Interpreting OSCAR, Clusters of Central Apnea

[Gideon]

Do you have another thread that shows history? It makes a big difference in how this is interpreted.

Other than Apnea, do you have any other breathing or heart issues?

The pattern is clearly CSR, Cheyne Stokes Respiration. There is not enough to be overly concerned but to let your doctor know so he can eliminate CHF, Congestive Heart Failure. No, I don't think that's what it is, but I would be remiss if I didn't point it out. CSR is serious.

It could also be that your your disturbed breathing thru ther night threw you int a cycle of heavy breathing, flushing out too much CO2 such that your CO2 levels dipped below your apneic threshold causing a central apnea, then slowly recovering untill you are once again over breathing and then repeating the cycle.

[Sleeprider]

I have merged your two threads. As Fred points out, this problem is a continuation of your previous problem with central apnea, and our recommendation has been to work towards getting ASV therapy. Your central apnea is real, and considering the intensity and duration of that cluster as well as the length of the apnea events, this is serious.. It cannot be treated with CPAP. You must talk to your doctor about getting a bilevel titration with the option to move to ASV. This will show the problem and allow efficacy of ASV to be demonstrated. Your other option is to self-fun ASV therapy. I think at this point, our conversation should focus on how to go about getting this test scheduled and moving to the needed ASV device. You have spoken to your doctor and not received an appointment for the study he said he would arrange. It is now time to complain loudly that your health is at risk and you need the ASV titration. You should be making daily calls.

[SarcasticDave94]

Hi Doc, when is that appointment for the test we agreed that I need? X date and time, OK thanks. The sooner the better.

[letsrun100]

I am working to get a lab sleep study as soon as an opening is available. I spoke with my doctor on Friday and he agrees that a lab sleep study is needed. He would be happy to prescribe ASV, but Medicare will need evidence that it is warranted, and that will be with the results of a sleep study. However, he told me the lab is trying to get caught up after being closed for over two months, they have many patients and I will have to wait until there is an opening. So, I don’t know what else to do but wait. I just thought that the reason for the cluster I saw last night might have been caused by something obvious to a trained eye. I don't see this every night. Should I try reducing the pressure?

I am now looking for a different doctor that uses a different test facility to see if an appointment can be made soon. I will make some calls tomorrow morning.

Thank you, I truly appreciate your comments and suggestions.

[Sleeprider]

You don't have obstructive apnea, so reducing pressure is a logical thing to try. I don't think it is a long term solution, and CA events will continue being consistently inconsistent. We understand that labs are backed up and hope you get what you need.

There are some used machines that may be affordable and give you immediate treatment, and may even suffice to demonstrate efficacy for a new Medicare funded machine. On DotMed, search the Respiratory/BiPAP category for a Resmed S9 VPAP Adapt 36007 with 9630 hours for $340 USD. A better deal, at $500 is another VPAP Adapt 36007 with only 340 hours. This is the model replaced by the Aircurve 10 ASV but will provide ASV therapy very similar to what we are suggesting. This machine is relatively inexpensive and will resolve your central events. If you can afford either of these options, you can move your therapy forward, collect data and continue to work with your doctor.

[letsrun100]

I made an appointment for a second opinion at a different facility for July 7. I will take my memory card and several OSCAR printouts with me. They told me on the phone that they can get me a lab sleep study pretty quickly if the doctor thinks it is warranted. I explained that I didn’t feel my home sleep study on March 19 was valid. I did not have the belt around my mid-section or an airflow sensor which I’ve read should be a part of a HST. All I had was a clip on my finger to measure SPO2 and pulse.  I don’t see how sleep apnea can be diagnosed with those two observations alone.

Of course, since using OSCAR, I can see that I have many nightly central apneas. I’m hoping my new doctor and the results from the sleep study will address this and he will agree that  ASV is needed.

Thank you for the information to self-fund a machine. I will wait to discuss this with my new doctor but I believe Medicare will cover this.

In the mean time, I reduced the pressure to 8 last night and my AHI was 2.34. I still have centrals but greatly reduced from the night before with pressure set at 10.

       

[SarcasticDave94]

Great, glad you're getting the 2nd opinion. It may be very helpful to getting you closer to an answer.

[letsrun100]

I wanted to report on my progress. I saw a new sleep doctor on July 14 and he suggested an ASV might be in order since I was experiencing a high number of CA events, but he wanted a sleep study done. I had a lab sleep study on July 23. The sleep study showed the opposite of what I was experiencing at home, lots of OA events and zero CA events. At home I was having zero OA and 20 to 30, sometimes 50 CA events per night. As a result of the study I was told to maintain a pressure of 10.

Reluctantly, I did as directed but saw very little progress for the next 2 months. I was still having zero OA events and lots of CA events, as many as 20 or 30 per night. I was averaging nightly AHI between 3 – 4 – 5 each night with zero OA and lots of CA events (averaging between 20 and 30 per night). I know AHI between 3 – 4 – 5 each night is medically acceptable, but I was not sleeping well and still tired during the day.

Because of the nightly nose itching episodes, I decided to try a nasal mask, chin strap and mouth taping. At least the itches are easier to get at. That was over a week ago. My AHI dropped immediately from 4.83 one night to .69 the next and hasn’t been above .90 for over a week. I went from a weekly average of 3.73 to .82. Instead of 20 or 30 CA per night, I’m only having 2 or 3, sometimes zero per night. I’m sleeping better and not sleepy during the day.

I can’t explain why the nasal mask has reduced my CA events, maybe just the time needed to get used to CPAP? I’ll have to think about that. Whatever it is, I’m feeling much better.

I’m still trying to solve the nose itch, the only complaint I have right now.

Thank you all for your help.

   

[SarcasticDave94]

Remember that CA are consistently inconsistent. This chart looks good, but how did you feel? See if the CA spike upward again in the future, even tomorrow. I would not hope they do, but that is how inconsistent they are. If they do, tell doc you demand an ASV.

[letsrun100]

So far, I haven’t seen a spike in CA events. I have been sleeping lots better since switching to a nasal mask and lowering the pressure to 8.

I would like to eliminate the Hypopneas, any recommendations? Are they central or obstructive? Not that it matters, but maybe I can change something to eliminate them if they are obstructive.

TIA