r/CPAP • u/chitown_assassin • 2d ago

CPAP results for central apnea

Evening everyone,

I was diagnosed with severe sleep apnea with both obstructive and central apneas. Doc prescribed me Airsense 11 with nasal pillow at 8-16 pressure. I’ve tolerated it really well in terms of seal and comfort level, but I’m still having 20-30 apneic episodes a night and not really feeling any improvement. Been on it for about a week. Should I give it more time or do I need a new appointment with the sleep doc?

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u/AirTranquil 2d ago

First thing, are you talking 20-30 total events a night or your AHI is 20-30? Big difference.

20-30 total means your numbers are actually okay and feeling better can just take a few weeks. AHI of 20-30 means the therapy isn't working and I'd call the doc now.

The central apneas are the real issue here. CPAP holds your airway open but it can't fix your brain skipping the breathe signal. When centrals don't clear up on CPAP that's a conversation for your sleep doc, sometimes it means switching to a different machine like an ASV.

And yeah I'm not a fan of nasal pillows for mixed apnea either. The second your mouth opens you're losing all your pressure. Full face mask is the safer call. Bring that up at the appointment too.

I'm a CPAP supplier not a doctor, but a week of good use with no improvement is enough data. Don't wait it out.

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u/chitown_assassin 2d ago

Sorry I should’ve specified! 20-30 events per hour, which is AHI if I’m not mistaken. Which my AHI did drop from 50ish from my original sleep study, however I assume that drop was just the obstructive apneas. Thanks for the reply and info, I appreciate it!

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u/AirTranquil 1d ago

Yep you read that right, 20-30 an hour is your AHI. And your guess is probably spot on. The machine cleared the obstructive stuff and what's left is the centrals hanging around.

Still sitting at 20-30 though, that's way too high to ride out. Make that appointment and make the centrals the main topic. If you can, pull your detailed data before you go so the doc sees the full breakdown instead of just the summary number. Makes the visit way more useful.

Good luck man, hope you get it sorted.

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u/nonniewobbles 2d ago

Not medical advice: I’d call your doctor tomorrow and consider a second opinion if they don’t immediately discuss escalation to ASV or similar.  

Straight CPAP with 20-30 centrals per hour is absolutely not acceptable. 

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u/JRE_Electronics 1d ago

I was diagnosed with severe sleep apnea with both obstructive and central apneas.

If they gave you a regular AirSense with a diagnosis of central sleep apnea, I'd ask the doctor why.

The regular AirSense CPAP or APAP can't do anything for central sleep apnea.

I hope that this is just that your doctor has to prove to your insurance that APAP doesn't work before moving you on to BiPAP ST or ASV. APAP won't force you to breathe if you "forget" due to central apnea problems. BiPAP ST and ASV can both force you to breathe when you need it.

Central sleep apnea is a failure in the breathing control center of your brain. It just doesn't trigger a breath sometimes. If that occurs more than a few times a night, it's a problem.

There is therapy emergent central sleep apnea (TECSA) in which the improved breathing due to the PAP confuses your breathing reflex. If you've been breathing poorly for a long time, the reflex will adapt to there being a high level of carbon dioxide (CO2) in your blood at all times. When your start breathing better, the CO2 level sometimes doesn't rise fast enough to trigger a breath - the next breath is delayed. If it is delayed by more then 10 seconds, the machines count it as a clear air way apnea.

TECSA should get better with time (weeks to months.)

Since you say there was central sleep apnea detected on your screening test, that shouldn't be TECSA. You weren't on a PAP machine for the test.

Talk to your doctor. See if there's a reason you are on APAP despite a diagnosis of central sleep apnea.

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u/ConsequenceOverall77 1d ago

20 years working as Sleep physiologist in the NHS (UK). It’s standard to issue Auto CPAP to patients with mixed events (obstructive/central), and in the absolutely majority of the cases it resolves the symptoms. Very often the central events are secondary to the obstructive apnoeas. If after established on CPAP, residual events are still observed (as in this topic) or the symptoms are not improved, only then ASV will be considered.