New user....help with diagnosis

[DonkeyBoy]

Hi all,

I've been quietly observing the great teamwork on this forum. I would like so help with understanding my data. From my interpretation its decent but I'm a bit worried about my AHI. It stays around 7-12 every night. I feel pretty rested and sleep better then before cpap, but am wondering if I need a BIPAP for all the centrals.

A bit of history, I had a home sleep study and was prescribed the apap but the docs statement on the study said its possible that i may develop "complex"
sleep apnea due to the percocet/methodone I'm on for cronic nerve pain from a motorcycle accident.

Opinions please?

[JohnBFisher]

We really don't have enough information to provide any opinions. Nor should we since this wanders way into the territory where your doctor should be. And frankly, it sounds as if he is thinking about it already.

You mention you AHI remains about 7-12. Though you feel better, do you feel as if you are still very tired?

Remember that most doctors will try to take the least possible intervention to solve a problem. If a bandaid works, there is no need for stitches. So it is with your case. The opiates tend to increase central apneas. I do not know if the home study can accurately capture and interpret central apneas. Based on what you said, it sounds as if his is speculating.

Is your machine data capable? Sounds as if it is. Does it differentiate between "Clear Airway" apneas and obstructive apneas? Does it tell you how many of each you have? Does it tell you how many of the AHI value is due to hypopneas.

If most or all of that 7-12 events in the AHI value is due to "clear airway" apneas, your doctor might want to address it.

You might want to research some more using Rested Gal's Links to Central Apnea:

viewtopic.php?p=22702

In particular, you might want to read:

Central Sleep Apnea: Pathophysiology and Treatment
http://chestjournal.chestpubs.org/conte ... l.pdf+html

Adaptive Servoventilation (ASV) in Patients with Sleep Disordered Breathing Associated with Chronic Opioid Medications for Non-Malignant Pain
http://www.ncbi.nlm.nih.gov/pmc/article ... .4.311.pdf

The Quest for Stability in an Unstable World: Adaptive Servoventilation in Opioid Induced Complex Sleep Apnea Syndrome
http://www.ncbi.nlm.nih.gov/pmc/article ... .4.321.pdf

Sorry to assign you some homework, but it shuold help you help understand what your doctor is talking about. The more you understand his questions and reasons, the more it will help him help you.

Hope this helps.

[chunkyfrog]

Or you could see another doctor for a second opinion. . .

[DonkeyBoy]

We really don't have enough information to provide any opinions. Nor should we since this wanders way into the territory where your doctor should be. And frankly, it sounds as if he is thinking about it already.

You mention you AHI remains about 7-12. Though you feel better, do you feel as if you are still very tired?

Remember that most doctors will try to take the least possible intervention to solve a problem. If a bandaid works, there is no need for stitches. So it is with your case. The opiates tend to increase central apneas. I do not know if the home study can accurately capture and interpret central apneas. Based on what you said, it sounds as if his is speculating.

Is your machine data capable? Sounds as if it is. Does it differentiate between "Clear Airway" apneas and obstructive apneas? Does it tell you how many of each you have? Does it tell you how many of the AHI value is due to hypopneas.

If most or all of that 7-12 events in the AHI value is due to "clear airway" apneas, your doctor might want to address it.

You might want to research some more using Rested Gal's Links to Central Apnea:

viewtopic.php?p=22702

In particular, you might want to read:

Central Sleep Apnea: Pathophysiology and Treatment
http://chestjournal.chestpubs.org/conte ... l.pdf+html

Adaptive Servoventilation (ASV) in Patients with Sleep Disordered Breathing Associated with Chronic Opioid Medications for Non-Malignant Pain
http://www.ncbi.nlm.nih.gov/pmc/article ... .4.311.pdf

The Quest for Stability in an Unstable World: Adaptive Servoventilation in Opioid Induced Complex Sleep Apnea Syndrome
http://www.ncbi.nlm.nih.gov/pmc/article ... .4.321.pdf

Sorry to assign you some homework, but it shuold help you help understand what your doctor is talking about. The more you understand his questions and reasons, the more it will help him help you.

Hope this helps.

Wow, thanks for the quick reply and the homework, I am very anxious to become educated and understand my treatment. Will try to upload my data from the resmed software soon to help with opinions. Off to do homework. Much appreciated!!!

[Goofproof]

You might post some of the nightly screens from the software. Resmed's tend to rate H higher that other brands. Leak rate is most important to your treatment. Jim