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Central Apneas/Daytime Breathing - Robosaur - 07-21-2021

Hi all,

I was diagnosed with sleep apnea ten years ago and have been using a CPAP since then. I've never been too happy with my AHI, but it's been really high lately. I've been averaging 21 AHI the last 30 days - last night was almost 27. More than half of the events are clear airway and obstructive apneas are usually below 3 events per hour. I tend to have the highest number of events while falling asleep and before waking up. I often have difficulty breathing while awake. I'll hold my breath and then try and get a good sigh/yawn in. My primary tried a few things (inhaler, allergy meds), but so far it's being pinned on anxiety.

I have been on anxiety/depression meds and am currently off due to participation in a research study. My AHI has been a bit higher since I've been off them, so I wonder if they were helping to manage central events somehow. 

I'm wondering if there's a connection between breath holding in the daytime and apnea at night, especially since so many events happen while I'm still awake. I would assume the health implications of breath holding are similar whether it happens during the day or night.

I have an appointment with a new sleep doc at the end of August. I'm hoping there's some breadcrumbs I can bring her to discuss possible treatments. Any advice?

Thanks in advance

[attachment=33978]
[attachment=33979]


RE: Central Apneas/Daytime Breathing - Gideon - 07-21-2021

the Standard daily OSCAR chart, please. We really, really need to see your settings.
I have a strong suspicion that you are experiencing a form of positional apnea. That you are tucking your chin and in the process kinking the garden hose we call a windpipe.
A pillow change may help, think flatter and less firm, one pillow instead of two. Many find that a soft cervical collar works. Read the Collar wiki linked in my signature.


RE: Central Apneas/Daytime Breathing - SarcasticDave94 - 07-21-2021

Yes I do breath holds while awake and have high CA if not treated.


RE: Central Apneas/Daytime Breathing - Robosaur - 07-21-2021

Thanks. Here's what I believe is the standard view. Let me know if there's something I'm missing.

[attachment=33986]

Would a kinked windpipe show up as clear airway events? I did have a lot of central events on my initial sleep study.

Can I ask how you're treating your CA? Does that have any impact on your daytime breathing?

Thank you


RE: Central Apneas/Daytime Breathing - Robosaur - 07-21-2021

Can I ask how you're treating your CA? Does that have any impact on your daytime breathing?


RE: Central Apneas/Daytime Breathing - SarcasticDave94 - 07-21-2021

My circumstance is extremely complicated, so just a thumbnail sketch for you. I used a ResMed ASV for CA control while asleep for about 2 years. My CA was revealed to be 124 to 24 OA in a 2017 sleep diagnosic. During that time, my daytime breath pauses seems to have diminished possibly due to that. Nighttime events all were 3.0 or less, overall AHI also 3.0 or less, on OSCAR. I now also have COPD, and ASV hasn't worked with this rare combo. Johns Hopkins Baltimore is now my pulmonary team.


RE: Central Apneas/Daytime Breathing - S. Manz - 07-22-2021

Hello;
Like most all of us here, I am not a medical doctor but I have researched sleep apnea religiously for the past few years.
From what you are describing and several studies that have been conducted in recent years, there is a high possibility that people with 'Obstructive Sleep Apnea (OSA)", who go on CPAP use, will develop Complex Central Apnea (CSA) after a prolonged use of CPAP. 
I doubt that consciously holding your breath in the day, will cause CSA and can't find anything relative about that, online.

This being said, CSA therapy will require a different machine (ASV or Auto/Adaptive Servo Ventilation), however these machines are considerably more expensive than normal Auto PAP machines and your healthcare practitioner must first diagnose your CSA and then prescribe it, before your insurance pays for it and even then you might get some resistance from the insurance company depending on your type of coverage.

Here is how Complex Central Apnea was first discovered:

https://www.sciencedaily.com/releases/2006/09/060901161349.htm


RE: Central Apneas/Daytime Breathing - Gideon - 07-22-2021

What the article describes as complex sleep apnea is what we call treatment emergent sleep apnea.

It is not apparent on initial CPAP use and the frequency of sleep tests I believe are the source of the long term.

We look at a titration test and see little to no central, more so on a diagnostic test. Shortly after starting CPAP we see clusters of CA, typically CO2 driven, appear.

I am assuming beings study something maybe every month in the lab to track progress. I seriously doubt every night is a PSG.

Obviously I have no proof, and based on that article, which was a good read btw, neither do you. I do appreciate the history of it.

Thanks.


RE: Central Apneas/Daytime Breathing - S. Manz - 07-22-2021

(07-22-2021, 07:58 AM)Gideon Wrote: Obviously I have no proof, and based on that article, which was a good read btw, neither do you.  I do appreciate the history of it.

True indeed.
Problem with Central is that it appears that research around it hasn't touched on demographics or the size of the disorder among mass populations.
That being said, I agree that not ever night is a CSA night as has been the case for myself as a long term CSA patient. I tend to go through a phase where I get into high frequency CSA episodes for several nights in a row and then nothing for a week or so, without any changes to my diet, stress level, drug intake etc etc.
Very frustrating at times.


RE: Central Apneas/Daytime Breathing - SarcasticDave94 - 07-22-2021

CA is just another Apnea group all its own. Since most doctors wouldn't know what it was when it bit their leg. Just don't hold your breath on wishing it gets easier. Self Advocate.

Coffee mmm