Apneas, Central Apneas and Hypopneas

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Janelle

Apneas, Central Apneas and Hypopneas

Post by Janelle » Wed Jan 26, 2005 8:28 pm

I just downloaded my first two weeks on my 420E, and as I suspected I also have central apneas, usually as many as I do apneas, sometimes more, sometimes less. Hypopneas are usually the highest but sometimes very low. No real pattern. I knew I slept better with the 420 than the Resmed Spirit, and suspected it was because of the central apneas. No central apneas were even mentioned on my first Sleep Study. Still do not have results of the second (titration) sleep study, so don't know if any showed up there or not. None were also indicated on the month I was on the Spirit, but I'm not sure the Spirit records central apneas.

Does anyone else suffer from all three types? What has your Dr. told you as far as any additional treatment or medication?

gailzee
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Re: Apneas, Central Apneas and Hypopneas

Post by gailzee » Wed Jan 26, 2005 8:40 pm

I had 124 hypops, 7 ap's and 2 central ap. The pulmonary dr. told me the ca's were not significant. During titration study I had 12 hypop's, 3 obs ap's, and 4 centrals. No sign O2 desat's. Which was very good to read, as I had ''severe hypoxemia" in the diagnostic first study.

I questioned the pulm. on the central ap's, he said it really didn't apply to me. Does this an. your question? At my titration study, I had a total of 19, and it averaged to 1 episode per hour. So their opinion was the CPAP titration second study was written up as normal and efficiency of sleep. Normal sleep architecture (WHAT IS THIS?) Significant improvement. No snoring or disordered sleep and no cardiac abnormalities seen. So I guess my titration study sounds much improved.

GET A COPY OF YOUR STUDIES AND YOUR PRESCRIPTION, ITS A MUST!

Janelle wrote:I just downloaded my first two weeks on my 420E, and as I suspected I also have central apneas, usually as many as I do apneas, sometimes more, sometimes less. Hypopneas are usually the highest but sometimes very low. No real pattern. I knew I slept better with the 420 than the Resmed Spirit, and suspected it was because of the central apneas. No central apneas were even mentioned on my first Sleep Study. Still do not have results of the second (titration) sleep study, so don't know if any showed up there or not. None were also indicated on the month I was on the Spirit, but I'm not sure the Spirit records central apneas.

Does anyone else suffer from all three types? What has your Dr. told you as far as any additional treatment or medication?

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rested gal
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Post by rested gal » Wed Jan 26, 2005 10:59 pm

Back when I was doing some experimental tweaking of pressure with my first autopap, the 420E, I used to panic at the sight of even one central appearing on the software report the next morning. "OMG, do I have the pressure too high?" The thought of the brain not sending a signal to breathe is rather scary sounding.

Since then, I've found out it's not unusual for people to have occasional centrals from time to time while they sleep...even "normal" sleepers who do not have sleep apnea of any kind. I also got more relaxed about seeing those scattered few marks on my chart when I read Christinequilts' posts about the number of centrals she has, every night.

I've used three different autopaps now with the software for each. There'll be a random night that has one or a few centrals show up on the chart, then quite a few nights in a row with no central marked at all. They are noted as "Ca" on the 420E report, and "NR" (for Non-responsive) on the Remstar report.

But here's the thing - the autopaps are only guessing that those are centrals anyway. They may, or may not, really be centrals. The equipment used during a full PSG sleep study can tell for sure (I suppose), but autopaps just have to make an educated guess at what's happening when a person's breathing suggests "possible central happening". That tick mark may mean that's what it was...or...maybe not.

That's why the 420E leaves the situation alone (doesn't try to up the pressure) when it senses conditions that might mean "a central". The REMstar tries three tiny increases, but if those small increases don't "clear it", then the REMstar also leaves the situation alone.

As I understand it, (I can be way off!) high pressure can cause centrals to start popping up in some - not all - people. Another good reason, imho, to be using an autopap and enjoying as low a pressure as is comfortable, for as much of the night as possible. But if it's only a few centrals scattered throughout the night on the reports, I wouldn't think there's a "central apnea" problem going on.

If a person started seeing a lot of marks denoting "centrals" on their data for several nights in a row (and don't ask me what "a lot" would be, 'cause I don't know...lol) then one might want to think about dropping their top pressure some or tweaking something about the machine. But occasional possible centrals marked here and there on a graph - I personally wouldn't worry about it. I'm not a doctor, though!!

