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Q re Central Apneas???
When I went for my sleep study in September, it showed only 3 apneas and 55 hypopneas. And diagnosed with OSA. No mention of Central Apneas. My sleep doc actually thinks I have UARS especially since I suffer from fibromyalgia.
However, now on my new APAP machine, I am having central apneas every night. Is this normal? A three-day average showed AHI 13.4; Total AI 13.4; Central AI 11.1. (No typos here)
Could these numbers be right? Would I have had central apneas before the sleep study, but they just didn't show up the night of the study?
And how do the PAP machines know the difference between central and obstructive?
Thanks for any clarification anyone can offer.
Views: 40
Replies to This Discussion
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Permalink Reply by Neal Buckner, LRCP on
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Mary,
First to address the CSA events. It is not unusual to have what's called "Transitional CSA's". However the number you are having is a little high. How long have you been on APAP? If it's been more than a month and you are still having a high level of CSA you may want to go have a formal titration done in a lab. BiLevel or possibly an ASV would be more suited to your needs.
How does a APAP machine tell the difference from and obstructive and Central apnea?
I am assuming you are using the new S-9 Autoset by Resmed. The way it was explained to me, (and please don't take this as gospel,) is that when there is a pause in flow the unit will send a high frequency pulse down the circuit and depending on how it echos back to the unit will determine if there was an open airway or not. If open and no flow=CSA. Not open and no flow=Obstructive.
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Permalink Reply by Mary Callahan on
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Neal, I have only been using the REsMEd9 for 4 nights. I guess too soon to tell what is going on? Or is there a reason the machine and/or myself are having this problem?
Neal Buckner, LRCP said:Mary,
First to address the CSA events. It is not unusual to have what's called "Transitional CSA's". However the number you are having is a little high. How long have you been on APAP? If it's been more than a month and you are still having a high level of CSA you may want to go have a formal titration done in a lab. BiLevel or possibly an ASV would be more suited to your needs.
How does a APAP machine tell the difference from and obstructive and Central apnea?
I am assuming you are using the new S-9 Autoset by Resmed. The way it was explained to me, (and please don't take this as gospel,) is that when there is a pause in flow the unit will send a high frequency pulse down the circuit and depending on how it echos back to the unit will determine if there was an open airway or not. If open and no flow=CSA. Not open and no flow=Obstructive.
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Mary,
Have you been on PAP therapy for a while and this is a new machine? Or are you brand new to using PAP therapy all together? If you are a PAP veteran and this is a new machine for you and you still aren't feeling like you are not fully benefiting from the PAP therapy then there is a good chance that you have a complex sleep apnea issue and should be seen. If this is a completely new therapy for you and you have only been on for a week or so, give it a couple more weeks and do another download. Like I stated before. Transitional CSA is not unheard of. And, will typically resolve itself.
Mary Callahan said:Neal, I have only been using the REsMEd9 for 4 nights. I guess too soon to tell what is going on? Or is there a reason the machine and/or myself are having this problem?
Neal Buckner, LRCP said:Mary,
First to address the CSA events. It is not unusual to have what's called "Transitional CSA's". However the number you are having is a little high. How long have you been on APAP? If it's been more than a month and you are still having a high level of CSA you may want to go have a formal titration done in a lab. BiLevel or possibly an ASV would be more suited to your needs.
How does a APAP machine tell the difference from and obstructive and Central apnea?
I am assuming you are using the new S-9 Autoset by Resmed. The way it was explained to me, (and please don't take this as gospel,) is that when there is a pause in flow the unit will send a high frequency pulse down the circuit and depending on how it echos back to the unit will determine if there was an open airway or not. If open and no flow=CSA. Not open and no flow=Obstructive.
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Neal, I am brand new to all this, so I will wait and see what happens. That is if I can make it thru, I have never felt so badly in a long, long while. My sleep has always been bad, but this is awful. I know, everyone says give it time, and I am truly trying, but it is been very trying. Thanks.
Neal Buckner, LRCP said:Mary,
Have you been on PAP therapy for a while and this is a new machine? Or are you brand new to using PAP therapy all together? If you are a PAP veteran and this is a new machine for you and you still aren't feeling like you are not fully benefiting from the PAP therapy then there is a good chance that you have a complex sleep apnea issue and should be seen. If this is a completely new therapy for you and you have only been on for a week or so, give it a couple more weeks and do another download. Like I stated before. Transitional CSA is not unheard of. And, will typically resolve itself.
