA was causing the CSA.

The April study results were turned over to my new sleep neurologist, and the SV titration was done in June. It controlled the OSA and CSA events (with oral appliance still in use, due to it helping to some degree with the retrognathic jaw).

Good news! The Respironics Auto BiPap SV works as well for me as the ResMed Adapt SV. I've had problems with the ResMed machine recognizing (learning circuit on) anything my face can tolerate mask-wise. Respironics is working out better for me.

Vicki

*********

Rock Hinkle said:

I believe that what Duane was trying to say was that a diagnosis of central apnea without a titration is very deceiving. In most cases CSA can't truly be seen unil the OSA has been corrected. The reason for this is due to the fact that OSA will disguise itself as centrals. In Jan's case at this point I would be more worried about the 186 obstructive events than I would about the 20 central events that were probably caused by the OSA arousals. Just my opinion though.
I recently had a pt that had over 200 mixed events in his first 2 hours of sleep. It was ugly! I cleared up hhis obstructions at a pressure of 12cm H2o. I got him into the first rem he had probably had in years. After this rem he rattled off central events like machine gun fire. I lowered and raised, and lowered and raised until I thought he was going to fail CPAP. At a pressure of 17cm H2o all events stopped and he entered a rem rebound that lasted for 3 hours. CPAP can cure CSA. Just not all of the time. Duane McDade said:

I hate to do this but, Oh my GOD! Does anybody know what Central Apnea is! I will speak middle class American here....Central Apnea is where your auto pilot shuts off while you sleep. The circuit in your brain that keeps you breathing while you sleep "shorts out" and you dont breathe. Your o2 level goes down and the people in the "you're gonna Die Room" wake you up so you breathe. The fact that you have been told you have Obstructive and Central Sleep Apnea is strange, Was your diagnosis done by a Machine? If so get a second Opinion.

• ▶ Reply

Permalink Reply by Vicki E Jones on October 8, 2009 at 12:58pm

Jan -
You may want to try the ResMed Swift II nasal pillows. If I adjust them right (which is individual), they feel comfortable. It is a soft clear cylinder that sits below the nostrils, and a soft bump (with a hole in it) protrudes into each nostril.

For a full mask, if it does not fit you exactly right, it will dig into the corners of the eyes. You may have tried one that is too big around the bridge of the nose (on the outside).

There are many, many full masks, and many nasal pillows. Trying one of each is no where near enough.

Vicki

*****

Jan said:

Thanks-- I just go back from a night at the sleep lab for the titration study. I expect I will have some results in the next day or two. We used two different masks full mask and one that just went into my nostrils. I rejected one (the regular nose mask). I can see that the challenge is going to be finding one that is comfortable....The full mask was actually digging into my eye at some point. Something tells me that this is going to be a journey,but hopefully one with a happy ending

Rock Hinkle said:

I believe that what Duane was trying to say was that a diagnosis of central apnea without a titration is very deceiving. In most cases CSA can't truly be seen unil the OSA has been corrected. The reason for this is due to the fact that OSA will disguise itself as centrals. In Jan's case at this point I would be more worried about the 186 obstructive events than I would about the 20 central events that were probably caused by the OSA arousals. Just my opinion though.
I recently had a pt that had over 200 mixed events in his first 2 hours of sleep. It was ugly! I cleared up hhis obstructions at a pressure of 12cm H2o. I got him into the first rem he had probably had in years. After this rem he rattled off central events like machine gun fire. I lowered and raised, and lowered and raised until I thought he was going to fail CPAP. At a pressure of 17cm H2o all events stopped and he entered a rem rebound that lasted for 3 hours. CPAP can cure CSA. Just not all of the time.
Duane McDade said:

I hate to do this but, Oh my GOD! Does anybody know what Central Apnea is! I will speak middle class American here....Central Apnea is where your auto pilot shuts off while you sleep. The circuit in your brain that keeps you breathing while you sleep "shorts out" and you dont breathe. Your o2 level goes down and the people in the "you're gonna Die Room" wake you up so you breathe. The fact that you have been told you have Obstructive and Central Sleep Apnea is strange, Was your diagnosis done by a Machine? If so get a second Opinion.

