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Permalink Reply by Bill Pilgrim on July 26, 2011 at 8:19pm

Hi Fred, My own experience has been that if you suffer from CSA and use a CPAP, you will most likely wake up tearing the mask from your face, because you will feel as if you are suffocating.  I had years of this, while being supervised by so called professionals, who insisted that I would benefit by continuing with CPAP.  As soon as I changed to VPAP there was immediate improvement.  Unfortunately however I still have Apneas

Regards, Bill

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Permalink Reply by Mary Z on July 27, 2011 at 10:42am

Fred, it is my understanding that a CPAP machine will not respond to CSA.  If your mixed events are bad enough I would talk to the doctor and he may prescribe a different machine. However, it seems as though you have tried every machine available! He might require another sleep study to look for central apneas in particular.  I don't believe an AUTO will respond to central events, either.  Again, with your AHI so high and your number of central events high I would have another visit with the doc.  All of us probably have some centrals, it just depends on how many if they need to be treated. With your AHI in the 30's you may require a simple adjustment of pressure.  I am just speaking from personal experience, I am not a professional. 

Was the AUTO SV a servo vent machine?  I know there is a new machine out there which responds to cheyne-stokes respirations.

I am glad you are otherwise pleased with the machine.  I also am having trouble having my OSA treated effectively,  but the doc attributes this to the may prescription meds I am on.

Good luck.

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Permalink Reply by Fred J. Stellabotte on July 27, 2011 at 2:01pm

Hi Mary,

Thanks so much for your reply. I had a sleep study in March of this .. which showed only OSA. Over the years I have had 11 sleep studies, most showing OSA. I had a sleep study at the Mayo Clinic last year which showed OSA, CSA and periodic breathing. They pescribed a Resp System 1 AutoSV. I stayed with that  machine for about 9 months,  I still felt tired, but not as bad as I am feeling now. When Mayo Solution did not give me the relief, I wound up going my current doc, who said I did not need any theraphy. After 3 months of that, I felt like I was going die. I then asked to see my sleep study,  I went over it with him, he realized that he had me confused with another patient ! 

Anyway, he put me on this machine. I am looking for another doctor now. I wish I could get mutiple studies at home. There has got to be a solution for me.

Thanks again for your reply.

-Fred

 

 

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Permalink Reply by RockRpsgt on July 27, 2011 at 11:40pm

The S9 would show CSA as an "open airway apnea". While the machines are getting better most clinicians would argue the validity of these events.

 

Did you go to the Mayo in Rochester Minnesota? Were you still living in St Johns at the time? How long were you there prior to the study? The chnage in geography could have caused a change in your sleeping events. I am assuming that St John's is at or near sea level? Rochester is around 1000'.

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Permalink Reply by Fred J. Stellabotte on July 28, 2011 at 9:11pm

Did you go to the Mayo in Rochester Minnesota? Were you still living in St Johns at the time? How long were you there prior to the study? The chnage in geography could have caused a change in your sleeping events. I am assuming that St John's is at or near sea level? Rochester is around 1000'.

 

I live in St Johns, FL .. near Jacksonville,  FL  there is a Mayo Clinic there. The  sleep Lab was not very impressive, and the Doctor they assigned was on his way out. So I moved on.

 

I am looking for a cutting edge doctor, any where, who might do an initial Sleep Study  at the center, and then follow up with home tests until we can bracket what the issue is.

Unfortunately, I may take a "dirt nap" before that happens. 

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Permalink Reply by Gil Ben-Dov on August 1, 2011 at 11:49am

Fred,

You present an interesting set of clinical observations.  You’ve got plenty of experience with CPAP, but I’d like to take a minute to define a few terms for the more casual readers of this thread to help put it all in perspective.

From our website, “CSA is a form of sleep-disordered breathing (SDB) caused by the temporary absence of a signal from the brain’s respiratory center. Without this signal, there is no effort to breathe. Mixed sleep apnea is fairly common and consists of both central and obstructive components. On the other hand, CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices.”