Mary Callahan said:Neal, I have only been using the REsMEd9 for 4 nights. I guess too soon to tell what is going on? Or is there a reason the machine and/or myself are having this problem?
Neal Buckner, LRCP said:Mary,
First to address the CSA events. It is not unusual to have what's called "Transitional CSA's". However the number you are having is a little high. How long have you been on APAP? If it's been more than a month and you are still having a high level of CSA you may want to go have a formal titration done in a lab. BiLevel or possibly an ASV would be more suited to your needs.
How does a APAP machine tell the difference from and obstructive and Central apnea?
I am assuming you are using the new S-9 Autoset by Resmed. The way it was explained to me, (and please don't take this as gospel,) is that when there is a pause in flow the unit will send a high frequency pulse down the circuit and depending on how it echos back to the unit will determine if there was an open airway or not. If open and no flow=CSA. Not open and no flow=Obstructive.
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Permalink Reply by RockRpsgt on
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Neal is correct in that this could be transitional events. Due to the newnesss of your therapy your machine could also be recording a higher than usual amount of wake events. These events would include swallowing, chewing, teeth grinding, and holding your breath. All of these types of events could show up as centrals on your machine. Personally I would not worry to much this soon as these events may slowly go away as your therapy progresses.
What pressure range is your unit set to?
What is your 96% pressure?
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Rock, my pressure is set between 5 and 15. Not sure what the 96% pressure means. I have a mac and therefore cannot use the software from what I understand. I can say that a 3-day average my pressure was 9.4. Thanks!
Rock Hinkle said:Neal is correct in that this could be transitional events. Due to the newnesss of your therapy your machine could also be recording a higher than usual amount of wake events. These events would include swallowing, chewing, teeth grinding, and holding your breath. All of these types of events could show up as centrals on your machine. Personally I would not worry to much this soon as these events may slowly go away as your therapy progresses.
What pressure range is your unit set to?
What is your 96% pressure?
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I am not a doctor and nothing that I say should be interpreted as such. It is still too early to say what is causing the centrals. My guess for now is transitional or wake events. These events are very common with new users. I might talk to your sleep team about tightening up your pressure range at your next appointment. Maybe get it down from a differential of 10 to say 5 with your average pressure being the median. Once this is done watch your numbers for a few weeks and see if you can get it down to a range of 3. Getting back to good sleep is alot like learning to walk. In the beginning we have to take baby steps.
How are you feeling? Is the therapy helping you sleep better. This early in the game that is the most important part. There is plenty of time to troubleshoot and finetune your therapy if the answer to these questions is yes.
Mary Callahan said:Rock, my pressure is set between 5 and 15. Not sure what the 96% pressure means. I have a mac and therefore cannot use the software from what I understand. I can say that a 3-day average my pressure was 9.4. Thanks!
Rock Hinkle said:Neal is correct in that this could be transitional events. Due to the newnesss of your therapy your machine could also be recording a higher than usual amount of wake events. These events would include swallowing, chewing, teeth grinding, and holding your breath. All of these types of events could show up as centrals on your machine. Personally I would not worry to much this soon as these events may slowly go away as your therapy progresses.
What pressure range is your unit set to?
What is your 96% pressure?
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This is the worst I have felt in 6 years. I am afraid I will have an accident while driving, I am so tired. I slept so much better before this machine, that is for sure.
And I don't have any appointments set. The doctor wanted me to use the machine for 30 days and see what the machine tells him. He didn't want me to to a titration sleep study because he felt I wouldn't sleep and I would aggravate his staff. So basically this is an at-home titration sleep study on the run for 30 days. I called his office and spoke with his assistant who had nothing to offer, but: "you just need time to get used to it." No help whatsoever. Thanks again.
Rock Hinkle said:I am not a doctor and nothing that I say should be interpreted as such. It is still too early to say what is causing the centrals. My guess for now is transitional or wake events. These events are very common with new users. I might talk to your sleep team about tightening up your pressure range at your next appointment. Maybe get it down from a differential of 10 to say 5 with your average pressure being the median. Once this is done watch your numbers for a few weeks and see if you can get it down to a range of 3. Getting back to good sleep is alot like learning to walk. In the beginning we have to take baby steps.
How are you feeling? Is the therapy helping you sleep better. This early in the game that is the most important part. There is plenty of time to troubleshoot and finetune your therapy if the answer to these questions is yes.
