Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

[Diagnosis] Advice for sleep doc appt.
#1
Advice for sleep doc appt.
Hi,

I was sent to a sleep lab by my allergist as she said almost everyone with severe asthma has sleep apnea.  I don't have daytime sleepiness and wake up refreshed in the morning.  I don't snore or wake up gasping for air.  I have childhood onset insomnia which has been severe at times but is currently well controlled with excellent sleep hygiene and using self-hypnosis/meditation and imagery to go to sleep.  I live about 1 mile above sea level.  

I took a very large dose of Benadryl  and ibuprofen to get to sleep during the sleep study but only managed a couple of hours of sleep.  It was a split night study but the only apnea I experienced was after 5 am so there was no trial of cpap.  I had one bout of apnea during about 10 min of REM sleep and during the 2 minutes following REM sleep. It began after I had been supine for about 20 minutes with no apneas.   It ended when I went into deep sleep still in the supine position.  There were no previous apneas during the study.

Results:  AHI 9.5 hour, RDI 9.5 hour, PLMI 0
Non-REM  AHI  3.6/hr
Supine 39.7/hr
REM 97.5/hr
non-supine 0.7/hr
Total Apneas = 16,  7 OSA  9 CSA
hyponeas 32
RERAs = 0    
Average awake SpO2 93%  
Time SpO2 < 90%  12.7 min,  Time SpO2 < 88% 12.7 
Min  SpO2  78%  
Mean heart rate 54.7

Normal sinus rhythm 

Recommendation was for autoPAP at 4-18 cm with heated inline humidification and nasal mask preferred.  

 I purchased a CMS 50F pulse oximeter and played around with no antihistamine at night, elevating head of bed on 3: blocks and sleeping with tennis balls on my back.  It is obvious when REM sleep occurs looking at the SpO2, heart rate and my fitbit sleep results.  

The tennis balls seem to make a small improvement  

       without  tennis balls               with tennis balls
Events/hour   6.7                            4

SpO2 baseline  91.6                        91    (these are when I am asleep, not awake)
Events < 88%     6                          7  (one was when I was rolling over)
Min oxygen         82                        84
Average low        89.2                     89.2
Average low < 88   84.7                      86.1

Oxygen desaturations occur after REM sleep starts (based on increased heart rate).  My oxygen level is very level in deep sleep. I don't wake up during these desaturations and had no respiratory arousals during the sleep study.  

My SpO2 when awake runs 94-93% which is normal for this altitude.

Concerns:  Is an APAP the best machine since I have severe asthma, small lung capacity and low peak flow.  I am unable to blow up balloons or purge the water from a snorkel tube by exhaling.  Will I be able to exhale against high pressure?

Will an APAP at high pressure increase the rate  of CSAs?  I had more CSAs than OSAs during the sleep study.

Is there a recommended mask for people with small faces and very small noses?  The sleep study technician said I had the smallest head and face he has ever measured.  The cannula was quite painful and my nose hurt for two days afterwards.  The technician said he should have used the pediatric cannula after the study was over.  

Is REM only apnea worth treating?  I am a light sleeper and easily disturbed by any discomfort.  Is the health gain from treating sleep apnea worth the likely severe sleep deprivation during the adjustment period.  I have had severe sleep deprivation with hallucinations in the past.  

Thanks in advance.
Mountain bird.
Post Reply Post Reply



Donate to Apnea Board  
#2
RE: Advice for sleep doc appt.
Hi, Mountain Bird...

I’m too much of a newbie to answer your main question, i.e. would APAP be the best treatment for you.

I’m puzzled about how you measured events with an oximeter, since those events AFAIK wouldn’t necessarily correspond with apnea events.

You can get past the adjustment period. In fact, I find it easier to breathe with my machine on. If I feel the need for calming down or decongesting, I plug right in. It’s like getting oxygen into my lungs.

Stuff like exhale pressure can be adjusted.

Yes, there’s a pediatric mask made by Respironics. In fact, it’s adorable. I wish they made one like it for grown ups. The best source for info on this kind of thing IMO is Supplier #1.
Post Reply Post Reply
#3
RE: Advice for sleep doc appt.
(10-21-2017, 04:01 PM)mountainbird Wrote: Concerns:  Is an APAP the best machine since I have severe asthma, small lung capacity and low peak flow.  I am unable to blow up balloons or purge the water from a snorkel tube by exhaling.  Will I be able to exhale against high pressure?

Your insurance company will likely make you try it to find out. If it doesn't work only then will they allow a more advanced machine that lowers the exhale pressure.

