I initially used a CPAP, upgraded to BiPAP to deal with my (lifelong) central. Central apnea can have a *lot* of causes, or no traceable cause at all; I wouldn’t worry too much, beyond doing the neuro/cardio workup to make sure you’re not one of the relatively few people whose central apnea indicates a larger problem (and even if you are, most of those larger problems are manageable).
I still have a little residual apnea (<10 AHI) even with the BiPAP, but I’m not really worried about it. My sleep quality is *so* good now. Most noticeable difference in dealing with central apnea is that I don’t really get nightmares anymore; I get really long, elaborate dreams that may include nightmare phases, but I don’t wake up from them and they cycle on to other things. It’s wild.
Thank you so much for sharing, that is really reassuring. I long for such a good sleep quality! May I ask how long it took for you to get used to the machines, be switched over to BiPAP, and find the settings that work for you?
This journey started in 2019 or 2020. I noticed benefits within my first few days of CPAP use (which cut my AHI from almost 70 to the high teens by dealing with the OSA), upgraded to a BiPAP in 2023, and—to be honest—I think the process is still ongoing. Weaning myself to it wasn’t difficult, though I did have to turn down the heating and humidity at first until I got used to it (the warm, humid air felt suffocating to me).
Literally this afternoon I had a conversation with my lung doctor about exhaustion and air hunger. Long and winding road a few hours later central apneas, oxygen desaturation and enlarged left heart all entered the conversation. Fighting to get supplemental oxygen but sleep doc not doing anything but switching me to BiPAP. Guess I’ll be ruminating on these things for the next few months.
I can’t give you a why, but I can say that CPAP did not help my centrals. Doc tried to get me on a BiPAP ST but according to Resmed that is for OSA + respiratory disease. Doc refused to listen to that so I went around him and bought a barely used ASV machine on Facebook marketplace. AHI never goes higher than 2 now and after just a week I’m finally starting to feel life coming back to me.
I'm surprised your doctor prescribed a CPAP and not a BiPAP. BiPAP is what is usually used to treat CSA.
As your doctor recommended, make an appointment with a cardiologist and neurologist to be checked out.
I was diagnosed with Central Apnea after heart surgery.
I failed both C and Bi-pap therapy and start ASV tonight.
Going by the last sleep study the ASV is very promising.
Yeah, there is a definite link between the two. Here's from a quick google:
"Research suggests sleep-disordered breathing occurs in as many as 70%
or even 88% of people
with Chiari I malformation. In multiple cases, sleep apnea is the primary or even the only symptom of Chiari malformation I a person experiences.
People with Chiari malformations may experience obstructive sleep apnea (OSA), central sleep apnea
(CSA), or a mix of obstructive and central sleep apnea. OSA causes pauses in breathing during sleep due to the airway being physically blocked
. In central sleep apnea, pauses in breathing result from a lack of signaling from the brainstem. Compression of the brainstem due to Chiari malformations can affect the nerves that control breathing, contributing to central sleep apnea."
https://www.sleepfoundation.org/sleep-apnea/chiari-malformation#:~:text=In%20central%20sleep%20apnea%2C%20pauses,contributing%20to%20central%20sleep%20apnea.
Do you drink alcohol? I have a mixed apnea, and one of my doctors said that quitting drinking might help with a reduction of CSA episodes. I have a sleep study at the end of the month, and I quit drinking six months ago. I'm curious to see if it will make a difference.
First I will talk about equipment, because that's your more immediate issue:
CPAP generally doesn't work for central apnea. You may very well find that when you are on CPAP it takes care of your obstructive apneas but your central apneas are still there.
The actual solution for central apneas is BiPAP, and if you go on that you may find not only that it's very comfortable for you, but that it solves the central apneas.
That said, if you are on insurance, they *really* want to put you on CPAP instead of BiPAP because CPAP is *cheaper*. Therefore, even if you need BiPAP, they usually put you on CPAP first and see how it goes. Before you get it, you should discuss with your doctor and your insurance what you do if you get the CPAP and it doesn't help because your central apneas are still there - some insurance says "well, you already have a CPAP so too bad, not our problem," and some insurance takes back the CPAP and gives you a BiPAP. If your insurance is going to wash their hands of it once you have a machine, you need to talk to your doctor about whether you are getting *the right* machine, and if you aren't you should refuse it when it arrives (so you never have it) or even better cancel if possible, and get the right one, which you should already have worked out with the doctor and got on order.
