Hello!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
cnaumann
Posts: 205
Joined: Sat Oct 11, 2014 8:46 am
Location: Huntsville, AL

Hello!

Post by cnaumann » Fri Oct 24, 2014 1:52 pm

Hello Everyone-

My name is Charles. I have been lurking around here for several weeks. This is a great board, I have learned quite a lot.
My dad was diagnosed with OSA years ago. He has gone from CPAP to surgery and now to a BiPAP machine. It has helped him quite a bit so I am somewhat familiar with OSA.

A couple of years ago, I started experiencing daytime sleepiness to point where I was not functioning well. It continued to get worse and about six weeks ago I went to a sleep specialist for evaluation.

I have since been to two overnight sleep clinic and have a third appointment next week. I have not started any therapy yet. The sleep clinic appointments have not been going well. I don’t seem to have any trouble falling asleep but I have been having trouble staying asleep and getting into a deep sleep at the clinic. I have not talked to my doctor since the initial evaluation, so I am not entirely sure what the suspected diagnosis is.

I am an engineer, and I love gadgets and data. So I bought a recording pulse oximeter so that I could gather some baseline readings and keep track of my therapy.

The pulse oximeter has produced some rather interesting data, and I am starting to believe that it is somewhat atypical for OSA. I will try to post some plots later, but here is a description of what I am seeing.

Basically, right after I fall asleep and during certain parts of my sleep cycle I only breath about once every 45 seconds. My SpO2 level is a sawtooth. It peaks rapidly to about 98%, and declines slowly over the 45 second interval to a low of around 85%, then rapidly peaks back up to 97%. This repeats for about an hour until I enter the next sleep phase. In the other sleep phase, my SpO2 level is constant around 92%. The whole sleep phase cycle repeats several times in the night. According to my wife, I don’t really snore that much. I take a great gasping breath periodically and then don’t seem to breathe at all. Her description is consistent with what I am seeing on the SpO2 data.

In some cases, I go well over a minute without breathing. In one case during a sleep study I went well over 2 minutes without breathing (I think I had become hyper ventilated). The lowest SpO2 level I recorded was about 68%.

Is this atypical pattern of OSA? Obviously, I need to talk to my doctor and I will at my next appointment but I was wondering if anyone here might have some insight into this.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: Hello!

Post by Wulfman... » Fri Oct 24, 2014 2:57 pm

cnaumann wrote:Hello Everyone-

My name is Charles. I have been lurking around here for several weeks. This is a great board, I have learned quite a lot.
My dad was diagnosed with OSA years ago. He has gone from CPAP to surgery and now to a BiPAP machine. It has helped him quite a bit so I am somewhat familiar with OSA.

A couple of years ago, I started experiencing daytime sleepiness to point where I was not functioning well. It continued to get worse and about six weeks ago I went to a sleep specialist for evaluation.

I have since been to two overnight sleep clinic and have a third appointment next week. I have not started any therapy yet. The sleep clinic appointments have not been going well. I don’t seem to have any trouble falling asleep but I have been having trouble staying asleep and getting into a deep sleep at the clinic. I have not talked to my doctor since the initial evaluation, so I am not entirely sure what the suspected diagnosis is.

I am an engineer, and I love gadgets and data. So I bought a recording pulse oximeter so that I could gather some baseline readings and keep track of my therapy.

The pulse oximeter has produced some rather interesting data, and I am starting to believe that it is somewhat atypical for OSA. I will try to post some plots later, but here is a description of what I am seeing.

Basically, right after I fall asleep and during certain parts of my sleep cycle I only breath about once every 45 seconds. My SpO2 level is a sawtooth. It peaks rapidly to about 98%, and declines slowly over the 45 second interval to a low of around 85%, then rapidly peaks back up to 97%. This repeats for about an hour until I enter the next sleep phase. In the other sleep phase, my SpO2 level is constant around 92%. The whole sleep phase cycle repeats several times in the night. According to my wife, I don’t really snore that much. I take a great gasping breath periodically and then don’t seem to breathe at all. Her description is consistent with what I am seeing on the SpO2 data.

In some cases, I go well over a minute without breathing. In one case during a sleep study I went well over 2 minutes without breathing (I think I had become hyper ventilated). The lowest SpO2 level I recorded was about 68%.

Is this atypical pattern of OSA? Obviously, I need to talk to my doctor and I will at my next appointment but I was wondering if anyone here might have some insight into this.
Welcome to the forum.

What you've described seems to be somewhat typical of "sleep onset Central Apneas". Quite a few people have experienced them and/or seen them on their downloaded reports.

Depending on what your sleep studies showed will depend on the type of machine you get. If you have lots of Centrals, maybe an ASV type of machine may be what will work for you.

