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visionoftruth · Post by **visionoftruth** » Sat Dec 16, 2006 7:29 pm

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Snoredog · Post by **Snoredog** » Sat Dec 16, 2006 7:45 pm

You cannot tell on your own if you have central apnea vs. obstructive.

The machine you have does NOT record any events, reason it doesn't have a SmartCard. You should obtain the copy of the report that came from the Sleep Lab to the doctor. It should be several pages long.

Do you have a GP that is acting as traffic cop to all these specialists? If not, you should have.

I would inquire about your heart. For example an irregular heartbeat can cause orthostatic hypotension and you can pass out or faint (syncope) at the snap of a finger, different than narcolepsy, I would think seeing a Cardiologist for the Hypotension would be the wisest thing to do. Sometimes a pace maker is called for. Hypotension can be more dangerous than having Hypertension.

jules · Post by **jules** » Sat Dec 16, 2006 7:46 pm

OSA is a lot more common than CSA but you should ask your doctor to go over the graphs with you from the sleep study if you feel you were misdiagnosed. If that doesn't work out, you could probably find another sleep doc (different practice for example) and pay them to interpret your sleep study.

A plus will not give any data that is more than compliance. It needs a separate card holder and all that card can do it change the prescription for the machine and record compliance. As you observed the m series pro will give AHI data as will the remstar classic Pro 2 (but not the classic Pro).

Goofproof · Post by **Goofproof** » Sat Dec 16, 2006 7:51 pm

The machine you have wouldn't record what you want. Also if you had one that would you would have to buy the software and reader.

Your first problem is to keep the mask on and sleep all night. Without that you can't treat apnea. CPAP won't do much good for Centrals, your lungs have to get a signal from your brain to breath, CPAP, holds your airway open so you can breath. Jim

offlineon · Post by **offlineon** » Sat Dec 16, 2006 8:44 pm

My wife will tell me I wake up all the time gasping for air and I can remember it happening and I will move and spring from the bed.

Definitely see a heart specialist. In your shoes I'd arrange for a passive echo-cardiogram and a ECG halter a.s.a.p (through your neuro if necessary), so you are fully armed with enough info for your cardiologist to make an initial assessment quickly. There is no point being miserable when there are medications which can help make you feel a whole lot better.

PS: usual disclaimer; I am not a medical Dr etc.

visionoftruth · Post by **visionoftruth** » Sat Dec 16, 2006 11:53 pm

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offlineon · Post by **offlineon** » Sun Dec 17, 2006 3:49 am

visionoftruth wrote:I guess it might take more consultations or second opinions with more studies to find out.

Snoredog said it. "You cannot tell on your own if you have central apnea vs. obstructive".

Please stay on subject with sleep apnea I have had an extremely ivestigated workup and know a ton about healthcare at this point.

Sorry - I realise you are frustrated, but you introduced the other symptoms. Some are not "typically" associated with CSA AFAIK.

Do i need to request a different model for control over the data? I probably am stuck with the one i got for insurance purposes.

Many people here have bought out of pocket. I bought the best machine I could afford, a Remstar BiPAP Auto, and find the data invaluable.

Are you guys taking your prescrptions and purchasing devices out of pocket for these nicer setups?

Some have been successful insisting for better machines than the ones they were first offered.

I hope you are able to find an answer to you health issues soon. Good Luck!

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CSA, auto

kteague · Post by **kteague** » Sun Dec 17, 2006 9:21 am

You seem to be a person who doesn't just accept blanket answers from your medical providers and wants to truly understand all that is going on. That trait is a two edged sword. On one hand it has literally saved people's lives by avoiding mistakes, misdiagnosis, or missed diagnosis. On the other hand, that nagging gut sense of not yet having the full answers can drive people like me to distraction, because the wondering is often more troublesome than facing the answers. I don't want doctor's opinions on what my symptoms could represent, I want to see test results in black and white with conclusive answers. Ten years into all this sleep disorder stuff, I still don't have all the answers to satisfy my sense that my medical file is stamped INCOMPLETE, but it's just been this past year that I've known enough to hone in on some of the issues.