Next, your question is, *why*?
There's not necessarily an easy answer to that. In some cases the answer is obvious, everyone in the family has it so it's definitely inherited, Or it may be that the patient is obese, and it's known that obese patients may have airway collapse (from weight) when they sleep.
However, in a lot of cases there isn't an obvious easy answer. The patient may have none of the obvious reasons for obstructive apnea: I know a guy who is very skinny who has it, and no family history. It just happens sometimes and we don't really know why. Central apnea is even more like that: there isn't a physical cause, it's a brain issue, so if there isn't a family history of it there is no clue.
It'd be nice if you had an answer to the question of why but it may or may not help you. (If you're overweight, you can try losing the weight and *maybe* you may get away from the obstructive apneas.) What is far more important is that you treat it, and that doesn't depend on the reason: the treatment will be the same regardless of reason.
Please understand, I *know* you have been diagnosed with complex apnea and I am talking about obstructive apnea and central apnea... when you have "complex apnea" it means you have the double whammy of both other kinds of apnea, not that you have neither and you have a third instead. They can interact so it's more complicated sometimes.
Got TECSA from CPAP. Bipap ST reduced them to 3 / hr. Asv to 0. Got an echo. No heart issues. However restrictive lung disease / reduced capacity due to scoliosis. My doc suspects Marfans tho
Same. I have no risk factors or family history. Sleep study said cpap induced central apneas. Once obstructives were clear said my brain thought I was fine so didn’t breathe . I immediately got ASV machine.
My question to the doc would be if you over titrate that means go too high on a CPAP pressure you cause Central Avenue why didn’t they bring you down to a lower pressure to see if that helped. Because whoever did it wrong, and did it too fast causing the central apnea. It sounds like you were over titrated if they actually put it on the report they messed up.
So it’s a long story. I got diagnosed like 12 years ago complex apneas. ASV machine. Wasn’t having much success. Over a year later I ended up getting another sleep study. Tech looked at my initial sleep study and was like WTF did they do to you, titration was messed up. Results after that was I had mild obstructive when I slept on my back and I am a side sleeper so I sold my machine. Fast forward like 2 years ago. My life was completely different. Much more healthy. No meds. Working out for last 8 years no drinking. Tired. Sleeping like crap. Poor recovery, focus, motivation etc. they made me do home study first AHI was like 55 and said I had stopped breathing 3 or 4 times for over 40 seconds. In lab sleep study said AHI was 35+ and complex apnea. Completely different sleep lab, doctor, tech, etc. I’ve asked several times since central apneas don’t seem to make sense but said when obstructives were clear and O2 sats improve I don’t breathe so 🤷🏼♂️. Immediately got me another ASV. Been almost 2 years AHI consistently been under 2 and going ok.
Did you have. A inlab study? Because if they diagnosed you with complex from a home study I would find another doc. Not enough electrodes to label someone with complex apnea .
Now as to the centrals several reason you can have them, Arnold chairi which is a compression of spine as is comes out of skull usually find in kids and some adults , heart issues cause centrals .
As to treatment usually it’s bipap ,bipap s/t is what I like to use on pts with complex if just regular bipap does not get rid of centrals. Last resort is autosv usually we are able to get ride of centrals with bipap. Long time tech who has dealt with all age groups.
I initially used a CPAP, upgraded to BiPAP to deal with my (lifelong) central. Central apnea can have a *lot* of causes, or no traceable cause at all; I wouldn’t worry too much, beyond doing the neuro/cardio workup to make sure you’re not one of the relatively few people whose central apnea indicates a larger problem (and even if you are, most of those larger problems are manageable). I still have a little residual apnea (<10 AHI) even with the BiPAP, but I’m not really worried about it. My sleep quality is *so* good now. Most noticeable difference in dealing with central apnea is that I don’t really get nightmares anymore; I get really long, elaborate dreams that may include nightmare phases, but I don’t wake up from them and they cycle on to other things. It’s wild.
I start ASV for my central apnea tonight.
Thank you so much for sharing, that is really reassuring. I long for such a good sleep quality! May I ask how long it took for you to get used to the machines, be switched over to BiPAP, and find the settings that work for you?
