I'm a 29yo male, computer nerd by trade during the day, volunteer firefighter, pretty active (gym 3-5 times a week, run 3-4 miles a couple times a week and various cardio, moderate lifting), I'm married with a 3yo and a 1 year old.
So, about 9 months ago I gutted a bathroom in my house then chopped about 2 cords of firewood, the next day I had some chest pain. Being an EMT I wasn't concerned, figured it was muscular, life went on. Well after a couple of weeks of this, feeling anxiety about it, and being scared (and a cardiac history in my family), I decided to get a full workup to ease my mind. See cardiologist, Nuclear stress test with imagery and an Echo. Stress test came back normal (except I had some PVCs) and echo showed Mild Pulmonary Hypertension, systolic pressure of 43 (this was after the stress test which may have increased the pressure slightly too).
First question doctor asks me, do I have sleep apnea. I laughed at her, absolutely not, I barely snore. Asked my wife to listed to me at night, she doesn't notice anything weird. Life goes on. I did start using breathe right strips at night and thought I felt better. I'm a mouth breather at night, probably because of a deviated septum which I'm seeing an ENT for in 2 weeks. So, for 9+ months I continue to worry about this, it consumed me. I started paying attention to my sleep and noticed that I would wake myself up at night, so sleep study here I come.
I've had 2 so far, and don't have the results in front of me but here they are in a nutshell (off the top of my head, sorry)
FIRST STUDY, NO CPAP
AHI was 18.2
Obstructive apnea - 8
combination - 2
Central - 17
hypopnia was in the 60's I believe
02 average was 97
average Desat was 93
Low was 88, 1 time
Pulse was 60
Normal sinus rhythm
SECOND STUDY, CPAP
AHI was 7, it took a while to dial in pressure, I didn't sleep well, was very anxious, and daylight saving time took an hour away
Obstructive Apnea - 0
Combination - 0
Central - 11 (only 1 at pressure 9)
Hypopnia - 40, don't know how many at right pressure but it wasn't many
02 average was 97 and I did not desat at pressure 9
Low was 89 in beginning while dialing pressure
Pulse was 59
Normal Sinus Rhythm
Diagnosis was Moderate Obstructive Sleep Apnea, and a couple other things that go with it.
I read my reports and the centrals scared the living daylights out of me. Obstructive is physical, central is the brain. I talked to the Tech and he said that wasn't abnormal and AHI with central was 2, and most people who have obstructive will have some centrals. He also said they can be hard to interpret sometimes but they lean on the side of caution when doing the reports. He also mentioned that during cpap, my body may be used to a certain CO2 level at night, and with CPAP keeping 02 up and CO2 down because of normal breathing, my body may pause as its not used to the numbers but it should resolve itself. Nothing in diagnosis said anything about Central. But its still worrisome.
So, I've been on CPAP for 2 days now, I've noticed I'm dreaming a lot more, AHI on machine (phillips cflex+ super cpap :-D and resmed quatro face mask), AHI has been 8.2 and 10.2 respectively (seems high). My BIGGEST problem is I'm a mouth breather, as I mentioned earlier, and have very sensitive gums because of dryness at night. With cpap and mouth breathing, I've NEVER had such a dry mouth, my gums hurt in the morning, its not been good and I see that getting worse.. Brushing hurts, so I don't get it as good as I should, and its all downhill from there. I wonder if all this started when I had my wisdom teeth removed???
So, long story short, the centrals scared the daylights out of me (should they, I was told they are not abnormal)
I have a very dry mouth
AHI on machine still seems high but its only a couple of days
I've noticed I may pause breathing as I'm falling asleep, normal in the beginning of cpap?
I have an appointment with a sleep apnea dentist this Tuesday, I want to explore my options.
I have an appointment with an ENT in 2 weeks to see about deviated septum and removing vital parts in my throat?
I really am struggling with this whole thing, but I know it is the cause of the pulmonary pressure and probably some of my restlessness during the day.
You are in the right place.
Dry mouth? try and get more humidity out of that machine. (I am building an augmented humidifier at the moment!)
You might need some moisturizing mouth wash too or mints with xylitol in them.
Your obstructive apnea therapy looks good though. I think you are minimizing those which is good!
As for central apneas:
If you are getting *REAL* centrals they will be accompanied by at least a 10% drop in O2 saturation.
The reason they are called 'centrals' is because they are based in the central nervous system (brain/spinal cord)
Don't freak out yet unless you start getting deep O2 desaturations along with the suspected apnea event. ie: the machine cant compensate for neurological issues. So that may be why your doc says no worries.