Lots of reading material here.......as you've probably already discovered.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Julie
Posts: 19898
Joined: Tue Feb 28, 2006 12:58 pm

Re: Hello!

Post by Julie » Fri Oct 24, 2014 3:07 pm

However... do not immediately think it means you 'have' central apnea. Many of us do have some centrals on going to sleep, and very often just before awakening, but it doesn't mean we have CA. That would be diagnosed only if you were to have very many (often in clusters) of those throughout the night, often more than you have obstructive events. You may already know this, but many newbies don't, and get fairly nervous at the idea of having a neurological condition that would not be treated the same as obstructive apnea is, and that indicates that your brain does not trigger normal respiration... but in fact it's pretty rare, but can still be treated by a relative machine of Cpap.

User avatar
Bill44133
Posts: 1087
Joined: Tue Jul 09, 2013 8:34 pm
Location: North Royalton, OH

Re: Hello!

Post by Bill44133 » Fri Oct 24, 2014 3:39 pm

Welcome to the forum. You are in a good place here.

Take 15 minutes and review this youtube video it will help you understand what is going on:
https://www.youtube.com/watch?v=-gie2dhqP2c

This video put the whole thing in perspective for me. I was able to show it to my family so they would understand what
exactly is going on.

I wish you well

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Zzz-Mask Full Face CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Settings are IPap 23 EPap 19

User avatar
cnaumann
Posts: 205
Joined: Sat Oct 11, 2014 8:46 am
Location: Huntsville, AL

Re: Hello!

Post by cnaumann » Fri Oct 24, 2014 4:16 pm

One of the things that I am confused about is the differential diagnosis of OSA and CSA. This seems like a straight forward question, but I can't seem to get an answer with enough technical detail to satisfy me. Googling produces tons of web pages that explain the difference between the two. Occasionally I will get a page that explains that the differential diagnosis is made 'using polysomnography'. That is all well and good but I still do not understand what sensors and signals differentiate between the two. It seems there may be some black magic here (otherwise known as 'software') and I am not a fan of black magic.

It does scare me to think that I may have a neurological condition. It scares me more to think that I might have a neurological condition that is getting worse. It bugs me that over the last 6 weeks I have only had about 5 minutes of time with my doctor. I see criteria like 'breathing stopped for ten seconds' and 'oxygen desaturation of 3%' listed as significant events. I am routinely seeing stuff 5 times larger, that is also adding to my angst. More than anything, I just want to get all these sleep studies over with and get on with trying to actually treat my condition, whatever it is.

I don't think that sleep onset centrals describes what is going on. I am breathing once every 45 seconds for a full hour after falling asleep. Then I have an hour of normal breathing. Then I have another hour of beathing once every 45 seconds. My AHI is around 40 and doesn't seem alarmingly high, but that is because half the time I am asleep I don't seem to be having any problems and the other half of the time I am having events that last so long that you can only have so many of them in an hour.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Hello!

Post by Pugsy » Fri Oct 24, 2014 4:37 pm

cnaumann wrote:My AHI is around 40 and doesn't seem alarmingly high,
Where did you get the 40 AHI number? From the overnight pulse ox report? or a sleepy study?

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
cnaumann
Posts: 205
Joined: Sat Oct 11, 2014 8:46 am
Location: Huntsville, AL

Re: Hello!

Post by cnaumann » Fri Oct 24, 2014 9:25 pm

Where did you get the 40 AHI number? From the overnight pulse ox report? or a sleepy study?
The 40 is about average for my overnight SPO2 events from my pulse oximeter. It is probably incorrect to call it an AHI. I did get a number from my first sleep study, it was higher, but I honestly do not remember what it was. My sleep at the clinic was poor and atypical, I don't know how that would affect their data. I hope to get written reports on my next doctors appointment.

Here is a picture of one hour of the sawtooth data from my pulse oximeter. There is approximately 60 seconds between the peaks.


Image

Here is one particularly large desaturation event that happened during my first titration study. This even lasted a little over 2 minutes.

Image

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Hello!

Post by Pugsy » Fri Oct 24, 2014 9:43 pm

An AHI of 40 from a sleep study earns the "severe" category. It's pretty significant and not something to pooh pooh off no matter what the desats showed and more so with significant desats.

40 events from the pulse ox report might not mean as much but it all depends on if those "events" were real and not artifacts and most importantly how low did it go. You've got an ugly pulse ox report and you have already had a sleep study and depending on what it says...appropriate therapy needs to be implemented.

As you already know, you really need to get copies of your sleep studies and put the doc on the hot seat and get clear answers to your questions.
It's pretty much impossible to determine if these desats are central or obstructive in nature from the pulse ox reports.
We are just guessing and since you have had a sleep study the answers should be in those reports.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.