Replies to This Discussion

Permalink Reply by GerryMooreRRTdotcom on September 22, 2009 at 12:15pm

Sandra Central Apneas can be caused by many things, but as you may have read it is the blockage or the lack of signal that comes from the brain telling your body to breath. It think at this point the most important thing is to find treatment, which most of the time is a BiLevel or BiPAP, sometimes even with a back up rate. This is a step above CPAP. The Rx is usually aquired through a sleep study split night study, where the first night they watch you sleep without anything then half way through the night they put a mask on with a system to help you sleep. They titrate the pressures on the data they are recieiving and that is how the Rx is obtained. Treatment at this point would be my most important issue. Gerry Moore RRT

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Permalink Reply by RichM on September 22, 2009 at 12:22pm

Sandra, I have complex sleep apnea also (that is the correct name for having both obstructive and central apnea) I started out in 1997 with obstructive only but I was in a bad car accident in 2007 which I then started having central apnea due to a head and neck injury. I have a Bipap S/T machine and it works great. The only thing is you need to use a full mouth/nose mask, sometimes called a full face mask. This is due to the back up pressure will have due to the central apnea and a nose only mask will not work due to the higher pressures. With Central Sleep Apnea you stop breathing and the Bipap S/T will send a back up pressure that is timed so when you stop breathing it will breath for you to start you up again. Central Sleep Apnea can be caused buy a number of things, for example: Your brain might be forgetting to breath due to your very deep sleep that a lot of central sleep apnea people have. One thing that when you are a very deep sleeper you do not remember that you dream most of the time. Another example that will affect this is medication, like pain killers - morphine and some oxycodone depending of the doses. I was on both of these due to the accident. The morphine I was on for almost 2 1/2 years. I just got off it a month a half ago, but I am still needing the oxycodone and get shots in my neck and lower back for appox 4 times a year for the rest of my life. My sleep doctor will recheck me sometime next year. I use my Bipap S/T every night and even take it with me on trips.

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Permalink Reply by Mary Ann McPheeters on September 22, 2009 at 12:48pm

I found a lot of info that even I hadn't had with my diagnosis when I googled 'central sleep apnea' and went to the AARP health site below:
http://healthtools.aarp.org/adamcontent/central-sleep-apnea
Read up, learn, and then take this info to your doctor and ask questions. Maybe he'll take the time (???!) to educate himself and then help you and others.
God bless!

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Permalink Reply by Remy Thierry on September 22, 2009 at 2:26pm

Hi Sandra,

As you can see, everyone tries to help you with information and links. Central apnea is not so common like obstructive apnea, therefore you can't find more information about this sleep disorder. Here is a link that may help you in your research:
http://www.sleep-apnea-guide.com/central-sleep-apnea.html

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Permalink Reply by Ron Sowell on September 22, 2009 at 2:30pm

Sandra, I have a combination of both central and obstructive as well. Basically what I was told was that obstructive sleep apnea is just that - and obstruction in the airway, making it so air can't get through - like when you are asleep and a portion of your airway sags in and that makes you snore. It could also be something in your nose causing the obstruction. Central sleep apnea, on the other hand, is basically your brain not giving the signal to your body to breathe! In my case I had an MRI which showed 'gray matter loss' in my brain. Why? Who knows! They certainly couldn't tell me! I am 60 so it could be that everyone of this age group who had an MRI would also show gray matter loss - who knows. What I am trying to say is that they have a name for it - central sleep apnea - but they really can't explain it. At least I haven't gotten a good explanation. I too went and had my heart checked - no problems as far as they could see. As a result I now have a different machine, called and ASV machine, instead of just a BiPap. The machine records my breathing and if or when I have an episode where I just stop breathing (because my brain didin't tell me to) the machine goes into its mode where it does rhythmic breathing for me until my body adjusts back to where it should be. Kinda scary, in that it means that I can never sleep without my machine!!!! Maybe some doctor will get on here and explain it better, or maybe they will find out what causes it down the road. For now we are pretty clueless, us and the docs I fear.

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Permalink Reply by Vicki E Jones on September 22, 2009 at 3:01pm

I have both Central Sleep Apnea and Obstructive Sleep Apnea.
Here's what I know about Central Sleep Apnea so far.

