Central Apnea

Replies to This Discussion

Permalink Reply by RockRpsgt on January 11, 2012 at 3:47

First of all I would not change any of the settings on your ASV machine. This is no ordinary CPAP. This machine has a very advanced algorithm that should only be messsed with by someone that knows what they are doing. In essance it is a ventilater. At least that is how I would think about it. Changing the settings could very well make things worse or at the very least make it not work.

 

Typically the problems I see with the ASV units are leak related. When the leak rate goes up the machine must compensate by raising the pressure. I would look at your mask fitting before anything else. The smaller the mask you can wear the bettter off you will be. Quite often us techs and sleep professionals screw the fitting up with women. I personally allways start with a small maks when dealing female patients.

 

What mask are you using?

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Permalink Reply by Elianna Halsey on January 11, 2012 at 4:14

Rest assured, I have no plans to change the settings myself.  I'm going through the DME, where a RT changes them if the doctor ok's it.  I wouldn't have the first clue since I don't, as of yet, completely understand all the abbreviations.

I have a ResMed Mirage FX nasal mask.  I was told it is currently the lightest mask on the market.  I also have a FFM (can't remember the name), but have found I can't go to sleep at all with it;  not b/c it isn't comfortable, but b/c it drives me crazy when the pressure changes.  Most of the time I don't have issues with leaks.  From what I can tell it's the central apneas that are causing the pressure to go up.  I was told that I have severe SA.  I didn't get a report of my sleep study, but I remember them telling me that I had 300+ arousals and my O2 sat was dropping into the mid-60's.  I generally fall asleep very quickly b/c I'm always so tired and I think the central apneas start right away.  At least that is my somewhat educated guess as to why the pressure increases so often and wakes me up.        
 
RockRpsgt said:

First of all I would not change any of the settings on your ASV machine. This is no ordinary CPAP. This machine has a very advanced algorithm that should only be messsed with by someone that knows what they are doing. In essance it is a ventilater. At least that is how I would think about it. Changing the settings could very well make things worse or at the very least make it not work.

 

Typically the problems I see with the ASV units are leak related. When the leak rate goes up the machine must compensate by raising the pressure. I would look at your mask fitting before anything else. The smaller the mask you can wear the bettter off you will be. Quite often us techs and sleep professionals screw the fitting up with women. I personally allways start with a small maks when dealing female patients.

 

What mask are you using?

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Permalink Reply by RockRpsgt on January 11, 2012 at 5:20

Do you use a chinstrap.

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Permalink Reply by Elianna Halsey on January 12, 2012 at 3:56

No, I don't.  I'm not a mouth breather, unless my nose is stuffy, so it hasn't seemed necessary.
 
RockRpsgt said:

Do you use a chinstrap.

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Permalink Reply by Kath Hope on January 12, 2012 at 10:53

Just an idea Elianna.....how about trying the ASV with a full face mask?  Whilst I know you're a nose breather, due to this machine working more like a ventilator I'm just wondering if a full face mask might help.

Elianna Halsey said:

No, I don't.  I'm not a mouth breather, unless my nose is stuffy, so it hasn't seemed necessary.
 
RockRpsgt said:

Do you use a chinstrap.

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Permalink Reply by Elianna Halsey on January 12, 2012 at 13:12

Kath,

I do have a ffm, but have found that I can't tolerate it with the pressure changes the ASV machine creates.  For some reason I can get to sleep with the nasal mask, even with the pressure ramping up, but I can't with the ffm.  I appreciate the suggestion, though.
 
Kath Hope said:

Just an idea Elianna.....how about trying the ASV with a full face mask?  Whilst I know you're a nose breather, due to this machine working more like a ventilator I'm just wondering if a full face mask might help.

Elianna Halsey said:

No, I don't.  I'm not a mouth breather, unless my nose is stuffy, so it hasn't seemed necessary.
 
RockRpsgt said:

Do you use a chinstrap.

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Permalink Reply by Kath Hope on January 12, 2012 at 13:14

Oh well, that's my theory out of the window LOL.  Back to the drawing board......

Elianna Halsey said:

Kath,

I do have a ffm, but have found that I can't tolerate it with the pressure changes the ASV machine creates.  For some reason I can get to sleep with the nasal mask, even with the pressure ramping up, but I can't with the ffm.  I appreciate the suggestion, though.
 
Kath Hope said:

Just an idea Elianna.....how about trying the ASV with a full face mask?  Whilst I know you're a nose breather, due to this machine working more like a ventilator I'm just wondering if a full face mask might help.

Elianna Halsey said:

No, I don't.  I'm not a mouth breather, unless my nose is stuffy, so it hasn't seemed necessary.
 
RockRpsgt said:

Do you use a chinstrap.

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Permalink Reply by RockRpsgt on January 12, 2012 at 15:47

How do you know you're not a mouth breather when asleep. I have seen many a nose breather's mouth drop open in REM when our muscle tone is at it's lowest. We often forget that apnea is a neuro-muscular problem rather than that of a pulmonary issue. Central apnea is a problem of the Central Neurvous System. Combined problems with these two systems can make it even worse.

