Seems Like I have Central Sleep Apnea - Switch to Bipap Worth it?

[blaird89]

So I've been looking through my Oscar data and noticed that the vast majority of the time my AHI is coming from central and not obstructive. I am averaging about 5.5 AHI each night and since CPAP isn't supposed to help very much with central sleep apnea I am now debating whether it would be worth it to switch to be BIPAP? I know it won't fix everything but is it worth it to look into getting a Bipap?

[Rubicon]

No.

[lazarus]

In support of Rubicon's excellently succinct answer:

Having a few "centrals" as reported by a home treatment machine, even if the centrals make up the larger proportion of the the home-machine-reported trending AHI, is nothing at all like actually being diagnosed with central sleep apnea, as confusing as that fact might at first seem to be. Having a few centrals is NOT the same at all as 'having central sleep apnea.'

Even when the centrals being reported are true centrals, optimizing the use of CPAP/APAP can often stabilize the airway enough for those centrals to resolve over time, if PAP therapy is consistently effective and used during all sleep.

What does that mean in the grand scheme of things? In your case, I believe it means exactly what Rubicon just said: "No."

Can bilevel be more comfortable for some than CPAP? Sure. Sometimes. And some here pay for that out of pocket for that reason, to improve the overall quality of their sleep from that added comfort. But that is not the question you asked.

[2young2bawake]

https://youtu.be/0j6m6ZRf8Kw

I saw a video on Sleep HQ about some devices that might help. Just what i have seen.

[ChicagoGranny]

So I've been looking through my Oscar data

Follow the instructions and post a typical night's OSCAR chart in this thread.

[blaird89]

So I've been looking through my Oscar data

Follow the instructions and post a typical night's OSCAR chart in this thread.

Sorry new to this my bad, here's a typical night:
https://postimg.cc/8j95jsjX - August 6

[dataq1]

Resmed home machines does not specifically identify central apnea events. The reason is because the standard cpap/Apap machine cannot distinguish between a clear airway event and a true central event.

Patients diagnosed with significant central apnea may require an ASV device, which are more like the ventilators used for patients who can not reliably breathe on their own.

Central apneas occur when the brain fails to signal the chest muscles and diaphragm to contract. If that is the case, a neurologic defect, cpap/apap/bipap will not magically correct that defect.

Why are you convinced that you are a central apnea patient?

[Pugsy]

Resmed home machines does not specifically identify central apnea events. The reason is because the standard cpap/Apap machine cannot distinguish between a clear airway event and a true central event.

Actually a ResMed cpap/apap machine does label open airway cessation of breathing as a central apnea and if someone was using ResScan they clearly identify/label central apneas separately from obstructive apneas and hyponeas.

OSCAR just uses the term clear airway....but the machine does call a central apnea a central apnea..

Now distinguishing between asleep cessation of breathing and awake cessation of breathing....it can't tell if we are asleep or not but it does flag central apneas quite clearly.

[lazarus]

This seems like a decent up-to-date summary of CSA:

https://www.sleepfoundation.org/sleep-a ... leep-apnea

[Tec5]

Having a few "centrals" as reported by a home treatment machine

Home machines do NOT report "centrals". They identify clear airway events. Clear airway events may or may not be "centrals" apneas.

(resmed algorithm lumps these two types of events together, BECAUSE the home therapy machine is unable to distinguish between a pathological central apnea and a 10 second cessation of breathing that might occur when a person rolls over in their sleep, or talks in their sleep, or a whole bunch of other things the are NOT pathological )

[dataq1]

This seems like a decent up-to-date summary of CSA:
https://www.sleepfoundation.org/sleep-a ... leep-apnea

Another resource: Mayo Clinic: https://www.mayoclinic.org/diseases-con ... %20apneas.

[lazarus]

Home machines do NOT report "centrals".

I believe that argument of yours us something you'd have to take up with ResMed:

"Most newer CPAP machines will report if you’re experiencing central apneas."--https://www.resmed.com/en-us/sleep-apne ... hi-change/

ResMed-machines even iinclude a number for "Central AI" in their machine software sleep reports. So ResMed calls those open-airway apneas "centrals" when it reports them to patients. Take them to court if you must.

Technically, yes, sure, you have a point, of sorts, since home treatment machines do not have the effort belts that lab PSGs have. Nevertheless, open-airway events are now often referred to by pros, both clinicians and researchers, as "centrals" in the context of treatment AHI reported in trending data.

It is understood as obvious that home-treatment machines ALWAYS report approximation estimates in most all aspects of AHI. By your logic, it would be wrong ever to call home treatment data "AHI" at all, since it is not the same as lab-PSG AHI, especially with all the brands' proprietary definitions of hypopneas. Is it wrong for them to call them "hypopneas" without the leads and O2 info? Of course not. Not wrong. Just different. Same with "centrals."

Home-treatment machines give valuable trending data that are valid in their own right, and it would be pedantic to insist otherwise for forum usage of the terminology. I will often put my first uses of "AHI" and "centrals" in quotes to differentiate from lab definitions, but not always.

The bottom line is that context determines whether lab definitions or home-treatment definitions are being discussed. I suggest you get used to that in posts by others in order not to bog things down unnecessarily with hair-splitting the apples and oranges in discussions that are focusing on reports from home machines.

But hey, that's up to you.

It took me awhile to get used to those open-airway apneas being called "centrals, " myself. But I have now accepted that all the cows and horses are already waaay out of the barn on that one.

Kinda like how "BiPap" has now virtually become a generic term that is considered synonymous with "bilevel" in the literature.

We just have to let those things go, in my opinion. Language usage evolves, and various parts of the sleep-breathing-treatment industries have varying standards of exactitude with wording that can change over time.

[Tec5]

it took me awhile to get used to those open-airway apneas being called "centrals" myself.

The OP is reading his OSCAR (see his Aug 6th Oscar), no where on this report does it mention "central apnea". It does however mention "clear airway apneas".

Is OSCAR misleading us? I don't think so. Did the OSCAR authors decide to change the EDF file header from "central apnea" to "clear airway apnea"?

From the same Resmed blog that you posted:

your brain might not always be telling your body to breathe. This can cause central sleep apneas, “central” because your apneas are causes by a dysfunction in the central nervous system,

It would seem that central apnea (caused by brain dysfunction) is a subset of clear airway apneas. (because not all clear airway apneas are caused by "brain dysfunction").

The consequence of all this is that the OP should take steps to satisfy himself that his "clear airway apneas" are not related to a brain dysfunction.

[lazarus]

I believe that the satisfaction the OP was looking for, at least as stated, was getting an answer to the question of whether it was worth it to pursue bilevel treatment.

Perhaps the course of wisdom on my part would have been not to have attempted a gilding of the lily of the first direct response that was posted to the thread.

Then again, the "central" function of this forum is that it is an open airway.

Good talk.

[dataq1]

What we (at this forum) don't know is:

What are the causes of the OPs clear airway events (are they actual brain dysfunction(s) or are they of "benign" causation ( rolling over in bed, dogs barking, etc (otherwise referred to as SWJ)).

Is the OP under medical supervision, or is he considering purchasing a BiPap without the benefit of individual professional medical guidance.

80% of his AHI is assignable to "clear airway apneas", he owes it to himself to find the root cause (hopefully to rule out any brain dysfunction or hypocapnia causation).

I agree with Rubicon, the short answer to 'should I consider a BiPaP' is "no". Perhaps a more complete answer would be, your doctor may consider a BiPapP trial, before finally prescribing an Auto Servo Ventilator.