I am on the Respironics Auto BiPap SV, after trading back the ResMed VPAP
Adapt SV for the Central Apnea (but also takes care of Obstructive
sleep apnea).

The ResMed would not consistently recognize the Swift II nasal pillows,
and that's the only thing I can get a good seal with, at least without
slaughtering my face with super-tight straps to get a seal with a full mask.
I have a narrow bridge of nose, and receding chin, and that means fitting problems.

I don't know what my Central Sleep Apnea is due to, either. I don't
have heart failure. Central Sleep Apnea is when there is a pause at the
end of an exhale, before taking the next breath. It is a longer pause than
normal, and although it seems you are asleep, the brain neurologically
awakens you each time it happens, to make you take the next breath.

That means you wake up exhausted, even if you think you slept well, and
even if you are on a CPAP machine, though the CPAP cut down on the
frequency of central sleep apnea incidents with me. I still had 21 Central
Sleep Apnea incidents an hour, even with CPAP. CPAP and an oral appliance
(to advance the lower jaw, which in my case is too far back, called a retrognathic
manidble or retrognathia) stop the obstructive sleep apnea for me, though.

Supposedly Central Sleep Apnea is due to a delayed signal, i.e. there is a delay
in the brain stem sending the signal to the lungs to start the next breath (the
next inhale). This causes a neurological awakening each time it happens, even
though you think you were sound asleep all night.

Central Sleep Apnea can also be caused by an interruption of the signal to breathe
as it travels from the brain stem to the lungs. In my case, I have several conditions
of the cervical spine (neck) that could be contributing to this, such as advanced
osteoarthritis, Fibromyalgia, badly bulging disks, stenosis, and anterior and posterior
(front and back) bone spurs, especially at the base of the neck. So far, I haven't found
the doctor to resolve some of the cervical spine problems.

Heart failure can be another cause. Knowing that Mitral Valve Prolapse can cause apneas,
I would think that could be another cause. I have that, also, but not severe enough to treat,
according to my cardiologist. However, maybe it is more severe than the cardiologist thinks
i.e., maybe it is contributing to my sleep apneas, even though it isn't causing Atrial Fibrillation
or heart attacks.

Here is the web site for the WrongDiagnosis.com list of causes of Central Sleep Apnea:
http://www.wrongdiagnosis.com/c/central_sleep_apnea/causes.htm

The painkillers it is referring to are opiate pain killers, such as Darvocet, or intravenous
Versed (given for sedation for endoscopies, colonoscopies, etc.). There is a risk of causing
Central Sleep Apnea or making it worse, when these are given.

If you have surgery or a colonoscopy, it is usually advised (according to what I've read) that
you have general anesthesia with an anesthesiologist with expertise in sleep apneas, not
opiate-related sedation or pain killers. The advantage is that the anesthesiologist can
run something in to bring you out of general anesthesia if breathing problems are encountered
during the procedure. Oxygen should be given (the little canulae that sit barely in the nostrils),
and continued until you are no longer drowsy and won't dose off anymore.

There is an approach to the obstructive sleep apnea that I don't know much about - called
positional therapy - and I'm wondering if it would help central sleep apnea.It consists of putting
tennis balls in a fabric tube, then putting that in a t-shirt to keep you turned on your side
instead of sleeping on your back. I will have to ask my sleep doctor about this.

What part of the country are you in?

Hope this helps. It is all I know about it so far. I did not find anything about a serious illness
causing central sleep apnea at all.

Vicki in Illinois

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Permalink Reply by Sandra Ford on September 22, 2009 at 3:02pm

Thanks Guys,

I have been using a cpap machine for about a month, have about two more weeks before they check me again to see how it's working. My pressure is set for ten, I guess they started me on a cpap because it wasn't as expensive as a Bipap.

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Permalink Reply by Sandra Ford on September 22, 2009 at 3:32pm

Hi Vicki,

I'm from Louisiana, I like you have degenerative disk disease in my cervical spine ,osteoarthritis, Fibromyalgia, herniated disks, bone spurs, and Mitral Valve Prolapse.









Vicki E Jones said:

I have both Central Sleep Apnea and Obstructive Sleep Apnea.
Here's what I know about Central Sleep Apnea so far.

