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Mixed Sleep Apnea
#1
Mixed Sleep Apnea
About 3 and half years ago I was diagnosed with Mixed Sleep Apnea, and since then I have been using ASV.  About 10 months ago, I had an overnight sleep study that was checking to see if an oral appliance would work for me, but the answer was no.

Just recently I requested a copy of the sleep study for the oral appliance and noticed that there were no recorded central apneas and there were none listed on the report. 

My question is, should I be questioning my mixed apnea diagnosis? 
Based on the information that there were none listed on that overnight sleep study for the dental appliance? 

The other thing to note is that in January I was switched from my Respironics ASV to ResMed AicCurve and since that time, I have seen no clear apneas listed. Just once in awhile I see one or maybe 2 unclassified and about 1 - 3 hypopnea listed. My average AHI is about .48

When I was using Respironics ASV, I consistently had some Clear apneas and several Hypopnea during the night. Also my AHI average was between 3 to 5 and every week or two it would spike up to 7 or 10 or 12 . . . 

Thank you very much-
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#2
RE: Mixed Sleep Apnea
Post a copy of the sleep study. All too often important details are left out of the summary so post a full copy, not just the summary.

a dental appliance will do nothing for Central apnea. But an ASV should also not be given to a patient that doesn't have Central Apnea in some form.

Also get a copy of your original sleep studies.

Something is not right.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
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Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Mixed Sleep Apnea
[attachment=14375 Wrote:bonjour pid='306519' dateline='1565584418']Post a copy of the sleep study. All too often important details are left out of the summary  so post a full copy, not just the summary.

a dental appliance will do nothing for Central apnea. But an ASV should also not be given to a patient that doesn't have Central Apnea in some form.

Also get a copy of your original sleep studies.

Something is not right.

Ok the initial study I had was a home study- that file was the proper size for attaching, I have to figure out how to make the other attachments smaller in file size . . . I had a home titration after this home study and because the treatment wasn't effective in reducing my AHI, I was scheduled for an overnight sleep study in January of 2013 . . . I tried to attach that one, but the file size is too big . . . [attachment=14375][attachment=14376]

Moderation note:  Attachments Removed at request of OP
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#4
RE: Mixed Sleep Apnea
the pdf for the whole study couldn't be attached, so here are 3 key charts from the first study - [attachment=14377][attachment=14378][attachment=14379]


Moderator Note: attachments removed at request of OP
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#5
RE: Mixed Sleep Apnea
Here is a copy of the titration for the ASV (I had trouble finding the report from the diagnosis of Mixed Sleep Apnea- it was actually an MLST study to figure out why I had daytime sleepiness, and because I didn't get a good night of sleep during the overnight part, they canceled the daytime part of the MLST) . . . so the best I could find was the titration for the ASV- here are pages 1-5 (pages 6-8 will be attached in another reply to this post)[attachment=14380][attachment=14381][attachment=14382][attachment=14383][attachment=14384]


Moderator note: Attachments Removed at request of OP
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#6
RE: Mixed Sleep Apnea
Here are the remainder of the attachments for the Titration for the ASV dated 2/7/2016
*Note, I didn't have this as a separate report and had to take several screenshots for this ASV titration

[attachment=14385][attachment=14386][attachment=14387]


Moderator note: Attachments Removed at the request of OP.
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#7
RE: Mixed Sleep Apnea
here is a summary of phone call with sleep doctor who told me I had mixed sleep apnea- I do not use any medications (there are some listed on the summary from the doctor)
[attachment=14388]

Moderator note: attachment removed at request of OP (original poster)
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#8
RE: Mixed Sleep Apnea
Ok I finally figured out how to reduce the file size of my sleep reports - here is a copy of my first overnight sleep study and the sleep study from the dental appliance 

As I was gathering up the information - it showed that I had centrals in the various reports, except no centrals were recorded/noted in the dental appliance overnight sleep study . . .  which I thought was kind of odd . . .

[attachment=14389][attachment=14390]


Moderator note: Attachments Removed at request of OP.
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#9
RE: Mixed Sleep Apnea
Your home study likely was not capable of flagging Central events.
Your subsequent sleep study and your ASV study showed Central Apnea. Did you use a CPAP prior to your ASV?

If so it is likely that you had treatment emergent Central Apnea which can go away as your body adapts.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Mixed Sleep Apnea
(08-12-2019, 07:47 AM)bonjour Wrote: Your home study likely was not capable of flagging Central events.
Your subsequent sleep study and your ASV study showed Central Apnea. Did you use a CPAP prior to your ASV?

If so it is likely that you had treatment emergent Central Apnea which can go away as your body adapts.

Thanks Bonjour - 
After the first overnight sleep study in January of 2013, I was prescribed an Auto-CPAP (PR System 1), and a few months later a Bi-PAP (PR-System 1) to use prior to being prescribed the ASV (PR System 1) which was given to me in March of 2016. . . 

This past summer when I met with my RT, she mentioned to me that my Respironics ASV showed that 80% of my breathing was initiated by the Respironics ASV that I had.  A couple months after that I had the overnight sleep study for the dental appliance, and then around a month and half after that, I had a sleep study to see if the ResMed or Respironics algorithm was better for me and since the sleep study validated that the ResMed was best for my treatment, I was switched in January 2019 to the ResMed AirCurve ASV . . . 

Do you think it would be advisable to inquire with my RT and or Sleep Doctor, to see if I still require the ASV? Both my RT and my Sleep Doctor are extremely helpful when I ask for assistance . . .
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