 

You say that you are sleeping 2-3 hours and are wakening due to pressure increases. The first REM cycle typically begins about 90-120 minutes into our sleep. This repeats in equal intervals with each REM cycle being longer than the last. If your mouth is opening at this time it would force the ASV algorithm to adjust to compensate.

 

I suggest you try a chinstrap. If I had my way no one using a nasal mask would leave the lab without a one. It is just not possible to control your breathing while you sleep. I also suggest that you wear the machine while watching tv or reading a book to help desensitize yourself to the pressure and the changes there-of.  Swallow and hold your breath to mimic events as this will cause the pressure to change.

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Permalink Reply by Elianna Halsey on January 13, 2012 at 5:21

You're right, I don't know for sure.  I appreciate you taking the time to read my posts and respond with intelligent, helpful suggestions.  Your employer is blessed to have someone as knowledgable as you working for them!
 
RockRpsgt said:

How do you know you're not a mouth breather when asleep. I have seen many a nose breather's mouth drop open in REM when our muscle tone is at it's lowest. We often forget that apnea is a neuro-muscular problem rather than that of a pulmonary issue. Central apnea is a problem of the Central Neurvous System. Combined problems with these two systems can make it even worse.

 

You say that you are sleeping 2-3 hours and are wakening due to pressure increases. The first REM cycle typically begins about 90-120 minutes into our sleep. This repeats in equal intervals with each REM cycle being longer than the last. If your mouth is opening at this time it would force the ASV algorithm to adjust to compensate.

 

I suggest you try a chinstrap. If I had my way no one using a nasal mask would leave the lab without a one. It is just not possible to control your breathing while you sleep. I also suggest that you wear the machine while watching tv or reading a book to help desensitize yourself to the pressure and the changes there-of.  Swallow and hold your breath to mimic events as this will cause the pressure to change.

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Permalink Reply by RockRpsgt on January 13, 2012 at 12:47

Shucks Elianna you're gonna make my head swell. The education received is much larger than the one given I promise.

 

Good luck. Your concern for your own health is half of the battle.

Elianna Halsey said:

You're right, I don't know for sure.  I appreciate you taking the time to read my posts and respond with intelligent, helpful suggestions.  Your employer is blessed to have someone as knowledgable as you working for them!
 
RockRpsgt said:

How do you know you're not a mouth breather when asleep. I have seen many a nose breather's mouth drop open in REM when our muscle tone is at it's lowest. We often forget that apnea is a neuro-muscular problem rather than that of a pulmonary issue. Central apnea is a problem of the Central Neurvous System. Combined problems with these two systems can make it even worse.

 

You say that you are sleeping 2-3 hours and are wakening due to pressure increases. The first REM cycle typically begins about 90-120 minutes into our sleep. This repeats in equal intervals with each REM cycle being longer than the last. If your mouth is opening at this time it would force the ASV algorithm to adjust to compensate.

 

I suggest you try a chinstrap. If I had my way no one using a nasal mask would leave the lab without a one. It is just not possible to control your breathing while you sleep. I also suggest that you wear the machine while watching tv or reading a book to help desensitize yourself to the pressure and the changes there-of.  Swallow and hold your breath to mimic events as this will cause the pressure to change.

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Permalink Reply by Cathy Smith on January 18, 2012 at 16:58

Hi Elianna, I have central and use a Respironics Bipap Auto SV (the older version of the one you are using).  I used to read, eat, watch TV in bed and found I had difficulty falling asleep quickly with the mask.  I don't go to bed now till I am ready to sleep, so I fall off instantly.  When I am using my mask, I have difficulty staying awake long enough to put in on!  Check your instruction booklet, it is fairly easy to adjust the ramp feature.  After a short time you will get used to the increase in pressure and won't even notice it. 

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Permalink Reply by Elianna Halsey on January 18, 2012 at 20:01

Hi Cathy,

 

Thank you for the encouragement.  Things are getting better.  Now I just have to get past hating putting it on every night.  I don't feel good enough yet to say I love the machine, but it is getting more tolerable.  I too wait until I'm really tired before going to bed and that seems to help me drop off quickly.  I did check my instruction book and found where it talks about the ramp feature, but it doesn't explain how to set it up.  The last few nights I have done fine without it, so I don't think it's going to be as big of a deal as I initially thought.  I'm looking forward to when I can say, "I wouldn't want to sleep without it."
 
Cathy Smith said:

Hi Elianna, I have central and use a Respironics Bipap Auto SV (the older version of the one you are using).  I used to read, eat, watch TV in bed and found I had difficulty falling asleep quickly with the mask.  I don't go to bed now till I am ready to sleep, so I fall off instantly.  When I am using my mask, I have difficulty staying awake long enough to put in on!  Check your instruction booklet, it is fairly easy to adjust the ramp feature.  After a short time you will get used to the increase in pressure and won't even notice it. 

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