I am on the Respironics Auto BiPap SV, after trading back the ResMed VPAP
Adapt SV for the Central Apnea (but also takes care of Obstructive
sleep apnea).

The ResMed would not consistently recognize the Swift II nasal pillows,
and that's the only thing I can get a good seal with, at least without
slaughtering my face with super-tight straps to get a seal with a full mask.
I have a narrow bridge of nose, and receding chin, and that means fitting problems.

I don't know what my Central Sleep Apnea is due to, either. I don't
have heart failure. Central Sleep Apnea is when there is a pause at the
end of an exhale, before taking the next breath. It is a longer pause than
normal, and although it seems you are asleep, the brain neurologically
awakens you each time it happens, to make you take the next breath.

That means you wake up exhausted, even if you think you slept well, and
even if you are on a CPAP machine, though the CPAP cut down on the
frequency of central sleep apnea incidents with me. I still had 21 Central
Sleep Apnea incidents an hour, even with CPAP. CPAP and an oral appliance
(to advance the lower jaw, which in my case is too far back, called a retrognathic
manidble or retrognathia) stop the obstructive sleep apnea for me, though.

Supposedly Central Sleep Apnea is due to a delayed signal, i.e. there is a delay
in the brain stem sending the signal to the lungs to start the next breath (the
next inhale). This causes a neurological awakening each time it happens, even
though you think you were sound asleep all night.

Central Sleep Apnea can also be caused by an interruption of the signal to breathe
as it travels from the brain stem to the lungs. In my case, I have several conditions
can cause apneas,
I would think that could be another cause. I have that, also, but not severe enough to treat,
according to my cardiologist. However, maybe it is more severe than the cardiologist thinks
i.e., maybe it is contributing to my sleep apneas, even though it isn't causing Atrial Fibrillation
or heart attacks.

Here is the web site for the WrongDiagnosis.com list of causes of Central Sleep Apnea:
http://www.wrongdiagnosis.com/c/central_sleep_apnea/causes.htm

The painkillers it is referring to are opiate pain killers, such as Darvocet, or intravenous
Versed (given for sedation for endoscopies, colonoscopies, etc.). There is a risk of causing
Central Sleep Apnea or making it worse, when these are given.

If you have surgery or a colonoscopy, it is usually advised (according to what I've read) that
you have general anesthesia with an anesthesiologist with expertise in sleep apneas, not
opiate-related sedation or pain killers. The advantage is that the anesthesiologist can
run something in to bring you out of general anesthesia if breathing problems are encountered
during the procedure. Oxygen should be given (the little canulae that sit barely in the nostrils),
and continued until you are no longer drowsy and won't dose off anymore.

There is an approach to the obstructive sleep apnea that I don't know much about - called
positional therapy - and I'm wondering if it would help central sleep apnea.It consists of putting
tennis balls in a fabric tube, then putting that in a t-shirt to keep you turned on your side
instead of sleeping on your back. I will have to ask my sleep doctor about this.

What part of the country are you in?

Hope this helps. It is all I know about it so far. I did not find anything about a serious illness
causing central sleep apnea at all.

Vicki in Illinois

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Permalink Reply by Mack D Jones, MD, SAAN on September 22, 2009 at 3:33pm

Sleep apnea is divided into: 1. Obstructive (OSA)... 83%.
2. Central (CSA) ...<1%.
Or both of the above.....3. Mixed (CSAS)...15% called Complex Sleep Apnea Syndrome).

The VPAP machine is the treatment of choice for CSAS. It is a machine with auto CPAP or APAP and a Ventilator backup that kicks in and breaths for you when your brainstem neurons forget to automatically breath for you. These respiratory nerve cells are said to be "destabilized" because of the years of high blood CO2 levels from OSA. Central sleep apnea is a complex subject. If you don't believe me, check out http://emedicine.medscape.com/article/304967-overview.

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Permalink Reply by Vicki E Jones on September 22, 2009 at 5:48pm

Yes, the VPAP is the machine of choice, but I can't use it. The short version - it would not consistently accept the Swift II nasal pillows, and I have tried 9 full face masks. All of them either don't give a seal (no fat tissue in my face, and retrognathic mandible, and narrow bridge of nose), or the straps have to be pulled so tight that I get sores or raw areas on my nose or other locations and have to stop using the machine.