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Permalink Reply by Jan on October 8, 2009 at 1:17pm

I am wondering if I should be seeing a sleep neurologist. It is my pulmonary doctor ( I have asthma which developed about 12 years ago) who is spearheading this as he is certified in sleep disorders. While we have had a long relationship on the asthma front, I have been less than pleased with the level of info he has been communicating on this front. For example, I really didn't know what they would be doing at last nights sleep lab visit. I knew they were doing more testing but assumed that I would be coming home with equipment and so was frantically (as you saw) researching questions I should ask about different equipment.

When he called (returning my call) about my intitial sleep test results, he said that I had severe sleep apnea with approximately 200 incidents in the 3 hours that I slept. It was not until I received a 2 page written report that I got all of the details-- most of which I posted on this thread already. It took me quite some time to figure out what all of the report was saying (which is how I stumbled on this site). I am sorta feeling that when a medical report tells me that I have a condition and when I look up that condition and I see the words heart and death and brain stem in the same sentence, well....I'm sorta feeling that I should have heard that, or an explanation from the doctor and not from a website.

Sorry, I guess I am venting a bit...but the question still stands-- in general would a sleep neurologist be a better bet for advancing to the "I'm feeling better stage" most quickly?


uide.com/forum/topics/central-apnea-info-please-help?page=6&commentId=2549090%3AComment%3A45239&x=1#2549090Comment45239">

Depends what is causing the CSA, though. I was on CPAP for 4 years with the CSA being ignored, because the sleep doctor I had 4 years ago assumed that my CSA must be due to my long-standing OSA. CPAP titration was done with oral appliance and nasal pillows. It still showed Central events, but he made that assumption and ignored it. Then again, the SV machines were not yet on the market, correct?

When my old CPAP machine started to act up this past spring, insurance said I had to have an overnight CPAP titration before Blue Cross would approve a new machine. That study (April) clearly showed CSA, at least 20 or 21 events an hour, even with oral appliance and CPAP. Fortunately, the sleep center now has a sleep neurologist for the first time in 4 years. I started with a sleep neurologist 4 years ago, but she soon took early retirement and had turned me over to the pulmonary guy that made the assumption that my OSA was causing the CSA.

The April study results were turned over to my new sleep neurologist, and the SV titration was done in June. It controlled the OSA and CSA events (with oral appliance still in use, due to it helping to some degree with the retrognathic jaw).

Good news! The Respironics Auto BiPap SV works as well for me as the ResMed Adapt SV. I've had problems with the ResMed machine recognizing (learning circuit on) anything my face can tolerate mask-wise. Respironics is working out better for me.

Vicki

*********

Rock Hinkle said:

I believe that what Duane was trying to say was that a diagnosis of central apnea without a titration is very deceiving. In most cases CSA can't truly be seen unil the OSA has been corrected. The reason for this is due to the fact that OSA will disguise itself as centrals. In Jan's case at this point I would be more worried about the 186 obstructive events than I would about the 20 central events that were probably caused by the OSA arousals. Just my opinion though.
I recently had a pt that had over 200 mixed events in his first 2 hours of sleep. It was ugly! I cleared up hhis obstructions at a pressure of 12cm H2o. I got him into the first rem he had probably had in years. After this rem he rattled off central events like machine gun fire. I lowered and raised, and lowered and raised until I thought he was going to fail CPAP. At a pressure of 17cm H2o all events stopped and he entered a rem rebound that lasted for 3 hours. CPAP can cure CSA. Just not all of the time. Duane McDade said:

I hate to do this but, Oh my GOD! Does anybody know what Central Apnea is! I will speak middle class American here....Central Apnea is where your auto pilot shuts off while you sleep. The circuit in your brain that keeps you breathing while you sleep "shorts out" and you dont breathe. Your o2 level goes down and the people in the "you're gonna Die Room" wake you up so you breathe. The fact that you have been told you have Obstructive and Central Sleep Apnea is strange, Was your diagnosis done by a Machine? If so get a second Opinion.

• ▶ Reply

Permalink Reply by RockRpsgt on October 8, 2009 at 1:33pm

The fact that CSA was seen in your first study and titration and you were not re-evaluated after six months would have me questioning your doc. You must treat the OSA before any other sleep disorder can be diagnosed. This was done in both of your studies Vicki. No other disorder can be isolated so long as there are obstructive events. Also a CSA index of 20 to 21 during a titration is alot different than 20 centrals mixed with 180 obstructive events during a diagnostic study. Duane is right Jan should not have been told about the centrals until they were confirmed. At least they should have been presented as insignificant until proven otherwise. I am not saying she does not have CSA just that it would not have been conclusive until last night. Without an underlying cause it may take 6 months of PAP therapy to conclusively diagnose her.

