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[Diagnosis] Advice on Central Sleep Apnea Diagnosis
#1
Question 
I was recently told I have Mild Central Sleep Apnea (CSA). This was after a sleep study where I stayed a night at the hospital and they hooked me up to all kinds of wires / hoses.

A little background:
I'm under 30 years old. I've been feeling extremely tired for a number of years now and it seems to have gotten progressively worse with time. I wake up in the morning more tired than I was the night before, am tired all day, always yawning, hiccups, and very frequent headaches. I struggle greatly with concentrating during the day and have a terrible time remembering things. My girlfriend noticed that I was stopping breathing all the time during the night and then breathing very heavily, and I also gnash my teeth together (note that this apparently only happens when I'm sleeping on my back and I don't sound like I'm chocking or struggling to breathe). After telling my family doctor I was sent to a sleep specialist who in turn had me come in for a sleep study.

I don't remember everything that was said in my follow up appointment, but I know he said I have mild central sleep apnea and is sending me for another sleep test to try therapy with CPAP or ASV???. My AHI was ~14.5 for the night I slept there. One thing that is bugging me is that almost all the apneas happened in a span of 2-3 hours during which time I was sleeping on my back. Total hours slept was ~7 hours, so with some quick math my AHI was 34-50 during those times. So which AHI number is the real measure here? (Note that I always end up sleeping on my back during the night, even if I start on my side). I also mentioned that I was frequently waking up during the sleep study to fairly intense pain / tightness in my chest but he didn't even acknowledge this.

After my appointment I do some research on CSA and find that it most often is caused by another underlying condition (some of which seem serious). Considering this I would have expected the doctor to be trying to determine if I have one of those issues, but instead he is just trying to reduce my AHI using a CPAP or similar machine. Is this normal?

Lastly, I'm not sure if CSA makes sense considering I only have them when I'm sleeping on my back? I don't understand how sleeping position would impact my breathing if its not OSA.

Anyway, I guess I'm just looking for some advice and thoughts on the process and CSA in general. This is all very new to me.

Thanks in advance.
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#2
Well, with obstructive sleep apnea (OSA), the sleeper struggles to breath. They'll twitch and their chest is rising and falling as the body tries to breathe. Finally the sleeper wakes up enough that the throat opens and they breathe again.

With central sleep apnea (CSA) the sleeper does not struggle. The chest does not move.

This is why a sleep test is so important for diagnosis. The machines and the techs would know if you struggled or if you just laid there.

It could be that you are the deepest asleep when you are on your back.

It could be you have mixed apnea, meaning you have both central and obstructive events. It is common.

AHI is the number of events (central or obstructive) + the number of hypopneas (shallow breathing) divided by the number of hours slept.

Even if your CSA is caused by another event, the idea is to treat the symptom even if you don't know the cause. Your overall health will be greatly improved by the ASV. Then you and your GP can figure out what the cause is. With your health improved, then others symptoms that may be masked by your exhaustion will be more noticeable.
PaulaO2
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#3
AHI is the average for the night so you might have more events at some time and none at other times but all events added up and divided by the hours. Some people have whats called positional apnea when sleep on their backs, its recommended to have a tennis ball in a pocket sewn on the back the pyjamas to prevent one rolling over on their backs. Central apnea is when the airways is open but the brain don,t send a signal to breathe unlike obstructive apnea where the airways closed and usually there is underlying condition. CPAP don,t treat this condition as the airways is open not closed but ASV can help by initiating breath when one is not taken.
Good luck with sleep study...keep us posted
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#4
Thanks for the advice/information! Very helpful.

I'll update with results from my next sleep test when I have them.
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#5
I would have another sitdown with the doc and if you're interested in pursuing any underlying causes of your CSA ask him about testing. Positional sleep apnea is fairly common as is clusters of apneas during certain sleep stages. I don't think it's very common to explore the underlying causes of CSA ( unless there is a underlying history which may point to a cause)- evidently you have looked into the causes and know if anything stands out. If you can learn to sleep only on your side it sounds as though you may greatly reduce your apneas. ASV is the treatment of choice for CSA and considering the severity of your symptoms I would start treatment ASAP.
Good look, keep us posted. Take notes at your next doctors visit.
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#6
I'll tell you what my sleep doc told me when we reviewed my sleep test results. I'm not a doc and can't vouch for the accuracy (other than a doctor did tell me this).

When you're laying on your back gravity affects two things. One, your chest has to rise directly against gravity, making laying on your back a "harder" breathing position than laying on your side. Two, the part of the airway that tends to close and is the major cause of OSA for most of us tends to close more under the force of gravity. Again, mitigated when you're laying on your side. All OSA related, CSA is a different beast altogether.

The only other thing he told me that stuck is that OSA tends to be worse in REM sleep due to a change in the muscle tone of your body during this type of sleep.

Anybody out there that can confirm or deny?

As previously mentioned, a simple AHI number can be misleading. Like you state, my events tend to come in clusters, not spread over the night. From your sleep test you should have data on what part of the sleep cycle your were in, what position, brain waves, etc. that might help pinpoint your most prevalent combination. I know some of the members of this forum have videotaped their sleep and learned a lot about position and AHI impact due to it.

Best of Luck!
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#7
Nameless, how are you doing?
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