The following explanation of CSA detection in our S9 Autoset and S9 Elite models is taken from our website as well: “[S9 Autoset/Elite] uses the forced oscillation technique (FOT) to determine the state of the airway during an apnea. When an apnea is detected, small oscillations are added to the pressure to measure airway patency. The CSA algorithm uses the resulting flow and pressure to measure airway patency and differentiate central and obstructive events.”

No respiratory flow indicates an apnea and coupled with the absence of a pressure increase in response to the forced oscillation indicates a central event. There’s a good video comparingobstructive and central events on our YouTube channel, http://www.youtube.com/user/ResMedAmericas?feature=mhee#p/search/0/....

Your observed symptomology is consistent with Complex Sleep apnea.  This can be treated with adaptive servo ventilation (VPAP Adapt SV).  Here’s a link to an interview from sleepradio.com that discusses how the adaptive-servo ventilation treats central events.  http://www.need4sleepradio.com/archive/Adapt_sv.mp3.  

Reading the thread, I see that you were placed on ASV therapy at one point - that appears appropriate for the symptoms described.  Different manufacturers use different algorithm in their devices; therefore, I would encourage you to work with a sleep doctor explore alternatives to find the solution that does work for you – everyone deserves a good night’s sleep and working with a good sleep doctor should help you get there.

Gil Ben-Dov                                       Jeremy Malecha

VP Social Media Strategy               Team Leader Sleep Products

 

 

 

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Permalink Reply by Judy on August 1, 2011 at 12:33pm

Gil, thank you so much for taking the time to clarify things for us and to offer suggestions for Fred.

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Permalink Reply by Fred J. Stellabotte on August 3, 2011 at 8:36am

Gil,

Thanks SO much for the links above !!!  and your comments ...

I have a lot to digest ...

 

I found a neurologist who has taken interest in my situation ...

He metioned that there is a pacemaker that can be implanted to treat the CSA .. I told him to "sign me up". He said .. that we need to do several tests, and try some other things before we get to the implant.

 

I asked him, partly joking, "can sleep apnea cause central sleep apnea" ... He said YES ..

Thinking about it .. I had to get a pacemaker, because sleep apena slowed my heart rate,.

 

I will keep posting, as I get more information ..

 

Again, thanks so much ..

-Fred

 

Gil Ben-Dov said:

Fred,

You present an interesting set of clinical observations.  You’ve got plenty of experience with CPAP, but I’d like to take a minute to define a few terms for the more casual readers of this thread to help put it all in perspective.

From our website, “CSA is a form of sleep-disordered breathing (SDB) caused by the temporary absence of a signal from the brain’s respiratory center. Without this signal, there is no effort to breathe. Mixed sleep apnea is fairly common and consists of both central and obstructive components. On the other hand, CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices.”

The following explanation of CSA detection in our S9 Autoset and S9 Elite models is taken from our website as well: “[S9 Autoset/Elite] uses the forced oscillation technique (FOT) to determine the state of the airway during an apnea. When an apnea is detected, small oscillations are added to the pressure to measure airway patency. The CSA algorithm uses the resulting flow and pressure to measure airway patency and differentiate central and obstructive events.”

No respiratory flow indicates an apnea and coupled with the absence of a pressure increase in response to the forced oscillation indicates a central event. There’s a good video comparingobstructive and central events on our YouTube channel, http://www.youtube.com/user/ResMedAmericas?feature=mhee#p/search/0/....

Your observed symptomology is consistent with Complex Sleep apnea.  This can be treated with adaptive servo ventilation (VPAP Adapt SV).  Here’s a link to an interview from sleepradio.com that discusses how the adaptive-servo ventilation treats central events.  http://www.need4sleepradio.com/archive/Adapt_sv.mp3.  

Reading the thread, I see that you were placed on ASV therapy at one point - that appears appropriate for the symptoms described.  Different manufacturers use different algorithm in their devices; therefore, I would encourage you to work with a sleep doctor explore alternatives to find the solution that does work for you – everyone deserves a good night’s sleep and working with a good sleep doctor should help you get there.

Gil Ben-Dov                                       Jeremy Malecha

VP Social Media Strategy               Team Leader Sleep Products

 

 

 

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