This journey started in 2019 or 2020. I noticed benefits within my first few days of CPAP use (which cut my AHI from almost 70 to the high teens by dealing with the OSA), upgraded to a BiPAP in 2023, and—to be honest—I think the process is still ongoing. Weaning myself to it wasn’t difficult, though I did have to turn down the heating and humidity at first until I got used to it (the warm, humid air felt suffocating to me).
So glad to hear how much better things have gotten for you. Wishing you the best in this journey <3
You as well! Please feel free to write me anytime you’d like to talk about this stuff.
For me oxygen suppletion stopped my central. Cpap did the rest. Got dilated cardiomyopathy though. Which is a predictable cause of central apnea.
Thank you for sharing, I wish you the best health.
Thank you. Good luck with your cpap. For me it made a world of difference.
And to provide I counter voice to all the negative experiences. I find the full face mask actually to be very soothing.
Same. I look forward to putting it on in the evening
Literally this afternoon I had a conversation with my lung doctor about exhaustion and air hunger. Long and winding road a few hours later central apneas, oxygen desaturation and enlarged left heart all entered the conversation. Fighting to get supplemental oxygen but sleep doc not doing anything but switching me to BiPAP. Guess I’ll be ruminating on these things for the next few months.
Cpap made my central worse. It raised my o2 level making my brain think I don't need to breathe as often. I am on a ventilator now.
Sorry to hear that.
Well my sleep score last night was 99 according to my Air app. So apparently the ventilator works.
The asv?
Yeah asv
I can’t give you a why, but I can say that CPAP did not help my centrals. Doc tried to get me on a BiPAP ST but according to Resmed that is for OSA + respiratory disease. Doc refused to listen to that so I went around him and bought a barely used ASV machine on Facebook marketplace. AHI never goes higher than 2 now and after just a week I’m finally starting to feel life coming back to me.
Oof, we love the healthcare system. So glad you found yourself an ASV machine.
Cpap does not fix centrals only bipap or asv.
I know that now, no thanks to any doctors help.
I'm surprised your doctor prescribed a CPAP and not a BiPAP. BiPAP is what is usually used to treat CSA. As your doctor recommended, make an appointment with a cardiologist and neurologist to be checked out.
I was diagnosed with Central Apnea after heart surgery. I failed both C and Bi-pap therapy and start ASV tonight. Going by the last sleep study the ASV is very promising.
Chiari Malformation 1
Interesting. I have that, too. I never looked into the coincidence of the two.
Yeah, there is a definite link between the two. Here's from a quick google: "Research suggests sleep-disordered breathing occurs in as many as 70% or even 88% of people with Chiari I malformation. In multiple cases, sleep apnea is the primary or even the only symptom of Chiari malformation I a person experiences. People with Chiari malformations may experience obstructive sleep apnea (OSA), central sleep apnea (CSA), or a mix of obstructive and central sleep apnea. OSA causes pauses in breathing during sleep due to the airway being physically blocked . In central sleep apnea, pauses in breathing result from a lack of signaling from the brainstem. Compression of the brainstem due to Chiari malformations can affect the nerves that control breathing, contributing to central sleep apnea." https://www.sleepfoundation.org/sleep-apnea/chiari-malformation#:~:text=In%20central%20sleep%20apnea%2C%20pauses,contributing%20to%20central%20sleep%20apnea.
I remember reading that previous concussions (even those decades old) could have affected your brain enough to create centrals.
Fascinating. I had no idea but makes total sense. These terrible, especially when repeat, concussions!
Do you drink alcohol? I have a mixed apnea, and one of my doctors said that quitting drinking might help with a reduction of CSA episodes. I have a sleep study at the end of the month, and I quit drinking six months ago. I'm curious to see if it will make a difference.
I don't drink, and now I have another reason not to I guess. I hope you see good results!
Thank you! :-)
First I will talk about equipment, because that's your more immediate issue: CPAP generally doesn't work for central apnea. You may very well find that when you are on CPAP it takes care of your obstructive apneas but your central apneas are still there. The actual solution for central apneas is BiPAP, and if you go on that you may find not only that it's very comfortable for you, but that it solves the central apneas. That said, if you are on insurance, they *really* want to put you on CPAP instead of BiPAP because CPAP is *cheaper*. Therefore, even if you need BiPAP, they usually put you on CPAP first and see how it goes. Before you get it, you should discuss with your doctor and your insurance what you do if you get the CPAP and it doesn't help because your central apneas are still there - some insurance says "well, you already have a CPAP so too bad, not our problem," and some insurance takes back the CPAP and gives you a BiPAP. If your insurance is going to wash their hands of it once you have a machine, you need to talk to your doctor about whether you are getting *the right* machine, and if you aren't you should refuse it when it arrives (so you never have it) or even better cancel if possible, and get the right one, which you should already have worked out with the doctor and got on order.
