central sleep apnea

[Tonymanero]

Hello,


I had my 2nd sleep study done with the nsal cpap and pressure that according to the report was 6 cm of water. It states that it was effective in eliminating sleep disorder respiration.
The problem I have was I was diagnosed with only central sleep apnea where I had 106 central sleep apneas the first time. The longest 18 seconds. The central sleep index was 20.6. There were only 5 obstructive sleep apneas in the 5+ hours I slept. 66 hypopneas
This is where it's confusing. The tech said I was sleeping like a baby for 4 and a half hours with the mask on and on my side. I changed positions for next 1 and a half hour and slept on back due to coming back from bathroom. The tech girl stated my central apneas started to read occur rapidly and and said I may have to come back.
My problem now is the pulmonolgist said that everything was alright and that he didn't see any central apneas and gave me a prescription for a cpap at a 6 water. When I called to price one two company reps said the cpap wouldn't work with my condition. According to sleep apnea wikipedia cpap don't work on central sleep apnea. The doctor reading my report did say that an auto pap device may prove more prudent. The prescription that this pulmonogist gave me says CPAP 6 and then he put dx OSA. That don't make sense since I don't have obstructive. Was this a mis diagose because I am confused. Thanks Tony

[James @ Intus]

It can be confusing indeed and I don't claim to be an expert on Central Sleep Apnoea either so that this for what it's worth.

In Obstructive Sleep Apnoea, the air pushed in by the CPAP acts as a splint to force open the obstructions so you yourself can breathe naturally. CPAP isn't a breathing machine, just an air splint.

Now in Central Sleep Apnoea, there is no obstruction. The brain fails to instruct the lungs to breathe. The airways are open, but nothing is pumping. A CPAP will push in air, but nothing comes out as the lungs aren't instructed to contract or expand. So the problem here is that air is going on but nothing is coming out.

That's why, as far as I know, people with complex sleep apnoea like the case with central sleep apnoea, often get a Bi-Level Positive Airway Pressure device, a BiLevel or BiPAP for short. These not only have two pressures, one for inhalation and one for exhalation, the more advanced £1K + units have a back up timer that measure the number breaths you are attempting to make and if it drops too low, it turns in to a ventilator, like those use with lung disorders. A ventilator blows air in and sucks it back out. A mechanical lung if you like.

What's unclear from your story is whether they recorded these CSA events when you were wearing CPAP. If so, this clearly isn't right. If they were recorded without CPAP, perhaps the consultant believes that by taking care of the few obstructions, somehow the body may be more at ease and less prone to the central ones. That's just me guessing by the way.

So what's important is that if you end up on CPAP or Auto-CPAP, that you have a follow-up multi channel respiratory study (at least more than a pulse oximetry alone) which can check whether central apnoeas still occur. Perhaps because of the money involved, only then they might consider BiPAP.

Either way, it's worth pressing them on this.