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Just learned I have Complex Apnea
#1
Hi Folks,

Last year I mentioned to my Dr that my spouse complains about me sometimes stopping breathing in my sleep. That set me up for a stay at a sleep lab to discover that I have severe apnea @ 36AHI.

The first night I slept with my CPAP with a pressure of 8 I woke up feeling very different... I felt awake and it was a new and a wonderful experience. About a month later after another night at the sleep lab the pressure was set to 9.

About 6 months later I started noticing subtle but progressive changes in the quality of my sleep. At first it was just a few not-so-great sleeps to more terrible sleeps. I saw my sleep doc about a month ago and she suggested that I might have developed central apnea.

I ended up purchasing an APAP machine 3 weeks ago that confirmed I have both OSA and CSA. But I felt fantastic again! I love that CPAP high!

My AHI averages about 2.1 with CSA and OSA at about 50% each (I tend to have more OSA in the early evening then CSA in the later). However, I have had some days where I feel like crap again (end up sleeping 13+ hrs). They are spontaneous. Meanwhile the data will show an AHI of 2.1. Just yesterday was a bad day and now today is a good dayDont-know

I am perplexed? Been doing a lot of research online without luck and hoping the experts on this forum can provide some suggestions.

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#2
Hi Ray S,
WELCOME! to the forum.!
Hang in there for suggestions and answers to your questions.
Best of luck to you on your CPAP journey.
trish6hundred
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#3
Hi Ray S
Neither CPAP or AutoSet treat central apnea, from ResMed:
A diagnosis of central sleep apnea (CSA) requires all of the following:
An apnea index > 5
Central apneas/hypopneas > 50% of total apneas/hypopneas
Central apneas or hypopneas occurring at least 5 times per hour
Symptoms of either excessive sleepiness or disrupted sleep

Usually central sleep apnea get picked up during the sleep study while wired-up, what was the diagnoses?
Do you have copies of the sleep studies, if not, get them, yours to keep

What was leak (median, 95th percentile, maximum), AHI (breakdown of events, obstructive, hypopnea, centrals)
while you,re on CPAP pressure 8 & 9?

Whats the leak and pressure (median, 95th percentile, maximum) now with the AutoSet 'CPAP Pressure: 8 to 17'

For some people (not everyone) turn off EPR helps reducing central events

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#4
Welcome Ray S!
I am sure you will be given the help needed. You sound very positive and plan on making this work, so hang in there.
Sleep Tight...
Gabby
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#5
(04-17-2014, 04:19 PM)zonk Wrote: Hi Ray S
Neither CPAP or AutoSet treat central apnea, from ResMed:
A diagnosis of central sleep apnea (CSA) requires all of the following:
An apnea index > 5
Central apneas/hypopneas > 50% of total apneas/hypopneas
Central apneas or hypopneas occurring at least 5 times per hour
Symptoms of either excessive sleepiness or disrupted sleep

Usually central sleep apnea get picked up during the sleep study while wired-up, what was the diagnoses?
Do you have copies of the sleep studies, if not, get them, yours to keep

What was leak (median, 95th percentile, maximum), AHI (breakdown of events, obstructive, hypopnea, centrals)
while you,re on CPAP pressure 8 & 9?

Whats the leak and pressure (median, 95th percentile, maximum) now with the AutoSet 'CPAP Pressure: 8 to 17'

For some people (not everyone) turn off EPR helps reducing central events

The last sleep study I did was for my initial diagnosis. At that time there was no CSA... I seem to have developed it afterwards.

I have not had a sleep study to confirm CSA since my insurance will not pay for another sleep study until March 2015 even though my dr requested one. So all the data I can provide is from my Resmed. Here is my last 7 days

Apnea index: 1.9
Obstructive: 0.8
Central: 0.7
Hyponea: 0.3
AHI: 2.2
Leak (95th) 2.4
Pressure (95th) 13.7

The numbers are awesome... I just can't understand why there have been some days where I feel like the AHI was 20+.... My dr mentioned something about the possibility of restless leg syndrome???
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#6
You are absolutely correct. Your numbers are awesome. Your doc may be on the right track. It may be another contributing factor.

Payton
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#7
(04-17-2014, 02:55 PM)Ray S Wrote: Hi Folks,

Last year I mentioned to my Dr that my spouse complains about me sometimes stopping breathing in my sleep. That set me up for a stay at a sleep lab to discover that I have severe apnea @ 36AHI.

The first night I slept with my CPAP with a pressure of 8 I woke up feeling very different... I felt awake and it was a new and a wonderful experience. About a month later after another night at the sleep lab the pressure was set to 9.

About 6 months later I started noticing subtle but progressive changes in the quality of my sleep. At first it was just a few not-so-great sleeps to more terrible sleeps. I saw my sleep doc about a month ago and she suggested that I might have developed central apnea.

I ended up purchasing an APAP machine 3 weeks ago that confirmed I have both OSA and CSA. But I felt fantastic again! I love that CPAP high!