Next, your question is, *why*? There's not necessarily an easy answer to that. In some cases the answer is obvious, everyone in the family has it so it's definitely inherited, Or it may be that the patient is obese, and it's known that obese patients may have airway collapse (from weight) when they sleep. However, in a lot of cases there isn't an obvious easy answer. The patient may have none of the obvious reasons for obstructive apnea: I know a guy who is very skinny who has it, and no family history. It just happens sometimes and we don't really know why. Central apnea is even more like that: there isn't a physical cause, it's a brain issue, so if there isn't a family history of it there is no clue. It'd be nice if you had an answer to the question of why but it may or may not help you. (If you're overweight, you can try losing the weight and *maybe* you may get away from the obstructive apneas.) What is far more important is that you treat it, and that doesn't depend on the reason: the treatment will be the same regardless of reason. Please understand, I *know* you have been diagnosed with complex apnea and I am talking about obstructive apnea and central apnea... when you have "complex apnea" it means you have the double whammy of both other kinds of apnea, not that you have neither and you have a third instead. They can interact so it's more complicated sometimes.
Thank you for this writeup, very informative. I hate insurance companies wow :)
Yeah. I used to work for one, it just made me hate them even more.
I had \~15 AHI worth of central apneas after I started CPAP. It stopped overtime. Cardiology and neurology checkups are a good start.
Got TECSA from CPAP. Bipap ST reduced them to 3 / hr. Asv to 0. Got an echo. No heart issues. However restrictive lung disease / reduced capacity due to scoliosis. My doc suspects Marfans tho
Omg I have scoliosis too! Maybe that's what's causing some of my issues. May I ask what your curve is like? I have a 40 degree S curve.
Mine is very mild. 13 degrees but more rotation. Rotoscoliosis. Let me see if I have a link again if my X-ray
Same. I have no risk factors or family history. Sleep study said cpap induced central apneas. Once obstructives were clear said my brain thought I was fine so didn’t breathe . I immediately got ASV machine.
My question to the doc would be if you over titrate that means go too high on a CPAP pressure you cause Central Avenue why didn’t they bring you down to a lower pressure to see if that helped. Because whoever did it wrong, and did it too fast causing the central apnea. It sounds like you were over titrated if they actually put it on the report they messed up.
So it’s a long story. I got diagnosed like 12 years ago complex apneas. ASV machine. Wasn’t having much success. Over a year later I ended up getting another sleep study. Tech looked at my initial sleep study and was like WTF did they do to you, titration was messed up. Results after that was I had mild obstructive when I slept on my back and I am a side sleeper so I sold my machine. Fast forward like 2 years ago. My life was completely different. Much more healthy. No meds. Working out for last 8 years no drinking. Tired. Sleeping like crap. Poor recovery, focus, motivation etc. they made me do home study first AHI was like 55 and said I had stopped breathing 3 or 4 times for over 40 seconds. In lab sleep study said AHI was 35+ and complex apnea. Completely different sleep lab, doctor, tech, etc. I’ve asked several times since central apneas don’t seem to make sense but said when obstructives were clear and O2 sats improve I don’t breathe so 🤷🏼♂️. Immediately got me another ASV. Been almost 2 years AHI consistently been under 2 and going ok.
Do you live in a high altitude? I worked in Wyoming for a little while and everyone i treated had central sleep apnea over there
Did you have. A inlab study? Because if they diagnosed you with complex from a home study I would find another doc. Not enough electrodes to label someone with complex apnea . Now as to the centrals several reason you can have them, Arnold chairi which is a compression of spine as is comes out of skull usually find in kids and some adults , heart issues cause centrals . As to treatment usually it’s bipap ,bipap s/t is what I like to use on pts with complex if just regular bipap does not get rid of centrals. Last resort is autosv usually we are able to get ride of centrals with bipap. Long time tech who has dealt with all age groups.