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Permalink Reply by Jan on October 8, 2009 at 1:38pm

Thanks-- this insight is very helpful. I am at the very beginning of the process and y doctor didnt mention the Central episodes, but I read it on the 2 page report that I received. Last night was my titration and I don't know anything about the results of that yet. I will call my doctor tomorrow and see if he has them.

Thanks-- you have all been very helpful. I hope to be able to return the favor in the future.

Rock Hinkle said:

The fact that CSA was seen in your first study and titration and you were not re-evaluated after six months would have me questioning your doc. You must treat the OSA before any other sleep disorder can be diagnosed. This was done in both of your studies Vicki. No other disorder can be isolated so long as there are obstructive events. Also a CSA index of 20 to 21 during a titration is alot different than 20 centrals mixed with 180 obstructive events during a diagnostic study. Duane is right Jan should not have been told about the centrals until they were confirmed. At least they should have been presented as insignificant until proven otherwise. I am not saying she does not have CSA just that it would not have been conclusive until last night. Without an underlying cause it may take 6 months of PAP therapy to conclusively diagnose her.

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Permalink Reply by Vicki E Jones on October 8, 2009 at 5:26pm

I agree with you, Rock.

I am just saying that in my case, there was no follow-up 4 years ago, and I didn't know enough back then to question the doc (the pulmonary guy that made assumptions, and doesn't follow up on anything). The OSA was treated - CPAP and oral appliance. When I went back for a CPAP titration this April, when the Fisher & Paykel CPAP machine started to break down after 4 years, the titration with CPAP and oral appliance showed no obstructive events, but 20 or 21 events per hour of CSA.

The April titration was done under direction of the center's new sleep neurologist. I had stopped going to the pulmonary guy because I was exhausted during the day even with CPAP and oral appliance and no obstructive events and realized his assumption (that the CSA events were coming from the OSA) must be wrong.

Since the April titration showed no OSA, but I had 20 or 21 (or more) CSA events per hour, the SV Machine titration was done in June (delays due to insurance approval - a common problem). That showed a SV machine, with my oral appliance in place, would correct both the OSA and the CSA. That's why I'm on a SV machine.

I feel a lot better during the day now.

I agree Jan's doctor needs to check if correcting the OSA corrects the CSA. After 6 months, they can do another titration and see if both the OSA and CSA events are gone. If she shows no OSA and still shows CSA, then they will need an overnight sleep study with a SV machine, correct? 180 events + 20 events is a whole lot of OSA, and certainly 20 could be masquerading as CSA.

Vicki

******


Rock Hinkle said:

The fact that CSA was seen in your first study and titration and you were not re-evaluated after six months would have me questioning your doc. You must treat the OSA before any other sleep disorder can be diagnosed. This was done in both of your studies Vicki. No other disorder can be isolated so long as there are obstructive events. Also a CSA index of 20 to 21 during a titration is alot different than 20 centrals mixed with 180 obstructive events during a diagnostic study. Duane is right Jan should not have been told about the centrals until they were confirmed. At least they should have been presented as insignificant until proven otherwise. I am not saying she does not have CSA just that it would not have been conclusive until last night. Without an underlying cause it may take 6 months of PAP therapy to conclusively diagnose her.

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Permalink Reply by 99 on October 8, 2009 at 6:07pm

the simularity is the same but it is from a diffrent source EG the signal is sent from the brain where as the other is a collapes there is a way of improving the brain signal but it may make your central apnea better or may cause it to worsen i do not know if i should tell should it prove to be worse, if you want to know i will not be held responsible for adverse effects, i will let you decide

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Permalink Reply by Vicki E Jones on October 8, 2009 at 6:29pm

I would love to know what it is. I will check with my doctor as to whether he feels it is safe for me before I do anything. Different approaches apply to differen people. -Vicki

****

99 said:

the simularity is the same but it is from a diffrent source EG the signal is sent from the brain where as the other is a collapes there is a way of improving the brain signal but it may make your central apnea better or may cause it to worsen i do not know if i should tell should it prove to be worse, if you want to know i will not be held responsible for adverse effects, i will let you decide

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Permalink Reply by 99 on October 8, 2009 at 6:38pm

it is potassium
you can take in apples
cider vinegar should you take cider vinegar take plenty of water as it can burn a hole in your stomach
in fact water will give a greator surface area as a tranport vehicle whice i strongly reccommend

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