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Sleep apnea from severe to minor??
#1
Sleep apnea from severe to minor??
Hello,

A few years ago, I was diagnosed with very severe sleep apnea (AHI around 55). This was based on an in-home sleep test and an in-lab titration study. The titration study showed I had mixed apnea and that a pressure of 18-19 was what I needed. I was first given a regular, non-auto device which I used for a couple of week, but felt like I was drowning, so they gave me an APAP one that they set to a max and min based on the lab sleep study. 

Fast forward to a couple of weeks ago. I had another sleep study done, this time an in-lab diagnostic study. This study showed that I only have mild sleep apnea and NO CENTRAL apnea. The AHI was under 10. I had a follow up titration study that showed a pressure of 8 was sufficient. No significant centrals during the second titration study. 

My questions:

1) How can someone go from severe to mild sleep apnea within a few years?? I have NOT lost any weight nor have there been any significant life changes. I have been to 2 sleep experts and no one can explain how this happened. 

2) Is there any possible long-term physiological side effects from being over-titrated and being treated for central sleep apnea when I do not have it? The machine I used for years had two pressures to treat central arena, but I do not have central apnea. 

I am deeply upset and angry that doctors would not consider treatment emergent sleep apnea as a possible cause. The doctor I recently saw, made some changes to my APAP machine as he felt I was being over-titrated as some setting was higher than needed, even though the typical pressure did not go over 8 since it was APAP. The first titration study showed an unusually high number of centrals that another doctor said would have set off red flags in his mind, but not the prescribing doctor. This makes me very angry. 

Thanks,
Helen
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#2
RE: Sleep apnea from severe to minor??
Welcome to the forum.

If you would like our opinion on your sleep studies post them here, we are IMHO very good at reading them. I'll ask for the full study, not just the summary. You would be surprised at how often important info is missing from the summary.

We give our best advice when we see daily data from OSCAR. Organize per my signature.

You say that you are/we're on an APAP. I'll assure you that there is no way to get an APAP, CPAP, or normal BiPAP/BiLevel to treat Central Apnea. Treatment of Central Apnea with these machines is by Avoiding the Central Apnea. These Auto machines are designed to do NOTHING if a Central Apnea is detected.

Well done on recognizing treatment emergent Central apnea as the likely cause . I would likely have suggested reducing epr/flex, a narrow pressure band, and a somewhat reduced pressure with close monitoring for several months followed by readjusting your settings as the Centrals reduced

Helen here are responses to your questions.
1: between my two diagnostic Sleep Studies my AHI went down about 20. I'm still severe at 77 AHI. Two main reasons, the first study I was never treated prior to it. I had built up impact from I'm sure years of severe sleep apnea. Second is that a Sleep Study is but a snapshot, a single night. And not necessarily a typical night. Also for the second sleep study you knew what was going to happen, a lot less anxiety.

2:. First realize what the pressures actually are. Get a tall glass of water straw. I definite tall glass as 8 inches of water. Now blow bubbles into the bottom of the glass. That is the maximum, the maximum, amount of pressure a CPAP is capable of producing. The higher risk is in having a high differential or pressure support (PS) say 12+/- on a timed basis which is what is done for COPD. Your APAP can only produce 3 and no timed breaths.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: Sleep apnea from severe to minor??
(06-03-2019, 03:16 AM)Sleepless12 Wrote: 1) How can someone go from severe to mild sleep apnea within a few years?? I have NOT lost any weight nor have there been any significant life changes. I have been to 2 sleep experts and no one can explain how this happened. 

Maybe your tonsils were swollen the first time. Anything like that could have done it. Also, medications that cause muscles to relax can make apnea worse.

Quote:2) Is there any possible long-term physiological side effects from being over-titrated and being treated for central sleep apnea when I do not have it? The machine I used for years had two pressures to treat central arena, but I do not have central apnea. 

No. The two pressures are the minimum and the maximum. The machine operates somewhere between these two pressures in an attempt to keep the pressure low unless higher pressures are needed to treat obstructive apneas and hypopneas. This machine is not treating central apnea, it's not designed for that purpose.

Quote:I am deeply upset and angry that doctors would not consider treatment emergent sleep apnea as a possible cause. The doctor I recently saw, made some changes to my APAP machine as he felt I was being over-titrated as some setting was higher than needed, even though the typical pressure did not go over 8 since it was APAP. The first titration study showed an unusually high number of centrals that another doctor said would have set off red flags in his mind, but not the prescribing doctor. This makes me very angry. 

