One Month Newbie Questions

[frogman]

Hi and thanks to all for your collective wisdom and willingness to share. Although I just registered, I have been checking out this forum on an almost daily basis since receiving my sleep study resluts in mid October.

I had a split study in mid September that reported a 27.8 AHI with 59 awakenings and arousals during the 2.6 hours sleep time. All of these events were hypopneas and the AHI was 74.8 while on my back (I almost never sleep on my back). I found it interesting and make note that only 35 of the 59 awakenings and arousals were associated with an AH event. My SaO2 during this period was reported as mildly abnormal with the minimum at 83% and a mean of 95% and 95% of the time above 89%. The second part of the study was less than perfect and not very productive. After application of CPAP, I only slept 58 minutes. This was not necessarily due to CPAP since I routinely awake after 2-4 hours sleep and roll around for the rest of the night. I did not sleep at all on my back with CPAP and even so the AHI increased to 30.8. The difference being that I had both AI and HI of 15.4 each with 8 Central Apnea events. During this time CPAP was titrated up to 11 cm H2O where I had a few central events and only slept there for half a minute. I also slept for a few minutes at 10 cm H2O and central events there too. I slept 18 minutes at 8 cm H2O and did not have any central events.

One recommendation was to have a second sleep study with CPAP starting at 8 cm and titrating up from there. The alternative that I went for was an APAP with followup in about 8 weeks to see what the data looks like. If I had understood the sleep study report a little more at the time, I may have gone for the second study since I now am concerned with the central events during CPAP and wonder how I would know if they are continuing with APAP treatment. I am also wondering how effective APAP is in treating hypopneas since that appears to be my primary problem. Does anyone have an opinion on these two points?

I think I am getting close to exceeding the allowable size of a post(?), so I will followup with later with data and how treatment is going.

Happy Thanksgiving to all!
frogman (new nickname given by my wife)

[KatieW]

since I now am concerned with the central events during CPAP and wonder how I would know if they are continuing with APAP treatment. I am also wondering how effective APAP is in treating hypopneas since that appears to be my primary problem. Does anyone have an opinion on these two points?

Hi frogman, welcome to the forum. I read your interesting post, but don't feel qualified to answer your questions since I don't have centrals. There have been several discussions on centrals, and perhaps this will help.

viewtopic.php?f=1&t=46877&p=422095&hili ... al#p422095

[JohnBFisher]

"Frogman" ... I like that. Humor is a creative way to make the whole situation seem much more acceptable.

... My SaO2 during this period was reported as mildly abnormal with the minimum at 83% and a mean of 95% and 95% of the time above 89%. ...

Don't know about you, but I have similar (though occassionally lower) numbers and they can give me horrible headaches. It's that 95 percent of the time that will get you. So, though you don't have big issues now, do keep at the therapy. You can avoid a lot of problems by making your sleep and breathing better.

... The difference being that I had both AI and HI of 15.4 each with 8 Central Apnea events. During this time CPAP was titrated up to 11 cm H2O where I had a few central events and only slept there for half a minute. I also slept for a few minutes at 10 cm H2O and central events there too. I slept 18 minutes at 8 cm H2O and did not have any central events. ...

Yup. As the pressure increases, the number of central apneas will initially increase. It's pretty normal for central apneas to appear when Positive Airway Pressure (PAP) is initially introduced. Essentially the PAP tinkers with the blood chemistry that controls breathing. As your body adjusts to the increased pressure during sleep, the number of central apnea events should decrease to an acceptable level.

... If I had understood the sleep study report a little more at the time, I may have gone for the second study since I now am concerned with the central events during CPAP and wonder how I would know if they are continuing with APAP treatment. ...

You will not directly know if you have obstructive or central events. However, if your machine show no obstructive apnea events, then you can infer there are no central events as well, since most machines can not differentiate between obstructive and central apneas. There are two objectives. First, the APAP will try to reduce your AHI score. Second (and much more important) is that it should improve how you feel.

... I am also wondering how effective APAP is in treating hypopneas since that appears to be my primary problem. ...

It is very effective. It strives to reduce obstructive apneas and hypopneas. It's not perfect, but for many if not most people it is much better than CPAP, which does not adjust as your needs change. I would have taken the very same path you took. Though you worry a second study might have been better, I think you chose the wiser path.

So, be thankful that you and your wife have much to celebrate!

[frogman]

Hi Katie,

Thank you for the link; I will check it out later today. After beginning to understand the sleep study report I did some research and found that central events during initial CPAP was not uncommon although it does not happen to everyone - it seems some are more susceptible for some reason. What I did not see was any information on how often it disappears after undergoing treatment for some time. Perhaps I will find a little more info within the link.

frogman

[frogman]

John, thanks for your insight.

... My SaO2 during this period was reported as mildly abnormal with the minimum at 83% and a mean of 95% and 95% of the time above 89%. ...

Don't know about you, but I have similar (though occassionally lower) numbers and they can give me horrible headaches...

I have taken sinus medicine every morning for years to deal with morning headaches, which I always attributed to chronic sinus issues - I still think that is major contributor, but since starting APAP there have been mornings when I did not need to take any medication. Interestingly enough, I have begun to suspect that my proportionally higher incidence of sever morning headaches on Sunday mornings is due to longer sleep periods and therefore longer periods at low O2 saturation levels.

...Essentially the PAP tinkers with the blood chemistry that controls breathing. As your body adjusts to the increased pressure during sleep, the number of central apnea events should decrease to an acceptable level.

...if your machine show no obstructive apnea events, then you can infer there are no central events as well, since most machines can not differentiate between obstructive and central apneas...Second (and much more important) is that it should improve how you feel.

I may be taking a leap here, but since I only had central events in the sleep study during the APAP portion, I may infer that the 0.9 HI my machine is reporting are probably central apneas. If this is in fact true, should I be concerned that I am still having central events a month into treatment? If these were only obstructive at this level I don't think I would give it a second thought. I do feel better with APAP; although I am still tired most of the time, that is better than the chronic fatigue prior to treatment.

... I am also wondering how effective APAP is in treating hypopneas since that appears to be my primary problem. ...

It is very effective. It strives to reduce obstructive apneas and hypopneas. It's not perfect, but for many if not most people it is much better than CPAP, which does not adjust as your needs change. I would have taken the very same path you took. Though you worry a second study might have been better, I think you chose the wiser path.

I thought it better to get auto and data capable machine while it was being offered. I have seen in posts by Rested Gal and others that the S8 Autoset II may score HI differently than others so my HI of around 13 - 14 for the last month may not be too bad. I would not be concerned with the numbers if I was not still feeling tired most of the time. There is improvement as previously noted and perhaps my expectations are unrealistic.

So, be thankful that you and your wife have much to celebrate!

I am thankful for the relief thus far, although I think the first couple of days were better than now. Although my wife has been prodding me for years to have a sleep study, I wasn't ready until the chronic fatigue finally got to me. And it was not until a couple of days into treatment that my wife realized that my disruptive sleep did actually affect her - sitting at work one day, she realized she felt much better too.

I am including a summary graph of my results thus far. I would appreciate any additional comments or suggestions from anyone of things to cover when I go for the followup with my respiratory doctor in a couple of weeks.



Thanks, frogman