Can someone interpret these results?

[Firehope]

I couldn't sleep well during my second sleep study, so the results weren't that great. My doctor told me he had to guess a pressure, or I have to go back for another night (which I didn't really want to do), so I asked him to guess one. He guessed 14.

Here is my first good (~7 hour sleep) results with my APAP machine (not embedding due to resolution of the image):
http://i54.tinypic.com/acwu1e.png

Are the results... good? I have no idea how to interpret these numbers, and whether or not I should increase my pressure.

[Pugsy]

Are the results... good? I have no idea how to interpret these numbers, and whether or not I should increase my pressure.

No. Don't increase your pressure. You are showing predominately centrals.

You have a 14 to 20 pressure range. It only once went tiny bit above 14.
Your leak is fine.

Way too many centrals and pretty much nothing else. Did you have centrals in your sleep studies?

Since the doctor was guessing at 14....I would reduce that minimum pressure and see if those centrals reduce (sometimes too much pressure can cause centrals or make them worse).
I would reduce minimum to 12....and see if the obstructives are still taken care of and see if the centrals are reduced.

We want a pressure high enough to take care of the obstructives but not make the centrals worse.
So in your case we want to go down and not up.
More pressure will NOT help those centrals and in fact could make them worse.

[Firehope]

Way too many centrals and pretty much nothing else. Did you have centrals in your sleep studies?

No central apneas during sleep study:

368 obstructive apneas, 11 mixed apneas, 0 central apneas, and 30 hypopneas, represent an AHI of 87.8 (severely elevated). In addition, there were 75 RERAs resulting in an RDI of 103.9.

Unless mixed = obstructive and central...

I see that OA (Obstructed Airway Apnea) is quite literally 0, and CA (Clear Airway Apnea) is high. I suppose Clear Airway Apnea = Central Apnea, when apnea occurs during a "cleared airway"? My, that's actually an issue (considering how in the first sleep study with no CPAP resulted in the above, 0 central apneas).

How is it that I had 0 central and now I'm having almost 25 centrals now? >.>

Thank you =).

[Pugsy]

How is it that I had 0 central and now I'm having almost 25 centrals now?

For some people cpap pressure induces centrals.. Normally seen on the titration part of a sleep study but not always, especially if a poor study. I think I read where the percentage of people who do develop centrals with cpap use (and zero history otherwise) is about 10 to 15 %. Not rare but not all that common.

Sometimes reducing the pressure will go below the pressure threshold that triggers the centrals.
Since your obstructive component is obviously pretty much nil at 14 cm minimum and no increases really then machine didn't feel the need to increase pressure for the obstructives. It won't do anything for the centrals as it is not supposed to. So hopefully you have some wiggle room between the pressure needed for the obstructives and not make the centrals pop up. Now if you were still having a truck load of obstructives at this pressure....whole different story.

I would for sure inform the doctor about this development and I would reduce the minimum pressure to see if I could reduce the centrals and not increase obstructives. Sometimes centrals will develop with cpap therapy and go away on their own with time. Your central component is not humongous but it is enough I would want to try to reduce it if it were me if I could do it without causing a truck load of obstructives.

[robysue]

Way too many centrals and pretty much nothing else. Did you have centrals in your sleep studies?

No central apneas during sleep study:

368 obstructive apneas, 11 mixed apneas, 0 central apneas, and 30 hypopneas, represent an AHI of 87.8 (severely elevated). In addition, there were 75 RERAs resulting in an RDI of 103.9.

Unless mixed = obstructive and central...

Yup, that's exactly what a mixed apnea is: One that starts off looking like a central (i.e. there's no effort to breath) and then once an effort to breath resumes, there's still no air getting through a blocked, obstructed airway, so it ends looking like an obstructive apnea.

I see that OA (Obstructed Airway Apnea) is quite literally 0, and CA (Clear Airway Apnea) is high. I suppose Clear Airway Apnea = Central Apnea, when apnea occurs during a "cleared airway"? My, that's actually an issue (considering how in the first sleep study with no CPAP resulted in the above, 0 central apneas).

The clear airway apneas are typically presumed to be central in nature. But since your machine does not have the belts around your chest and abdomen, there's no way to prove that they are central---in the sense of there being no effort to breath.

How is it that I had 0 central and now I'm having almost 25 centrals now? >.>

Higher pressures (as in above 10) can induce central apneas to start occurring in some patients with OSA. In a good titration (i.e. one where you actually sleep), if centrals start appearing at a particular pressure level, the tech has an algorithm to follow for trying to determine how well the OAs can be controlled with the CAs not becoming a problem. If the OAs cannot be controlled without triggering large numbers of CAs, the diagnosis of OSA from the diagnostic study may be changed to CompSA (Complex Sleep Apnea) after the titration study. And CompSA can be a challenge to treat because in CompSA, there's a delicate dance that must be done: Ideally you want to find a pressure high enough to bring the OAI down to below 5 without inducing large numbers of CAs.

And you said it yourself, you didn't have a "good" titration study because you slept too little. And so the doc is taking a guess for what pressure you need. It could well be that if you'd slept for a long enough period of time at 14cm that the centrals might have started occurring during the titration study. But you didn't sleep well enough for the titration study to reveal much about how much pressure might be needed to control the OAs without triggering CAs.

Like pugsy, I'd think about lowering that min pressure a bit and see if the number of OAs stay low and the number of CAs starts to decrease.

[Firehope]

I see. Alright, thank you very much, pugsy and robysue. I'll try reducing it down to 12 tonight, and see if the numbers are any better. If I encounter any unknowns, I'll post here again =P.

[Lizistired]

Hell, I could guess a pressure for you! What did he get paid for that?