Quote:Will an APAP at high pressure increase the rate  of CSAs?  I had more CSAs than OSAs during the sleep study.

It could, especially at first. No way to tell without trying it. If it does turn out to be the case then you may qualify for a more advanced machine designed to treat that issue.

Quote:Is there a recommended mask for people with small faces and very small noses?

There are other factors to consider, such as your ability to tolerate a nasal mask versus a full face mask.

Quote:Is REM only apnea worth treating?

Most definitely. Without it you'll keep waking up to breathe, depriving yourself of REM sleep. You need REM sleep to be healthy, and a lack of it could be the underlying cause of some of the problems you mentioned you've battled since childhood.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#4
RE: Advice for sleep doc appt.
Hi mountainbird,
WELCOME! to the forum.!
I would say that CPAP therapy is worth trying.
Hang in there for more responses to your post.
Good luck to you.
trish6hundred
Post Reply Post Reply



Donate to Apnea Board  
#5
RE: Advice for sleep doc appt.
Thanks for the advice.  I will be seeing the sleep specialist on Wednesday.
Post Reply Post Reply
#6
RE: Advice for sleep doc appt.
MB, it's really up to you. Considering the use of benedryl to induce sleep for the study, it may not be entirely representative, and your results with 9.7 AHI with nearly 50% central apnea, and a bunch of hypopnea suggests pretty mild apnea. It qualifies for treatment , but your doctor did not do a titration. Your prescription is wide-open for an auto CPAP. I think you might find CPAP therapy is comfortable, and beneficial , especially at altitude. Your results are not much unlike my wife's, but I think the minimum pressure is (pardon me) stupid. I would put at least 6 cm in any auto CPAP or wouldn't bother. Also, if you decide to pursue treatment, get a machine that has good data like the Resmed Airsense 10 Autoset...in fact don't accept anything else. At least you will see what is going on and that the therapy is working and is beneficial. The Resmed is more comfortable than a Dreamstation, and seems a bit easier for most people to deal with. JMHO.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#7
Smile 
RE: Advice for sleep doc appt.
Thanks for the encouragement.  

Last night with the pulse oximeter 

I had 13 desaturation events in 7 hours and 14 min.    1.8/hr of sleep with one occurring when I was still awake and one when I got up to put our dog out.

My minimum oxygen saturation was 87 with 24 seconds below 88 %.  

My basal oxygen saturation was 91.8% which is normal at this elevation.  I spent 6.5 minutes below 90%

I'll see what the sleep specialist recommends this week.  And I am going to contact my allergist about reducing the high level of antihistamines I am currently on to prevent angioedema anaphylaxis in response to a food allergy.
Post Reply Post Reply



Donate to Apnea Board  
#8
RE: Advice for sleep doc appt.
Resmed's Airsense P10 for Her is a smaller mask frame. I'm currently trying one out. I have problems with a smaller head, very little hair and a small nose also.
Post Reply Post Reply
#9
RE: Advice for sleep doc appt. update
I met with the sleep specialist today.  His recommendation was that I did not need pap therapy.  I had a week of overnight oximetry data which showed many fewer oxygen desaturation episodes compared to the sleep study.  In the sleep study I only had apnea during REM sleep with no respiratory event arousals.  So the apnea is not waking me up.   At home my desaturations are very infrequent, mild and of short duration.  It looks like the sleep study was atypical and the apnea detected may be an artifact of the Benadryl I took to sleep.   He said the health benefits of pap therapy would be minimal and any benefit would be more than offset by the likely insomnia while adjusting to the therapy.

So, no pap therapy for me at this point.  I will be following up on my sensitivity to respiratory depression from antihistamines.  

Thanks for the advice and good luck to everyone on your journey to a good night's sleep.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Looking for Advice [Erratic results, many centrals] snoopj123 17 531 09-29-2019, 07:24 PM
Last Post: mesenteria
Cool Looking for any advice WhySoTired 36 765 09-11-2019, 09:04 AM
Last Post: WhySoTired
  Advice on settings, am I ok? johanson 3 175 09-11-2019, 07:52 AM
Last Post: johanson
  Newbie - 2 nights - can't tolerate full mask. Advice? sleepysharon 6 303 08-26-2019, 06:12 AM
Last Post: sleepysharon
  Need advice before going to bed! Maxmom 17 459 08-19-2019, 12:03 PM
Last Post: Maxmom
  New User, looking for advice Blessed 4 210 08-11-2019, 06:43 PM
Last Post: mesenteria
Smile New, results from day 1 - looking for advice Dulcet 5 254 08-09-2019, 04:42 AM
Last Post: bonjour


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.