Since a machine that can give 95% correction is better than not using a machine at all, I was switched to the Respironics Auto BiPap SV, which is also for Central Apnea. VPAP is the ResMed VPAP Adapt SV. I was switched to the Respironics after 6.5 weeks of an average of 4 hours sleep a night, because no matter what full face mask I used, by 4 hours use I had raw areas and had to take it off.

The VPAP Adapt SV recognized the Swift II nasal pillows only once (which must be used with a ResMed Pressure Port Plug instead of the blue plug, and the oxygen sensor line attached to the pressure port plug instead of the proximal cuff). When I then tried a full mask the next night, then saw it wouldn't work and tried to switch back to the Swift II nasal pillows, the VPAP Adapt SV would not learn the circuit. I tried for two days.

I was so sleep-starved after 6.5 weeks of getting the VPAP Adapt SV to work for me that I was desperate to make the switch to the Respironics unit, and my sleep neurologist, who had the overnight titration (sleep study) done with the ResMed machine, finally agreed to the changed.

I am now getting 7 to 8 hours sleep a night, with the Respironics unit and the Swift II pillows. On an average of 4 hours sleep a night, I was getting supraventricular tachycardia during the day. I am at far greater risk of serious repercussions from the 4 hours a night and tachycardia, which can lead to A-Fib, than I am from having a 95% correction with the Respironics unit, 7 or 8 hours sleep, no tachycardia during the day, and total compliance i.e. I am able to use the machine.

Vicki in Illinois

***********

Mack D Jones, MD, SAAN said:

Sleep apnea is divided into: 1. Obstructive (OSA)... 83%.
2. Central (CSA) ...<1%.
Or both of the above.....3. Mixed (CSAS)...15% called Complex Sleep Apnea Syndrome).

The VPAP machine is the treatment of choice for CSAS. It is a machine with auto CPAP or APAP and a Ventilator backup that kicks in and breaths for you when your brainstem neurons forget to automatically breath for you. These respiratory nerve cells are said to be "destabilized" because of the years of high blood CO2 levels from OSA. Central sleep apnea is a complex subject. If you don't believe me, check out http://emedicine.medscape.com/article/304967-overview.

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Permalink Reply by RockRpsgt on September 22, 2009 at 6:20pm

Obrtuctive apneas can disguise themselves as central apneas. have you had a titration study done? Are you on PAP?

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Permalink Reply by Vicki E Jones on September 22, 2009 at 8:18pm

Hi, Rock. I don't know about the person who started the thread, but I've had 5 sleep studies done.
The first showed obstructive and central, but there were no PAP machines out for the central
apnea. Worse, the doctor ignored the results and didn't order CPAP. He did order an oral
appliance to bring the lower jaw forward, but it could only be brought forward a little due to
long-standing TMJ (jaw joints limit the moving it forward to a very small amount).

The second two studies, a year later, showed the obstructive and central, and I was put on CPAP.
The second study that year was the overnight CPAP titration.

Unfortunately, that doctor didn't follow up, and I was on the CPAP 4 years, until my old Fisher & Paykel
machine started to break down. I was loaned a CPAP machine by my DME (durable medical equipment)
provider, an overnight study was done, and showed I needed a machine for Central Sleep Apnea i.e.
the oral appliance + CPAP corrected the obstructive, and only the obstructive.

The VPAP titration was done late June, but it took until the end of July to get rent-to-buy approved
by our insurance. I had asked the doctor to do the titration on Respironics, because I knew enough
by then to know I may not be able to wear something on my face that is compatible with the
ResMed VPAP.

I tried the VPAP 6.5 weeks, then gave up, and called my doctor in desperation to switch me to the
Respironics. That can be done if the DME consults tech support at Respironics as to how to convert
over to the equivalent settings on the Respironics. The two machines work two different ways, but
accomplish the same thing.

Vicki in Illinois

*************

Rock Hinkle said:

Obrtuctive apneas can disguise themselves as central apneas. have you had a titration study done? Are you on PAP?

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