Mary Callahan said:Rock, my pressure is set between 5 and 15. Not sure what the 96% pressure means. I have a mac and therefore cannot use the software from what I understand. I can say that a 3-day average my pressure was 9.4. Thanks!
Rock Hinkle said:Neal is correct in that this could be transitional events. Due to the newnesss of your therapy your machine could also be recording a higher than usual amount of wake events. These events would include swallowing, chewing, teeth grinding, and holding your breath. All of these types of events could show up as centrals on your machine. Personally I would not worry to much this soon as these events may slowly go away as your therapy progresses.
What pressure range is your unit set to?
What is your 96% pressure?
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Permalink Reply by Donna B. on
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Mary,
IMO, you will get better advice and empathy here than from your doctor's office. My doctor doesn't have OSA but my DME guy does. Who listens to me more? My DME guy. He understands all the quirky things we are going through. My doctor is very "matter of fact" and doesn't give me but 15 minutes of his time. The folks here have been wonderful in answering all my newbie questions. You will learn a lot over time. Don't give up girl, you can do it !!!
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Thanks, Donna. My DME guy didn't want to deal with me and told me to call the doctor. I have found much help here and am very grateful for it all. It is nice to know people really care and try to help each other out. It has been wonderful!
Donna B. said:Mary,
IMO, you will get better advice and empathy here than from your doctor's office. My doctor doesn't have OSA but my DME guy does. Who listens to me more? My DME guy. He understands all the quirky things we are going through. My doctor is very "matter of fact" and doesn't give me but 15 minutes of his time. The folks here have been wonderful in answering all my newbie questions. You will learn a lot over time. Don't give up girl, you can do it !!!
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Your welcome !!
I do not have the technical and medical advice but I can offer you my experiences and support. I would not have made it this far without this group.
Wishing you a better night's sleep.
Donna B.
Mary Callahan said:Thanks, Donna. My DME guy didn't want to deal with me and told me to call the doctor. I have found much help here and am very grateful for it all. It is nice to know people really care and try to help each other out. It has been wonderful!
Donna B. said:Mary,
IMO, you will get better advice and empathy here than from your doctor's office. My doctor doesn't have OSA but my DME guy does. Who listens to me more? My DME guy. He understands all the quirky things we are going through. My doctor is very "matter of fact" and doesn't give me but 15 minutes of his time. The folks here have been wonderful in answering all my newbie questions. You will learn a lot over time. Don't give up girl, you can do it !!!
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This is the problem with the auto-titration process. Thirty days to refine the pressure range, then another 30 to find optimal pressure. Sixty days is just to long when the goal of a titration is immmediate improvement in sleep efficiency. This process will put even more PAP units in the closet.
Mary I am glad that you are being pro-active.
Mary Callahan said:This is the worst I have felt in 6 years. I am afraid I will have an accident while driving, I am so tired. I slept so much better before this machine, that is for sure.
And I don't have any appointments set. The doctor wanted me to use the machine for 30 days and see what the machine tells him. He didn't want me to to a titration sleep study because he felt I wouldn't sleep and I would aggravate his staff. So basically this is an at-home titration sleep study on the run for 30 days. I called his office and spoke with his assistant who had nothing to offer, but: "you just need time to get used to it." No help whatsoever. Thanks again.
Rock Hinkle said:I am not a doctor and nothing that I say should be interpreted as such. It is still too early to say what is causing the centrals. My guess for now is transitional or wake events. These events are very common with new users. I might talk to your sleep team about tightening up your pressure range at your next appointment. Maybe get it down from a differential of 10 to say 5 with your average pressure being the median. Once this is done watch your numbers for a few weeks and see if you can get it down to a range of 3. Getting back to good sleep is alot like learning to walk. In the beginning we have to take baby steps.
How are you feeling? Is the therapy helping you sleep better. This early in the game that is the most important part. There is plenty of time to troubleshoot and finetune your therapy if the answer to these questions is yes.
Mary Callahan said:Rock, my pressure is set between 5 and 15. Not sure what the 96% pressure means. I have a mac and therefore cannot use the software from what I understand. I can say that a 3-day average my pressure was 9.4. Thanks!
Rock Hinkle said:Neal is correct in that this could be transitional events. Due to the newnesss of your therapy your machine could also be recording a higher than usual amount of wake events. These events would include swallowing, chewing, teeth grinding, and holding your breath. All of these types of events could show up as centrals on your machine. Personally I would not worry to much this soon as these events may slowly go away as your therapy progresses.
What pressure range is your unit set to?
What is your 96% pressure?
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