Central Apnea Treatments

I am pretty sure I have central apnea and not OSA. I have been on CPAP for 18 months and recently had a tonsillectomy/septoplasty and uvuloplasty. I am back on the CPAP but am still waking up after continuously exhaling for a long time or holding my breath. My AHI is usually around the 8 range. I am planning on going back to the ENT and sleep doctor. My question is, assuming I have central apnea, how is it generally treated? Since cpap and surgery have basically eliminated any obstructive causes, I'm wondering what is usually done to treat the neurological causes. Medications? Surgeries? Anyone who has had success treating central apnea, your info would be greatly appreciated. Thanks.

You need to have a PSG to confirm if you are having centrals or not.

I'm just working under the assumption that I have central apnea. Assuming I do (or anyone does), what are the methods used to treat it?

some of the following ------- cpap, bipap, specialized bipap, O2, unvented masks, medication

you might want to look for posts by lubman and by christinequilits

CSA is a lot harder to find a treatment plan for than OSA and the treatment needs to be individualized.

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, CSA

Check out this link. Here, you will find a wealth of information on Central Apnea:

cpaptalk-faq.php

A bilevel S/T machine used to be the machine of choice to treat primary Central Sleep Apnea.

Nowadays the preferred machine to treat CSA or CompSAS (Complex Sleep Apnea Syndrome or "CSDB" - Complex Sleep Disordered Breathing as CompSAS is also called) is an Adaptive Servo Ventilator. An "ASV" machine.

The two ASV machines available:

Respironics BiPAP Auto SV

ResMed VPAP Adapt SV

The surgery (tonsillectomy/septoplasty and uvuloplasty) are sometimes helpful, but not usually a cure. Pure central apnea is possible, but very unlikely. Most people have obstructive apnea, and start to have central apneas at higher pressures. The hope/goal for most is to find a pressure that treats the OSA, but doesn't trigger centrals.

The best treatment today for pure CSA are the more complex cpap machines as rested gal mentioned. They basically change pressure to remind your body to breath if you forget.

You may need that, or perhaps your pressure is too high, or low, or your leak rate is too high.

What pressure are you running at?
Have you completed a sleep study?
What model cpap machine do you have?
What mask are you using?

If there is one thing I have learned after a decade of horrible sleep. The person sleeping is worst judge of how well they slept. I always thought I was sleeping great, now I review the data.

What pressure are you running at?
I've changed this numerous times, I'm pretty sure my original prescription was 6-10, i'm now running something like 10-13, still messing around with it

Have you completed a sleep study?
i've had 2 with the most recent one being august 06, from the results of that i got prescribed my cpap and eventually the surgery

What model cpap machine do you have?
resmed s8 autovantage

What mask are you using?
not sure without looking at it, its a full face mask (my problem seems to be completely mouth related, not nasal)...its pretty comfortable and i have few complaints about it

Pressure: You have already upped the pressure a few cm, has it helped? Does it get better or worse if you up it another 3 cm?

Sleep study: Ask you doctor for a copy of it. This should answer your questions about CSA vs OSA. If you have questions, ask your doctor or ask here.

CPAP Machine: Very nice! Do you have the software to download data to a computer? I have found this to be incredibly helpful.

Mask: I've found that I get better results with a nasal mask than a full, but everybody is different. Something to consider though...

"my problem seems to be completely mouth related, not nasal"
If the problem were just your mouth, or just your nose you probably wouldn't need cpap. The goal is to get air through either one while sleeping.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, CPAP, CSA

my pressure is an ongoing experiment....

i have a copy of my sleep study and it basically said that i don't have a problem or if i do that is extremely mild...however, i know i have had and still have problems on CPAP...while i know i am the worst person to diagnose myself, i know that i completely wake up while continuously exhaling for a significant period of time at least once a night and who knows how many times i don't wake up and still do it

i don't have the software, i don't think it came w/ my machine, can i purchase it and if so how do i get the data from the machine to the computer? is it with the memory stick thing that came with it?

my ENT wants me to have another surgery 3-4 months post op (aprilish), when i go for that i'm going to make sure they do a PSG so we can see where to go from there...

thanks again for all the input

"If the problem were just your mouth, or just your nose you probably wouldn't need cpap. The goal is to get air through either one while sleeping."


this is the whole thing, from what i can tell it is not a physical blockage of any kind, especially since the surgery, its just that my body will continuously exhale for a long period of time or i will simply hold my breath

axpmaluga, without a PSG study and PSG titration (especially after having had so much surgery) everything you're speculating about is a "guess." But you already know that -- I'm not chiding you in any way for trying to figure out what's happening.

Everything you've described about your wakeups -- finding yourself doing a long exhale and/or holding your breath -- can be completely consistent with still having obstructive sleep apnea. Doesn't have to indicate a neurological "central apnea" problem at all.

For example -- if, during sleep, you have an obstructive apnea and your body has an arousal (still in your sleep) to finally take several big recovery breaths (still in your sleep) AND you wake up immediately after those recovery breaths, it would not be at all unusual for you to find yourself doing a long exhalation, or even pausing (holding your breath.)

The recovery breaths you take after an apnea while still sleeping can cause hyperventilation (still in your sleep); thus, you don't need another "regular" breath for awhile. Following hyperventilation, you experience what I'd call a normal "central" before you need to take another breath.

If you occasionally wake up at the end of an obstructive scenario like that, you're AWARE of ONLY the tail end. You never were aware of the struggle to breathe during the obstructive apnea. And you were never aware of the hyperventilating breaths you were taking to recover from the obstructive apnea. All you're aware of as you're waking up was the end of the whole thing...the "after hyperventilation" feeling of not really needing to take another breath now. Or noticing the sighing long exhale we do after hyperventilation.

Of course, the obstructive apneas or obstructive hypopneas that caused those big hyperventilating recovery breaths (and subsequent "normal" central) need to be addressed.

Sounds like time for investigating whether your machine pressure is set for enough to adequately keep apneas at bay.

An investigation via PSG sleep study would give the most info, of course. Preferably a full night gathering diagnostic info, and another full night of titration.

Short of that, using software to examine the machine data would be the next best thing to do.

Without the software, next best thing is AHI data from the machine's LCD, if the machine shows that kind of thing (yours does.)

Without even LCD info, then.... I'd start experimentally and methodically raising pressure -- the particular pressure setting to raise being dependent on what kind of machine a person is using:

Depending on the type of machine I was using, I'd raise one of these:
1. CPAP machine - the cpap pressure
2. Autopap machine - the minimum pressure in the range
3. Bilevel machine - the EPAP
4. Bilevel Auto machine - the Min EPAP

With the autopap and bilevel machines, if raising the minimum (or EPAP) pressure a few times didn't give me better results (subjectively "feeling better") I'd try setting any of those machines for a single cpap pressure and start working my way through several straight pressures to see if that was better. I'd give each pressure change at least 3 or 4 nights before making another change.

But a full two nights of PSG -- one full night diagnostic data gathering and another full night for a thorough, methodical titration -- would be the best way to really see what's happening. Especially in a sleep lab that is very savvy about any indications of CSDB (Complex Sleep Disordered Breathing) that can show up during titration.

Just my non-medical two cents worth of speculation, too.