Treatment of Mixed Sleep Apnea

By: Angie McAdams Click author's name for more of his/her articles

Treatment of Mixed Sleep Apnea
The various methods used to treat the symptoms of mixed (complex) sleep apnea.

Mixed sleep apnea is a combination of obstructive and central sleep apnea symptoms. When the patient exhibits physical blockage as well as an inability to maintain normal breathing due to a malfunction of the brain, the patient is diagnosed with mixed sleep apnea. Unfortunately, mixed sleep apnea is usually much harder to treat than the others when exhibited separately. This is because conventional methods of treatment for one type of sleep apnea often make the other type of apnea more severe. An example of this is the occurrence of CPAP and BiPAP causing the patient's central sleep apnea to worsen, or the use of drugs such as theophylline and acetazolamide, which help relieve central sleep apnea symptoms but worsen obstructive sleep apnea symptoms.

One treatment that has had some success in mild cases of mixed sleep apnea is the introduction of small amounts of CO2 through non vented masks in an attempt to reduce CO2 homeostasis instability. This is achieved using a PAP Gas Modulator, which has yielded promising results. However, this is still an experimental treatment and is not yet an accepted solution.

Currently, there is a very effective form of treatment that has recently been given the stamp of approval from the FDA: adaptive servo-ventilation, or ASV. An ASV machine monitors the breathing of the patient and rapidly changes the pressure of the air fed into the patient. This combats the erratic breathing the patient is experiencing, eventually eliminating it all together. This is accomplished using various complicated algorithms. These algorithms take in data gathered from sensors monitoring the patient, and can provide the ASV machine with information that it uses to adjust its pressure within three breaths. The machine takes into account the previous three minutes of breathing and then calculates an optimal target breathing, which it then implements in the event the patient's breathing begins to deviate.

The ASV machine also varies its pressure in a much gentler manner. Imagine the pressure of both a BiPAP and an ASV machine were graphed as a function of time. The BiPAP's graph would look square, as its pressure is increased in a burst and decreased just as quickly. The ASV machine's graph, however, would closer resemble a sine wave, as the pressure is gradually increased and decreased with breathing, making for much smoother and natural ventilation. This decreases the erratic tendencies of the mixed sleep apnea, and eventually eliminates the symptoms as the ASV machine adapts.

Thought the treatment of mixed sleep apnea is still a developing science, many leaps and bounds are being made in the field. The promise of controlled CO2 introduction through the PAP Gas Modulator and the rapid response of the ASV machine is great, and continued research into these treatments as well as the development of new and more effective treatments continues. There is much to be learned from mixed sleep apnea, even today, and the more that is learned, the better we are able to treat it.

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