It is great that you are proactive in your treatment. Having your complete sleep study results in hand will help you direct your probing. On a few points in your original post...

...The relationship between weight and OSA is often but not always absolute. If weight wasn't the only contributing factor in causing OSA, losing weight won't make it disappear.

...An inconclusive study will undermine your confidence in your therapy. You could go the route of titration with an autopap and monitoring your data, but that will still leave your concerns about centrals largely still inconclusive and untreated if valid. If after reviewing your tests from both the diagnostic and titration studies you are not satisfied that they fully represent your situation, maybe another one will answer your questions. Even among centrals, a person can have them due to other medical conditions or be neurologically based, or they can be pressure induced. Comparing your two studies with a professional you trust should help.

...Taking the mask off and/or struggling to breathe are not uncommon. It could be be getting familiar, or the pressure is not right for you or there may be a setting that is incorrect on your machine. More details on your settings and the timing of your symptoms could help those on here who have dealt with that pinpoint some possible causes.

...By the virtue of sleep apnea happening while we are asleep, the occasional awakenings that are dire enough for us to jump up or sit up or cough represent just a few of our nightly episodes. I personally wouldn't put too much stock on how I was awakened, as it can be influenced by position and cause. People with vocal cord issues or GERD may describe something different those with a floppy throat tissue, but that's all so subjective I doubt it can be more than a small piece of the puzzle.

For me the bottom line is that it has been proven I have OSA, so I need to treat that. Is it complicated by other issues, yes, but that doesn't negate the fact that I need to treat my OSA. That piece of the puzzle is the cornerstone. Best wishes on narrowing the field while tweaking your OSA treatment.

Kathy

christinequilts · Post by **christinequilts** » Sun Dec 17, 2006 11:01 am

Actually what you described sounds more like OSA to me then CSA. I can't remember anyone mentioning jumping up out of bed to breath from a central event or even describing gasping as a result of central events. I know for myself with severe CSA/ComplexSA, that when I wake up to breath, its always been very calm, quiet & serene...to the point that when I was on BiPAP ST, that it would take me a while to figure out why I was awake & 'not breathing' was pretty far down on my checklist. With centrals, there isn't the struggle to breath that there is with obstructives, because nothing is preventing breathing.

Another big clue that you are having obstructive episodes is your original study showed significantly more hypopneas during REM then nonREM sleep- nonREM AHI 13 & REM AHI 45. OSA events are typically higher in REM, where CSA events are higher in non-REM or at least about the same in REM/nonREM. You said you only have 14 hours on your CPAP, over how many days/weeks? No matter what, even 14 hours in one night is not enough to determine if its helping or not. A lot of people go through difficult adjustment periods, the important thing is not to give up- not using xPAP cannot be an option. If you take if off during your sleep and you notice it if you wake up during the night, put it back on. If your wife wakes up & notices you've taken your mask off, tell her its okay to wake you up to put it back on. You may need to wear it for an hour or so before you go to bed, so you can get use to how it feels. Check with your DME about trying different masks- the mask is the most important part at this point. Weight along does not determine OSA or its severity- there are extremely skinny people with OSA, just as there are overweight people who do not have OSA.

You mentioned problems with the arteries in your stomach? Do you mean in your esophagus? That could very well explain why you have instances of springing out of bed, from the effect of stomach acid reaching your throat- and that same stomach acid also leads to damage of the arteries in the esophagus over time. Worsening acid reflux/GERD could also explain why your apnea is appearing to get worse, even as you lose weight, as the acid can also damage your vocal cords, which clamp down, making it difficult to breath, as they obstruct your airway. You may want to Google Vocal Cord Dysfunction & GERD to see if any of that information helps. VCD could also explain the difficulties you are having with breathing during the day.

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Obstructive vs Central