The data collected by your machine will help us address these issues. Once we know what's going on it will bring you some peace of mind that the doctors have not been able to provide.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#4
RE: Sleep apnea from severe to minor??
(06-03-2019, 08:11 AM)Sleepster Wrote:
(06-03-2019, 03:16 AM)Sleepless12 Wrote: 1) How can someone go from severe to mild sleep apnea within a few years?? I have NOT lost any weight nor have there been any significant life changes. I have been to 2 sleep experts and no one can explain how this happened. 

Maybe your tonsils were swollen the first time. Anything like that could have done it. Also, medications that cause muscles to relax can make apnea worse.  

Response: My tonsils were taken out when I was 8 so that could not be an issue. 

Quote:2) Is there any possible long-term physiological side effects from being over-titrated and being treated for central sleep apnea when I do not have it? The machine I used for years had two pressures to treat central arena, but I do not have central apnea. 

No. The two pressures are the minimum and the maximum. The machine operates somewhere between these two pressures in an attempt to keep the pressure low unless higher pressures are needed to treat obstructive apneas and hypopneas. This machine is not treating central apnea, it's not designed for that purpose.

Response: I was put on a very high pressure of 19 prior to being switched to the APAP. My question is, for the couple of weeks that I was over titrated, could that have caused any physical harm. I felt like I was drowning and woke up with severe gas and dry throat. The docs refused to do anything about it until I made it clear that I would stop therapy if they do not reduce the pressure, that's when they put me on an APAP. But I used a steady pressure of 19 for a couple of weeks at least. 

Quote:I am deeply upset and angry that doctors would not consider treatment emergent sleep apnea as a possible cause. The doctor I recently saw, made some changes to my APAP machine as he felt I was being over-titrated as some setting was higher than needed, even though the typical pressure did not go over 8 since it was APAP. The first titration study showed an unusually high number of centrals that another doctor said would have set off red flags in his mind, but not the prescribing doctor. This makes me very angry. 

The data collected by your machine will help us address these issues. Once we know what's going on it will bring you some peace of mind that the doctors have not been able to provide.

Response: My typical pressure was 8 but the doc refused to see the success of the treatment because the first lab study showed 19. When the second study showed a max pressure of 8, he finally gave in. 

I cannot find comfort in knowing what I know now because they grossly misdiagnosed my sleep apnea. I was way over titrated for a while and I wonder if some of the breathing issues I have developed are a result of it. 
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#5
RE: Sleep apnea from severe to minor??
(06-03-2019, 06:50 AM)bonjour Wrote: Welcome to the forum.

If you would like our opinion on your sleep studies post them here, we are IMHO very good at reading them.  I'll ask for the full study, not just the summary. You would be surprised at how often important info is missing from the summary.

We give our best advice when we see daily data from OSCAR. Organize per my signature.

You say that you are/we're on an APAP.  I'll assure you that there is no way to get an APAP, CPAP, or normal BiPAP/BiLevel to treat Central Apnea.  Treatment of Central Apnea with these machines is by Avoiding the Central Apnea.  These Auto machines are designed to do NOTHING if a Central Apnea is detected.

Well done on recognizing treatment emergent Central apnea as the likely cause .  I would likely have suggested  reducing epr/flex, a narrow pressure band, and a somewhat reduced pressure with close monitoring for several months followed by readjusting your settings as the Centrals reduced

Helen here are responses to your questions.
1: between my two diagnostic Sleep Studies my AHI went down about 20.  I'm still severe at 77 AHI. Two main reasons, the first study I was never treated prior to it.  I had built up impact from I'm sure years of severe sleep apnea.  Second is that a Sleep Study is but a snapshot, a single night.  And not necessarily a typical night.  Also for the second sleep study you knew what was going to happen, a lot less anxiety.

Response: Thank you for sharing your experience. Mine went down 47 points! I still feel like someone made a mistake with the first one.

2:. First realize what the pressures actually are.  Get a tall glass of water straw.  I definite tall glass as 8 inches of water.  Now blow bubbles into the bottom of the glass.  That is the maximum, the maximum, amount of pressure a CPAP is capable of producing. The higher risk is in having a high differential or pressure support (PS) say 12+/- on a timed basis which is what is done for COPD.  Your APAP can only produce 3 and no timed breaths.

Response: What makes me concerned is the fact that I need a pressure of only 8, but for weeks I was given 19 which did not allow me to sleep or caused all kinds of physical symptoms. I just wonder if there are any long-term health effects as I've had breathing problems on occasion after that experience that have not gone away. 


Fred
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