mixed apnoeas

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Permalink Reply by Kath Hope on February 20, 2015 at 19:32

Sorry to hear of your problem Russ, and I have heard of this before.  I'm assuming you were put on the APAP so that when not needed you could have lower pressures.  The problem with this can be that if the auto pressures are left on the default (normally minimum 4cm to max 20 cm) then the increase in pressure as the machine senses apnoeas/hypopnoeas can actually cause the centrals.  It sounds like you have severe sleep apnoea, and the treatment is certainly CPAP as the gold standard, but there are different machines.  Also, the hospital may consider changing your minimum pressure.  As an example of this, my own pressures are high, but my minimum pressures has to be set at 14.5 to give me decent therapy.

If it were me I would be asking the hospital what my initial sleep study showed and want to know if central apnoeas were diagnosed.  Treatment for people with Mixed (Complex) Sleep Apnoea is normally better with ASV (Adaptive Servo Ventilation) but these are expensive. 

I would also ask the hospital if I could try BiPAP so you could have a lower exhale pressure.  This can often help with the centrals and also make the higher pressures more tolerable.

Two posts for you to look at on this forum are:-

• http://hope2sleepguide.co.uk/forum/topics/no-need-to-suffer-are-you... by Snoreyhead who also struggled when on the wrong type of machine.
• http://hope2sleepguide.co.uk/forum/topics/survey-to-help-with-new-n... about the trials taking place at Guy's & St Thomas with the new non-invasive electrical stimulation.  Incidentally one of our Facebook members had night 2 of his trial last night and reported to us that he felt marvellous when he woke up this morning.  He too had been struggling on CPAP and does have severe sleep apnoea.

I hope some of this helps you Russ, and please keep us posted how you get on.  Good luck!

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Permalink Reply by Edam on February 21, 2015 at 13:20

I have found that getting the the exhale relief set to the right level makes higher pressures more bearable when using a APAP:.

In my case the hospital did not set it or even know how to do so

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Permalink Reply by Sleep2snore on February 24, 2015 at 21:18

Yes, ASV would be ideal but as you said they are very expensive.

Hi Edam, Central Sleep Apnoea is not so straight forward as Obstructive Sleep Apnoea and needs a bit more specialist care.  I am surprised the hospital didn't know how to set the expiry relief!  As I understand it CSA can be caused by the normal electrical signals from the brain that tells you to breath being interfered with or stopping temporally.  OSA (Obstructive Sleep Apnoea) is when your throat collapses or your tongue slips back into your throat closing the airway. Sometimes CSA can be treated with drugs or an ASV machine.  Sometimes they give a little oxygen to make sure your lungs get enough oxygen when you breath.  However, (I don't know which clinic you go to or hospital) but they may need to send you to a larger clinic that deals with CSA.

When you go back, ask if they can deal with CSA or if not can they send you to a clinic that does?

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Permalink Reply by Russ on February 25, 2015 at 2:36

Hi, thanks again for your replies, the hospital I go to really should be "genned" up on all forms of apnoea as it's the London Chest Hospital! When I first started having sleep Apnoea I went to a smaller clinic that referred me to them. They first told me that unless I had some form of mental problem it was impossible for me to have central apnoeas until I found the results from the first cpap machine that I was given as the first hospital could read the cards in the cpaps. It seems that the high pressure that it's put at or reaches in the case of the auto cpap causes the central apnoeas to happen but they all seem to agree that it has to be set at 20 for me. BUT I will take all advise and be a bit more verbal on my next visit unless I am half asleep which is usual for me now!

Sleep2snore said:

Yes, ASV would be ideal but as you said they are very expensive.

Hi Edam, Central Sleep Apnoea is not so straight forward as Obstructive Sleep Apnoea and needs a bit more specialist care.  I am surprised the hospital didn't know how to set the expiry relief!  As I understand it CSA can be caused by the normal electrical signals from the brain that tells you to breath being interfered with or stopping temporally.  OSA (Obstructive Sleep Apnoea) is when your throat collapses or your tongue slips back into your throat closing the airway. Sometimes CSA can be treated with drugs or an ASV machine.  Sometimes they give a little oxygen to make sure your lungs get enough oxygen when you breath.  However, (I don't know which clinic you go to or hospital) but they may need to send you to a larger clinic that deals with CSA.

When you go back, ask if they can deal with CSA or if not can they send you to a clinic that does?

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Permalink Reply by Kath Hope on March 12, 2015 at 23:40

So sorry for my avoidable delay Russ (life hasn't been the kindest lately to my family and I).  It's good your clinic referred you to the London Chest if they felt you needed more specialist care, but I have to disagree on the 'mental' problem with central sleep apnoea.  It can be drug-induced (with meds such as opiates), can be caused through high pressures and why it's important to have the automatic pressures adjusted sometimes, but there are many other conditions that are linked to centrals, such as spinal column damage, neck injuries, chiari malformation, parkinson's etc.  You need carefully managing by good therapists, such as seeing if fixed CPAP is better (which it is for some people), BiPAP if constant high pressures are needed and ASV if you're having mixed apnoeas (obstructive + centrals).  I would be asking your new clinic to do a further in-hospital sleep study on you.

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