Getting a machine advice

[dolppl]

Last nights results.  Dropped the pressured down to 7 (from 8) no Oral Appliance.  Pretty much a carbon copy of the night before mostly centrals, sporadic OAs and Hypops.

Let me know if anyone has any thoughts on this.

A few other questions:
Is CPAP even doing anything to help my sleep?  

How confident are we that these are central apneas?

This question may be off the wall but could the centrals have anything to do with anxiety?  The only reason i bring this up is sometimes i will just be sitting on the couch relaxing watching TV and I will notice i get really lightheaded and when that happens i notice that I am not breathing because my whole body is tensed up in a knot.  What is to say i am not carrying this over into sleep and holding my breath at times?


   

[Gideon]

Based on your results I see an ASV in your future. Have you talked to your doctor about it? What is the plan? Your immediate goal is to get an ASV Titration sleep study to prove that it therapeutically works for you (it will) then to get one.

[dolppl]

Well I have been on CPAP for less than a week now.  Can i go into my sleep doctor and request an ASV titration?  

I assume they are going to say to continue using the CPAP to see if the centrals clear up on their own and we will reevaluate at my 1 month appointment in the middle of May.

[Gideon]

It is never too early to start the discussion. We have not seen a noticeable improvement in your CAI with the lowering of EPR which tends to indicate an ideopathic central apnea which is usually not treatable with time and an APAP. Perhaps bring it up that you are unable to manage your CA, how can WE get to ASV which I understand will manage it. What do you think?

[dolppl]

Ok.  I will give my sleep doctor a call and see what I can do.  Just want to get all my ducks in a row first so a couple of clarifying questions.

All of my sleep studies, Probably about 7 in total.  Baseline and others with various CPAPs, BiPaps, Oral appliance, Oral appliance and CPAP together, etc. all showed mostly ~85%+ Hypopneas w/arousal.  Very few Centrals, Obstructives, Hypopneas with Desat. except the last study when they bumped the pressure up and went onto BiPAP. 

1. How sure are we that what OSCAR is saying is correct and these are in fact Centrals and not Hypopneas?  Me being the new guy and still believing in doctors and the healthcare system (I know I am still so naïve) would think that me being hooked up to a bunch of sensors and monitors and having somebody watch me sleep all night would give more accurate results than what can be detected coming through one hose. 
   NOTE: I am not doubting this, just want some ammunition to go after the sleep doctor with if he brings up this same point.

2.  How do we know that these Hypopneas are not treatment emergent and that these will go away with continued use or just require the Enhanced Expiratory Rebreathing Space (EERS) that sleeprider mentioned a few posts back?


Thank you all for your help, I don't know what I would do without your support.

[dolppl]

Last nights results.  Best results yet.  Actually got under 5.  Does this lend itself to maybe the fact that these ARE treatment emergent centrals and will go away with time or is that wishful thinking?

I also did not get any feedback on my questions in the last post.  Added them here:

Ok.  I will give my sleep doctor a call and see what I can do.  Just want to get all my ducks in a row first so a couple of clarifying questions.

All of my sleep studies, Probably about 7 in total.  Baseline and others with various CPAPs, BiPaps, Oral appliance, Oral appliance and CPAP together, etc. all showed mostly ~85%+ Hypopneas w/arousal.  Very few Centrals, Obstructives, Hypopneas with Desat. except the last study when they bumped the pressure up and went onto BiPAP. 

1. How sure are we that what OSCAR is saying is correct and these are in fact Centrals and not Hypopneas?  Me being the new guy and still believing in doctors and the healthcare system (I know I am still so naïve) would think that me being hooked up to a bunch of sensors and monitors and having somebody watch me sleep all night would give more accurate results than what can be detected coming through one hose. 
   NOTE: I am not doubting this, just want some ammunition to go after the sleep doctor with if he brings up this same point.

2.  How do we know that these Hypopneas (in the sleep study) / Centrals (on OSCAR) are not treatment emergent and that these will go away with continued use or just require the Enhanced Expiratory Rebreathing Space (EERS) that sleeprider mentioned a few posts back?

   

[Sleeprider]

When I reviewed your last sleep study, I pointed out that the technician used the term "RERA" instead of hypopnea for many events because they consisted of flow reductions consistent with hypopnea, but without the 4-cm desaturation that was used to classify events. That is a typical pattern of someone with idiopathic or treatment emergent central apnea. It was predictable that these would become hypopnea and CA events with a machine. The events are real, and the machine is pretty accurate in classifying them. You can confirm any event by reviewing the high resolution flow rate data. We have seen a lot of people come to this forum with similar issues, and I think the possibliity of ASV was mentioned to you early in this thread, but we wanted to continue with your prescribed fixed CPAP pressure and see if the events would eventually subside. It can take a month. It is worthwhile keeping your doctor informed that you are concerned with the high incidence of CA and H events, and pointing out these are consistent with the findings of the titration study. If you want to test the hypothesis that your central apnea is real, just turn on EPR and try the exhale pressure relief feature. My prediction is your events will at least double, but if I'm wrong, you might find more comfort.

[SarcasticDave94]

Hopefully this adds a bit of help. And I'm aware you're not on BPAP as I recall. I was on a BPAP however. I was on it all of 2 weeks and due to getting the docs attention that the BPAP was making things very messy with CA all over the place, he actually told me to cease using it. Once I forced him and his staff to look at the very high CA to OA ratio I had on the PSG sleep study that is. We were quickly then on the path to ASV. So my point is, time on a machine isn't so important. You tried it, here's the results doc. Let's go over here to ASV. Stat. Best to ya on this ASV path. Quick hint, focus on telling doc how bad things are with the CPAP you have.

[dolppl]

Ok.  I think I am on board now.  My last sleep study said I had mostly Hypopneas w/Arousal (Not Desat.).  These are also considered RERA's.  I did not catch that before.  Still catching up on the terminology.

So from all your comments I think the course of action is that these COULD still be treatment emergent centrals and the could take a month to clear up and that I should keep the doctor informed of my concerns, but I should probably stay the course at least for now and hopefully they keep trending in the right direction. 

If you look over the week that I have been on the machine they are trending downward.  (Only 6 days of data though so no conclusions yet but heading in the right direction at least for now).

Let me know if you disagree with this.  My sleep deprived brain gets confused easily.

Edit: Couldn't add my graph but the trend line started at 8 CAs per hour to 6 per hour after 6 days.  If this were to hold it is on pace for going to zero in just under a month.

[SarcasticDave94]

Here's how I see this, you should make the current therapy as best as possible regarding OSCAR and an emphasis on how you feel. I understand you are doing so, so don't take that as criticism, just outlining the path you're on. If you can use the machine and it helps, keep doing so. If these CA and Central oriented events are based on treatment emergent, they should diminish and possibly be gone within 3 months. If they were/are pre-existing, only the ASV will do, and sometimes the same with idiopathic.

Take note that if it's impossible to make the machine work for you, this should be conveyed to the doc. When does that occur? It depends on what type of CA and other events you're getting.