jsewell wrote:Hi , i am new to all this. After my sleep study my doc prescribed a cpap even though he saw central apneas as well. I went back to see him after 2 weeks when my AHI numbers had stayed high, usually above 20. He looked at the data and went back to my sleep study and said i need an ASV machine. Has anyone with a similar situation had a problem with the insurance company not paying for the ASV?
If i use the cpap it takes care of all my obstructive apneas, but it is causing more centrals. Does anyone know if i should still be using the cpap?
Did anyone ever investigate to find out the cause of the central apneas.
Thanks for any answers
Central apnea comes in two basic flavors, hypercapnic and hypocapnic.
In hypercapnic central apnea the brain really does “forget to breath” so the carbon dioxide (capnic) levels rise above normal (hyper).
In hypocapnic central apnea the breathing control systems cause the person to over breath which washes out the carbon dioxide (capnic) levels so they become lower than normal (hypo).
CPAP emergent central apnea is also known as Complex Sleep Apnea (I assume that OSA is being treated by xPAP) and tends to occur due to the constant pressure of the CPAP reducing the effort it takes to breath a greater volume of air. This tends to move things toward hypocapnic. The person being upset by the greater volume of air may well be part of this.
If I were you I would make it a point to spend some quality time using the machine during the day for at least the next month. Perhaps an hour a day.
Part of it should be in bed, relaxing, and concentrating on breathing very quietly and gently with the machine. You are at rest and your body needs little air to keep up with your needs. Part of the time in bed should be spent moving to all of the positions you are likely to use during the night. This is a good time to check mask fit, hose management, etc …
Part of it should be doing somewhat distracting things such as reading books, watching non-violent TV, listening to quiet peaceful music. Both the in bed and partially distracted times get you familiar with the machine and help to develop breathing reflexes while breathing with the pressure of the xPAP machine.
The more you are familiar with the machine the less what it does will bother you.
I have found a way to treat my Post Traumatic Stress (PTS) emergent hypocapnic central apneas by using enhanced expiratory rebreathing space (EERS). It uses a few simple parts added to your hose. Please work with your doctor to see if this may be a much more practical solution for you.
They are working hard on making new kinds of CPAP machines. The future may hold much better solutions (e.g. Dynamic CO2 therapy).
From my own experience I would say that anything you can do to reduce the stress in your life is likely to help with your xPAP therapy.
May you quickly find the best solution!
: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008