Getting a machine advice

[Sleeprider]

Let's see if I can make that readable.  We can see from the study that you were tested for CPAP pressure at 4, 6, 8, 9 and 10 cm, and what appears to be bilevel at 14/10 and 16/12 (IPAP/EPAP), these are noted with EPAP pressure and pressure support as 10/ 4.  Starting with the bilevel trials, we see central apnea emerged a significant problem, so your test shows no trial of CPAP pressure resulted in an RDI less than 9.0, and you do not tolerate BiPAP due to treatment emergent central apnea at a very high level.

There are two trials with 8-cm total of 150 minutes with 10 minutes in REM, and these are your best results. Although these results are not particularly good, they are the best titration with CPAP or bilevel achievable.  You are going to be issued a CPAP (hopefully the Resmed Autoset) and given a trial.  Your doctor will continue to evaluate these results.  It is possible that in time, your RERA and hypopnea will diminish and result in satisfactory therapy. I strongly suspect these hypopnea are central in origin and result from the fact you are not accustomed to the ventilation on CPAP. Time will tell if you can achieve satisfactory results.  We really can't predict that.  The best bet is to give it a try.  You can still ask for the Resmed Autoset, but I think any CPAP device will be challenging for you until you adapt to the ventilation. Your sleep may feel disrupted by the RERA (arousals), but your oxygen saturation is good with CPAP.

[dolppl]

 I strongly suspect these hypopnea are central in origin and result from the fact you are not accustomed to the ventilation on CPAP.

Thank you for your interpretation.  I am curious what makes you say this statement?

[dolppl]

       

I also found my diagnostic at home sleep study that confirmed the sleep apnea.  I don't know if anybody can interpret this or have some insight that may be helpful in addition to the CPAP titration.  I did notice a lot of Centrals toward the morning along with Cheyne-Stokes breathing pattern.  I don't know the accuracy of this being an at home sleep study.

Thank you,

[Sleeprider]

It's really simple. Your test shows predominately central apnea at higher pressure and with bilevel pressure support, and your oxygen results show little or no desaturation. That is the basis for concluding the hypopnea are not obstructive and are the result of a temporary washout of CO2. When your breathing flow rate diminishes (hypopnea) CO2 increases back to normal levels, and breathing spontaneously resumes.

This is going to be a bit advanced for you, but take a look at our wiki on Enhanced Expiratory Rebreathing Space (EERS) http://www.apneaboard.com/wiki/index.php...ace_(EERS) This technique is used to intentionally retain some CO2 in the breathing circuit, while allowing all the pressure benefits of CPAP to continue. For people like you, it can result in the elimination of the therapy onset centrals and hypopnea. If you have questions ask, but I'm only having you read this to help you understand the relationship between CO2, respiratory drive and central events. You are not going to start using EERS now, but you can consider it as being in our hip-pocket if you need it.

[dolppl]

So what do you think about all the centrals that showed up toward the end of my at home diagnostic and the Cheyne-Stokes respiration?   This was without CPAP.

[Gideon]

The centrals being toward the end of the night could simply be the result of your sleep pattern slowly decreasing your CO2 concentration to your apneic threshold. The CSR could be from the same result. CSR does trigger us into asking about any heart and/or respiratory issues even if we do not think that is the cause.

[dolppl]

I am a relatively fit 39 year old. I did have an EKG done about a year ago because I was concerned because my resting heart was in the low 40s while I was sitting at my desk working and the EKG came back normal. Low resting heart rate runs in the family. Never had any other tests done. Do you think I should be concerned?  I would think my sleep doc would have seen this and said something if there was a concern, no?

[Gideon]

No, looking for CHF, COPD etc.

[dolppl]

I guess my question was should I be concerned about CHF, COPD?  Is the Cheyne-Stokes respiration an indicator that I have CHF, COPD?  If i google it it seems that is the case especially for CHF but Dr. Google makes me think i have every disease known to man especially for someone with an anxiety disorder such as myself.

[Sleeprider]

Without the flow rate chart trace, we don't know what happened here, an the report might be classifying periodic breathing as CSR, but there is a big difference. CSR is definitely closely associated with congestive heart failure, but periodic breathing is not. CSR has a very distinctive appearance in the flow rate, with very evenly spaced waxing and waning of the flow rate punctuated at the nadir by a central apnea, while periodic breathing ranges from a periodic oscillation of flow rate and may include hypopnea and obstructive events. Periodic breathing can result from airway instability, or being near the apneic threshold and is not related to more serious disease. If this aspect of your sleep test bothers you, then ask for a copy of the respiratory flow trace and ask for the doctor's opinion. This event is often simply flagged by the testing machine, and is not a diagnosis. It is fair game to ask your doctor to give you a more expanded opinion on this. Once you start CPAP with a data-capable machine, it will be very easy to tell you.