My AHI averages about 2.1 with CSA and OSA at about 50% each (I tend to have more OSA in the early evening then CSA in the later). However, I have had some days where I feel like crap again (end up sleeping 13+ hrs). They are spontaneous. Meanwhile the data will show an AHI of 2.1. Just yesterday was a bad day and now today is a good dayDont-know

I am perplexed? Been doing a lot of research online without luck and hoping the experts on this forum can provide some suggestions.

G'day Ray, welcome to the forum.

It's not uncommon for people to develop central apnea for the first time when using CPAP therapy. It is a reaction of the body / brain to breathing under pressure and also to different relative levels of O2 and CO2 in the blood. (I'm not a medical professional, so I'm not sure of the details, but a certain level of CO2 is needed to trigger an inhalation).

In a lot of cases the centrals will go away again after a while (weeks, months...who knows?). If they don't then a different type of PAP machine is needed (bi level auto-servo ventilation or ASV). These are expensive so the insurance companies won't fund them without a lot of evidence.

In your case the numbers are low, which is of course a good thing. If the centrals are coming in clusters there could be enough disruption that your sleep is seriously disturbed for a period of the night, even though your average CAI is very low. I see you using ResScan. Can you see how the centrals are clustered? Could this could be the source of your poor sleep?

Finally, it's possible to have a poor night's sleep even with apnea fully under control. We tend to focus just on the AHI, but there are a whole lot of other factors at play - mask leaks (especially into the eyes) can wake you even if the leak numbers are low. There may be external noises - traffic, aircraft, your partner snoring. Maybe your bed's not comfortable, maybe you have muscular aches and pains... a whole of of things to consider in addition to the apnea.


DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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#8
Wink 
Have you tried conservative treatments? Like losing weight and maintaining a healthy one, cutting down on alcohol and getting enough sleep? I know these are just basics but what my husband and I realized is that it is always better to treat your apnea form within. Both of us are using our own devices for sleep apnea and just recently we decided to accompany the "physical help" of the devices with just the basics. We still use our devices
(and yes, WE LOVE 'EM, very helpful!) but we are hopeful that we will be able to treat our apnea from within in the future.
Post Reply Post Reply
#9
(04-17-2014, 09:14 PM)DeepBreathing Wrote: G'day Ray, welcome to the forum.

It's not uncommon for people to develop central apnea for the first time when using CPAP therapy. It is a reaction of the body / brain to breathing under pressure and also to different relative levels of O2 and CO2 in the blood. (I'm not a medical professional, so I'm not sure of the details, but a certain level of CO2 is needed to trigger an inhalation).

In a lot of cases the centrals will go away again after a while (weeks, months...who knows?). If they don't then a different type of PAP machine is needed (bi level auto-servo ventilation or ASV). These are expensive so the insurance companies won't fund them without a lot of evidence.

In your case the numbers are low, which is of course a good thing. If the centrals are coming in clusters there could be enough disruption that your sleep is seriously disturbed for a period of the night, even though your average CAI is very low. I see you using ResScan. Can you see how the centrals are clustered? Could this could be the source of your poor sleep?

Finally, it's possible to have a poor night's sleep even with apnea fully under control. We tend to focus just on the AHI, but there are a whole lot of other factors at play - mask leaks (especially into the eyes) can wake you even if the leak numbers are low. There may be external noises - traffic, aircraft, your partner snoring. Maybe your bed's not comfortable, maybe you have muscular aches and pains... a whole of of things to consider in addition to the apnea.

Thanks for all the great information mate! I have not been able to draw a correlation between CSA clusters and the days I feel crappy (like today Huh ) but will start paying close attention now. You also gave me hope that my CSA might just eventually go away. I think I have had apnea for decades before my diagnosis as I have always been a very very heavy snorer.... always tired in the mornings... it was "normal".

I should also mention that I am borderline anemic and read that that can contribute to restless leg syndrome. I am now on iron supplements to bring my haemoglobin back up and see what happens on that front.

Perhaps I should invest (pay) for a night at the sleep lab out my own pocket to get more information?

Thanks again for the advice and hope Thanks
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#10
(04-18-2014, 04:52 AM)EvelynCale Wrote: Have you tried conservative treatments? Like losing weight and maintaining a healthy one, cutting down on alcohol and getting enough sleep? I know these are just basics but what my husband and I realized is that it is always better to treat your apnea form within. Both of us are using our own devices for sleep apnea and just recently we decided to accompany the "physical help" of the devices with just the basics. We still use our devices
(and yes, WE LOVE 'EM, very helpful!) but we are hopeful that we will be able to treat our apnea from within in the future.

I agree with your points on conservative treatments. I quit smoking a few months ago, cut way back on my alcohol consumption and trying to eat healthier. Right now I am about 20 pounds overweight and in the process of trying to shed it.

Is it really possible to "treat apnea from within"? I mean be cured? I thought my machine was going to be my sleep buddy for life? Unsure
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