Guest

Post by Guest » Thu Jan 27, 2005 10:06 am

AutoPAPs are guessing when they classify an apnea as central- that is why some won't even label them as 'Centrals'. The only way to tell if an apnea is central is with the more sophisticated monitoring equipment used in sleep studies. Even in a sleep study some events that look like centrals are not always really central apneas- the band around your chest and stomach can be dislodged while moving momentarily or be misfitted. Most people- even those without sleep disorders- have a few central apneas while sleeping. A common cause is when you roll over...have you ever noticed when you're exercising or lifting something heavy that you hold breath unless you actually think about your breathing? The same thing can happen at night as you toss and turn. THere are other things that cause centrals too- there is a certain amount of variance in our breathing patterns when we sleep just like there is when we're awake.

I wouldn't worry about central events unless there were a significant number per hour- the actual # will vary from equipment to equipment & doctor to doctor but under 5 per hour is usually considered normal and over 10 most doctors will note the possibility of central apnea. With OSA some doctors will even consider a higher number of central events as okay as OSA can cause centrals in some individuals- their centrals go away once the OSA is brought under control. SOme people will report central events on titration studies- those usually are from a higher pressure being tried and should not be a problem as long as a lower pressure is used. I have also heard that they have done studies and a lot of people who had pressure induced centrals stop having them after a week or so as their body adjust to higher pressure.

A lot of people get more concerned about just a few central events disproportionably so in relation to the number of obstructive. I think it probably has to do with the idea of 'forgeting to breath' versus something mechanically blocking the airway. Remembering to breath seems like such a basic function like our hearts beating but it is more similar to our eyes blinking- most of the time our eyelids are on autopilot though we make take control when needed. Maybe a better way to think of central events is as a glich in the autopilot program that thankfully the captain (you) and other members of the crew (backup systems) jump into action to correct. Central apnea events numbers are gauged the same way as obstructive with 0 to 5-10 being normal, 5-10 to 20ish being mild, 20ish to 30ish being moderate, and 30ish & over being severe. Of course like with OSA, oxygen desaturation is also taken into account in determining the severity.

To give you a perspective I had 65 Central apnea per hour in my first sleep study and about 1 obstructive apnea an hour with O2 desats in the low 80's- I slept something like 9 1/2 hours so that means I had over 600 central apneasand 8 obstructive. I had probably had Central Sleep Apnea for over 13 years before being diagnosed so I potentially had 2 million central apnea events during that time and I woke up every morning...though my sleep quality was fairly poor as one would expect with high number of events. In my titration study even with BiPAP ST they were only able to reduce me down to 30+ centrals per hour so I still have between 200-300 central events every night.

I hope this helps you understand what central are and what your autopaps are telling you (or not telling you).

Christine

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christinequilts
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sorry...last post was mine

Post by christinequilts » Thu Jan 27, 2005 10:18 am

thought I was logged in...had checked & answered PM's too but I must have gotten distracted doing other stuff to long <sigh>

Most old timers probably recognized my post...its kind of hard to hide when you have a 1 in a million diagnosis of treatment resistant CSA.

I'll try to watch to make sure I'm logged in....

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rested gal
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Post by rested gal » Thu Jan 27, 2005 10:18 am

Absolutely great explanation, Christine. I'm noting this topic for future linking when anyone asks about "centrals" showing up on their data. The info you share is fascinating...as always. Thank you, thank you!

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Apneas, Central Apneas and Hypopneas

Post by ahujudybear » Mon May 30, 2005 9:05 am

OK you guys....

I got all excited when I saw the name of this thread... finally! Something about HYPOPNEAS!!



Christine, your description of CA's as something like the brain forgetting to breathe is sort of what my dr is calling hypopneas. This occurs during the day as well, where I will be thinking about something and suddenly take a huge gasp of air, and then realize that I had not been breathing. They say that I have a lot of these in my sleep studies, and so they up the pressures. But as I have posted elsewhere here, I don't have the muscle strength to exhale against those higher pressures and end up exhaling through my mouth and waking up with a CO2 headache!

Can you possibly explain the difference and why the difference in treatment? Wouldn't the back-up feature address this problem?

- JB