I was just looking again at my titration study and saw that there were some central sleep apneas recorded there.  That was troubling to me, and I looked up on Medline Plus about central sleep apnea which got me even more concerned (given that they said it occurred in patients already seriously ill!).  Anyhow they did state that a treatment of it if there was no other known cause was CPAP, and  I sure can't figure out why CPAP would help as it doesn't initiate breathing.  Anyone know?  Anyone know more about central sleep apnea, does everyone have some of it?

Judy

judyb wrote:

I was just looking again at my titration study and saw that there were some central sleep apneas recorded there.  That was troubling to me, and I looked up on Medline Plus about central sleep apnea which got me even more concerned (given that they said it occurred in patients already seriously ill!).  Anyhow they did state that a treatment of it if there was no other known cause was CPAP, and  I sure can't figure out why CPAP would help as it doesn't initiate breathing.  Anyone know?  Anyone know more about central sleep apnea, does everyone have some of it?

Judy

Hi Judy. I'm in the same boat and I feel like a big doof at the moment because I just posted to what I thought was this list but it was a different one from where I had followed a link.  LOL.  To top it off, I hit the preview button a couple of times after editing and it posted both to the 'net.  Sigh.  

Anyway, I am wondering the same things you mentioned. I have been using a bipap for a couple of years and was recently re-titrated. I was told that the sleep study indicated my numbers need to be changed from 8/12 to 15/19, and that I have predominantly CSA with some OSA. I've also been reading the scant material available on the 'net and it scares me. One of the things I've read is that cpap/bipap might not help CSA and one article indicated it could even make it worse. At the moment I don't know what to think about all of it.

If anyone who is being treated for CSA can shed some light on it I'd appreciate it. I see my doctor this week and will try to get more information from him, but he isn't very talkative.

SleepHunter

I have 70% central and 30% OSA.  I had a full nights tritration with just a few apneas.  Proceeding with CPAP treatment but I would have liked an explanation of what is causing the centrals.  I know my sleep PA showed the studies to a neurologist but he didn't have any answers.  I need to bother my PA for a referal to who I should see next for the centrals. It looks like CPAP is the answer but I would like to know if there is something I should look out for such as heart failure, brain tumor or some of the other scary explanations...but I think CPAP would not work for those issues so at least that is positive.

It's interesting that there are several of us with this given that it is supposed to be relatively rare and also that our doctors haven't said much.  I'll see mine in a week or so also and see what he says, reporting it back.  He has said I have congestive heart failure (though I'm not sure everyone believes that) so might just say yes, it is part of that.  We had a conversation once about how doctors tend to not talk about things they expected to see anyhow.

I still don't see how CPAP can help any central if the brain is not giving the clue to breathe.  

Let's stay in touch!

Judy

I'm scheduled for a 4 week check up (post retitration) with the sleep doc (pulmonologist), and also I'm scheduled to have an echocardiogram later the same day to rule out chf. It bothers me that my doctor doesn't seem particularly concerned about the CSA and didn't mention that its the type of apnea I have. It was the psg who told me this time. He also told me it was a little unusual because it was consistent over the whole night or the whole study. Apparently, it is more common to see it at the beginning. And the doctor didn't suggest that I have my heart checked. I asked him about it after reading a pamphlet about CSA in his office while I was waiting for him. I'm a little upset that he didn't suggest a heart study, especially since I have high blood pressure and a very strong family history of heart disease. After I brought it up he said it would probably be a good idea. It makes me wonder if the reports on the internet are making it sound more rare and worse than it is and I'm being overly concerned.

SnoozeHunter

Central apneas can be perfectly normal- there really don't get worried in adults unless you have a considerable amount of them. I was diagnosed with severe CSA that also happens to be treatment resistant- I had 65 apneas per hour in my original study and with BiPAP ST properly titrated, they could only reduce it to 30+ central apneas. I probably had CSA for atleast 10 years prior to my diagnosis 2 years ago- they still are not sure what caused them and in many cases they never find the cause. They are not as scarey as some of the web sites say- they are talking about centrals from very specific causes, like traumatic brain injury or severe heart problems.

Treatment wise, BiPAP is the first thing they try, once its appartent CPAP will not work. In some cases, BiPAP STs are needed- they have a backup rate were the machine takes over control of when to switch from IPAP (inhale) to EPAP (exhale), in an attempt to trigger the person to breath. That doesn't always work- my case is a clear example of that.  Sometimes they add oxygen- I've already been told I will need to be on oxygen at night  as I get older. In my case, my sleep doctor has me use sleep meds to help keep the centrals I still have on BiPAP ST to keep from waking me up completely. I also take Provigil & Ritalin during the day, to help with the Excessive Daytime Sleepiness. I'm scheduled for another sleep study at the end of this month to see if there is anything else can do.

I'm not up to making a full post, so I copied from some other post I've made....sorry...

Everyone has central apneas- take 3 or 4 very slow & deep breaths right now, then count how many seconds after the last inhale until you feel the need to inhale again. Was it more then 10 seconds? If it was, you just had a central apnea. Next time you sigh take note how long before you inhale again....yep, another central apnea. Yawn? same thing can happen. Pick up a heavy box or weight- did you remember to breath? if you didn't, then you had another central apnea. Think of what you hear exercise trainers lecture about breathing while exercising- its human nature to not breath when we exert themselves.

Of course all of these are awake apneas- but any time you don't breath for 10 seconds, you technically have an apnea. While sleeping, you can have similar things happen- you can take several deep breaths and not need to breath for several seconds. During transitions between sleep stages, it is common to have central apneas because the acceptable levels of O2/CO2 are different for each stage...sort of like when you're still going 55MPH as you enter the 35MPH zone. When you turn over at night, it is common to not take a breath- just like when you lift something or exercise when awake. In people with OSA, they don't consider centrals a problem until they are well above 5 per hour- central apneas can be a symptom of OSA, just like snoring, arousals, etc. A few centrals are nothing to worry about- most sleep labs don't get concerned about centrals unless there are a lot of them.

Central apneas can be a symptom of OSA, just like snoring, daytime sleepiness, high blood pressure, etc. Obstructive apneas can also be misread as centrals- that is pretty common; if they respond to CPAP they are more then likely obstructive. Doctors usually don'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 much 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.

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.


Rested Gal has put together a collection a links to past post on CSA that may help- a lot of them are posts I have made over the past two years: Links to Central Apnea Here are a couple articles on CSA that I recomend- Apneos CSA details & British overview of CSA

Thanks Christine, that is a really informative post.  Just what a was looking for!

Judy

Thanks for all the info, Christine. You said in your post "they still are not sure what caused them..." What kind of studies did they have you do to try to find out what was causing them? I've read that treatment for CSA usually focuses on treating the cause, so what has been bothering me is that my doctor didn't seem interested in looking for a cause and I didn't know the right things to ask him. If I hadn't been handed a pamphlet by the nurse a few minutes before seeing the doctor I wouldn't have even known to ask him about a heart check up. Did you have heart studies and testing to check brain stem function? Is there even a test for that?

Thanks for your help.

SnoozeHunter