[Firehope]

Hell, I could guess a pressure for you! What did he get paid for that?

lol my co-pay is $20, so at least $20? =P

Seriously though, the results from the second sleep study (one with CPAP) is terrible, less than 10 minutes of sleep for pressures above 10 (the most was 234.5 minutes of sleep at a pressure setting of 9, which resulted in 56.7% of sleep, so it's too low).

Pressures 12 = 6.5 minutes and 100% sleep, 13 = 8.5 minutes and 88.2% sleep, 14 = 9.5 minutes and 100% sleep, 15 = 4 minutes and 100% sleep, all with 0 CA/OA/MA/Hyp/AHI/RERA/RDI.

I don't know why the sleep technician did it like that...

[Pugsy]

Pressures 12 = 6.5 minutes and 100% sleep, 13 = 8.5 minutes and 88.2% sleep, 14 = 9.5 minutes and 100% sleep, 15 = 4 minutes and 100% sleep, all with 0 CA/OA/MA/Hyp/AHI/RERA/RDI.

I don't know why the sleep technician did it like that.

Did it show AHI results for pressure of 9? 10? 11? I don't know where he was going with that..
From this data 12 cm would be fine... Sounds like maybe spent a lot of time at 9 for whatever reason then started playing around with stuff. Maybe the % of sleep being so much less indicated lots of fragmented sleep during that time so couldn't get a good handle on pressures and events.

If you have a report showing 0 AHI and 0 centrals at 10 cm.... heck drop that minimum to 10.. maybe even 9 if there is not much obstructive AHI going on at 9.

[Firehope]

Did it show AHI results for pressure of 9? 10? 11?

Here's the table (typed out in MS:Word, screencapped and up'd):

[Pugsy]

Here's the table (typed out in MS:Word, screencapped and up'd):

It's hard to compute an AHI (hourly index) when one only has a fraction of an hour to compute from so they extrapolate.
Hard to say what happened at 11 cm. Could have been a fluke...who knows. When we extrapolate sometimes it looks worse than it really is. Meaning those 9 minutes might have been ugly but if things had progressed they could have settled down and overall it wouldn't have been so ugly.

You know if it were me...and I have been known to be a maverick....so take that as you will... I would start off with 10 minimum. I like to use as low of a pressure as possible that will get the job done. No sense in using the atomic bomb to kill that fly when you could just use a fly swatter. You can always go up depending on what we might see. Depending on your other sleep study particulars perhaps you are worse REM (it is common) and the AHI zeroes are because of no REM due to fragmented sleep.

It is hard to get a true idea what goes on when we sleep during these sleep studies.. Foreign bed.. foreign surroundings.. poor sleep..fragmented sleep...all those wires..etc. Then when we get in our own home and our own bed we get our true sleep pattern.

Looks to me like you are going to have to do a bit of self titrating. Not hard to do and you will quickly see what works and what does not work. For sure reduce minimum to 12 and if you are up for it 10... Plus you can always use 12 and try 10 later.

[Firehope]

It's hard to compute an AHI (hourly index) when one only has a fraction of an hour to compute from so they extrapolate.
...
Looks to me like you are going to have to do a bit of self titrating. Not hard to do and you will quickly see what works and what does not work. For sure reduce minimum to 12 and if you are up for it 10... Plus you can always use 12 and try 10 later.

Yea, the low time = bad data =P. It's a good thing I went with an APAP then, I suppose, so I can see all these data xD.

I'll start it off at 12 for tonight (middle grounds of 10 and 14), and deduce what to do from there. If I need further help, I'll post here, or ask my doctor.

Thank you, Pugsy =).

[Pugsy]

I'll start it off at 12 for tonight (middle grounds of 10 and 14), and deduce what to do from there. If I need further help, I'll post here, or ask my doctor.

Sounds like a good solid plan to start out. I think you have a good idea what to look for. Mostly this is common sense anyway. We are always here to bounce ideas off.

FWIW.. I had horrible titration study also. Grand total of 156 minutes of horribly fragmented sleep.
My OSA is much worse in REM sleep and I got maybe 6 minutes of REM out of that 156 minutes. It's no wonder they didn't get my pressure right but in my case I had to increase the pressure.. Luckily centrals have never been an issue for me.

[Firehope]

My OSA is much worse in REM sleep and I got maybe 6 minutes of REM out of that 156 minutes. It's no wonder they didn't get my pressure right but in my case I had to increase the pressure..

Did you have to go in for another sleep study, or pretty much doing it at home like I am? o.O

And here are last night's results:
http://i53.tinypic.com/30croky.png

I guess 13 is the way to go! Have no idea why 12 is producing more CA than 13, and 13 is producing more OA than 12 >.>. Seems counter-intuitive.


P.S. Noticed that the times (especially from the previous one) is very wrong. Last night's report shows that I slept at ~2pm to 11pm on 9/21 hah. Google search shows that there's no way to change the internal clock. That's grreeaaattt -_-.

[Pugsy]

Did you have to go in for another sleep study, or pretty much doing it at home like I am?

At home.. No reason to think I could sleep any more at another sleep study. Took me a little over a week to get things dialed in once I had the software.

I guess 13 is the way to go! Have no idea why 12 is producing more CA than 13...

Are you basing this on the daily events numbers graph at the bottom of the report?
Please don't... it is misleading. You spent much more time at 12.. that is why the higher numbers.
MaP is Minutes at Pressure.. Just how many minutes you spent at that pressure. It would be a normal law of numbers thing for you to show more events at that number.
You need to go down...not up with the minimum.
Your Obstructive component on this report is still quite low. You have some wiggle room.
I would reduce the minimum to 11..see how the obstructive component does.

Also once we get these pressures to where we like them I would suggest trying straight cpap. APAP pressure swings upwards may not be the best thing with pressure induced centrals..