Also keep in mind that you are having to adapt to the therapy. After the adaptation is past you can be on lookout for any centrals that may show up by running your own data logging pulse oximeter in parallel with your CPAP data.
As usual, if I say anything incorrect here, any MD's out there please swat me with a newspaper.
Good Luck, wojo!
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton
well, I only desaturated from 97 to 88 1 time during both sleep studies, most were 97 to 93. At 9cm of air, they said I never desaturated beyond 97%, even with the 1 central that they noted in the sleep study.
I'm using the humidifier that comes with the Philips respironics...even at 5 still dry mouth. I'm not a big fan of the warm air blowing in my mouth either, but I probably need to get used to it.
Yah, living in the swamps here, I don't like warm air in the chops either but I hate waking up with the parched mouth. BLEAH.
I'm getting used to the warm air bit though, my big problem is that the S9 humidifier only holds 480ml of water.
This is NOT SUFFICIENT! I run dry in about 5-6 hours sometimes.
I am trying to build an extended long range tank for my set up. One that can hold an additional 650ml. That should hold me all night.
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton
WELCOME! to the forum.!
You've come to the right place to learn about sleep apnea, as you have no doubt, found out, there is lots of information here. Hang in there for more suggestions.
Best of luck to you.
Thanks Everyone, I'm a little anxious about the "central" results, if I can get any more insight on that?
Welcome, wojo. Just a couple of thoughts in response. Throwing a few PVCs during a stress echo is not a problem, I was told following a recent one myself during which I had some PVCs.
My understanding is that current machines attempt to detect centrals, but it's not yet a developed technology. ResMed doesn't use the name central. Instead, they describe the machine's ability to detect clear airway events, which are sort of open for interpretation.
I have few centrals, but others on the board have more and as a result know more about it. I do know there are machines available that are specially designed to treat centrals.
As far as AHI, you are apparently aware that the goal is under 5.
Finally, others will also tell you that adjusting to xPAP takes time. What's important is longer term numbers. A few nights' data can be misleading. My numbers can vary a fair amount from night to night, and I'm not alone.
Hope this helps a little.
Central events are to be concerned about. Increased count of them with CPAP use is also common. You've only used the machine for 2 nights.
Here's my advice:
- Try to stop worrying. I know, easy to say, hard to do. But the worry is affecting your sleep.
- Give it time. Use your machine, faithfully, for ten days or longer. It will take at LEAST that long for your body and brain to settle into the new normal.
- Your profile says you use Onkor software. View the data each day. How many events? How long do they last?
- Toss into the mix a report of how you are feeling. AHI is just one part of a big picture. Start a sleep diary. Note the stress level of the day, if you did anything new (new food, new drink, new stress), and how you feel overall. The next morning, note how you feel when you woke up, what the dreams were like (if any).
- With your O2 sats being normal with CPAP use despite the central events, your concern over them is misplaced for now. Only time will really tell how you are doing.
- Also, consider not doing too many things at once. You just got your machine. Try it for a while before you try the dental device. Your AHI is low even before CPAP and a dental device may help you. If you decide to go that route, invest in an oximeter. You won't know if it is working if there's no way to track it. The oximeter will show you if your O2 drops, which it shouldn't if the dental device is working.
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Breathe deeply and count to zen.
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Do not let them do any cutting on your throat until you've tried everything else. Some ENTs are really chop happy. Success rates are low and the surgeons definition is a lot lower than the patient's definition of success. Side effects are permanent, and may be severe.
Be especially reluctant to get what's called UPPP.
Deviated septum surgery may be worthwhile even if you don't have apnea, if it's bad enough.
First, we need to know which CPAP machine you have. What does it say near the display? Something like REMstar blablah.
Also take out the water tank so you don't damage the machine and look on the bottom of the blower unit for a number like REF 560P.
Centrals aren't necessarily any more harmful than obstructives. The problem is that they're harder to eliminate. If you were given a good CPAP machine, you can monitor your results at home and tell how bad your apnea is.
Your body doesn't care whether it's central or obstructive apnea. The harm comes from stopping breathing.
Even if you do have too many central apneas, you can usually fix that with a more complicated ASV machine. It's harder to get used to and harder on your wallet, but it generally works.
Get the free SleepyHead software here
for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
FYI device is a REMstar PRO c-Flex+ with a heated humidifier. REF 460p...is this a good machine?
I've looked on onkor.net and pulled in last nights files but I'm only getting like 20-30 minutes of data, not the whole night. The file size is like 60K and another is 50K...I turned it off at 3am. Was at the firehouse and got a call. Seems like its missing a lot of data?