Dr wants me to do another Sleep test

[Ratchick]

*wave* Hi. Fellow severe CSA person here. Also waiting for my doctor to get me onto ASV and having a bunch of events.

Your first overall chart looks a LOT like mine - not so many central events in the first couple of hours, but AFTER that, it just blows up. I have yet to figure out why. But it DOES mean that I can (often) reduce my events if I only sleep for a couple of hours or less at a time. Unfortunately, that isn't great for restful sleep either, and it's not a fix. I'd (personally) be interested to know what your initial sleep studies showed in terms of the number of CA to OA and Hypops...

You also might want to get yourself a pulse oximeter that will record your pulse and oxygen saturation overnight, just to see what's happening there. If your oxygen levels are dropping during those long streams of central events, you definitely need to push for something to be done faster. If you have a look on the wiki, there are a list of pulse oximeters that work with OSCAR at various price points.

[clrv]

*wave*  Hi. Fellow severe CSA person here. Also waiting for my doctor to get me onto ASV and having a bunch of events.

Your first overall chart looks a LOT like mine - not so many central events in the first couple of hours, but AFTER that, it just blows up. I have yet to figure out why. But it DOES mean that I can (often) reduce my events if I only sleep for a couple of hours or less at a time. Unfortunately, that isn't great for restful sleep either, and it's not a fix. I'd (personally) be interested to know what your initial sleep studies showed in terms of the number of CA to OA and Hypops...

You also might want to get yourself a pulse oximeter that will record your pulse and oxygen saturation overnight, just to see what's happening there. If your oxygen levels are dropping during those long streams of central events, you definitely need to push for something to be done faster. If you have a look on the wiki, there are a list of pulse oximeters that work with OSCAR at various price points.

Thanks Ratchick I will look into getting a pulse oximeter as well.  I plan on spending the last half of the day studying up on the suggest information giving here.  I will post my 2 nights of sleep study so you can see.  I am not sure I could handle sleeping only a few hours   at a time. I am cranky enough as is 

       

[Ratchick]

Your central events are lower during the home studies (but I don't know how good that particular study is about differentiating obstructive vs central apneas). That may be partially down to the treatment, or it may be just because central sleep apnea is consistently inconsistent. For example on my sleep study, my CAI was 80+/hr, and on CPAP (while I wait for ASV) my results are lower but can vary from around 15/hr to nearly 60/hr, and there's no rhyme or reason for it.

But it does, at least, show that the therapy is managing your OSA far better. Unfortunately, it can be a balancing act, as what helps with obstructive stuff can sometimes exacerbate central events, and vice versa. It may be just that you need more careful titration to balance things out, but it may be that you need to switch from APAP to something like ASV if there isn't a sweet spot that manages both sides well.

I'm definitely not the expert on these things (still a newbie myself) but you've come to the right place.

[SarcasticDave94]

The insurance may be hesitant to pay for ASV as the required 50% of the events need to be CA. I'd keep complaining and reciting symptoms until the doc's ears bleed. You're very likely not going to be well rested without ASV.

Typical they want to see you fail CPAP, BPAP, maybe ST, then onto ASV.

[clrv]

Your central events are lower during the home studies (but I don't know how good that particular study is about differentiating obstructive vs central apneas). That may be partially down to the treatment, or it may be just because central sleep apnea is consistently inconsistent. For example on my sleep study, my CAI was 80+/hr, and on CPAP (while I wait for ASV) my results are lower but can vary from around 15/hr to nearly 60/hr, and there's no rhyme or reason for it.

But it does, at least, show that the therapy is managing your OSA far better. Unfortunately, it can be a balancing act, as what helps with obstructive stuff can sometimes exacerbate central events, and vice versa. It may be just that you need more careful titration to balance things out, but it may be that you need to switch from APAP to something like ASV if there isn't a sweet spot that manages both sides well.

I'm definitely not the expert on these things (still a newbie myself) but you've come to the right place.

The insurance may be hesitant to pay for to the required 50% of the events need to be CA. I'd keep complaining and reciting symptoms until the doc's ears bleed. You're very likely not going to be well rested without ASV.

Typical they want to see you fail CPAP, BPAP, maybe ST, then onto ASV.

Thanks again for waking me through all the aspects.  Do you keep a separate sleep log or do you put it in the notes of OSCAR..? I guess both are pretty easy so I might just do that.

[Ratchick]

I just put mine into OSCAR now. I was keeping it in the software for my pulse ox (which at some point I need to transfer all that data across) but I figure may as well use OSCAR now. But whatever works for you. Also, OSCAR has the Zombie setting (i.e. how good do you feel from Zombie to Awesome at the bottom of the notes page) so that's also helpful too as a general overview - but definitely keep detailed info too.

[SarcasticDave94]

Within OSCAR is fine. Then you have personal notation and the OSCAR chart to point to.

[Geer1]

Your home sleep study indicates that central apnea were present in a high enough quantity to indicate that basic PAP treatment may not be satisfactory especially with the increased quantity of central apneas that have become apparent on results so far.

The titration study your doctor wants to have done is the correct step forward. They will be able to see the large number of central apneas and try different machines/settings to figure out what works best for you. When talking to your doctor about getting this study done make sure to mention that you understand central apnea appears to be the main problem, that central apnea were also present in your home sleep study and that you believe ASV should be included in the titration study. If they balk at idea of ASV I would contemplate looking for another clinic/doctor to do study as ASV is the best treatment for central apnea like this.