For those that do not know I'm self treating my apnea.

[tired57]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.
If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.
Any suggestions to what I should say and how to go about it?

http://s1262.photobucket.com/user/fastf ... t=3&page=1

[Todzo]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.
If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.
Any suggestions to what I should say and how to go about it?

http://s1262.photobucket.com/user/fastf ... t=3&page=1

My first impression is that you would make better progress by working with a dietitian and personal trainer for three years. Which I would recommend regardless.

Perhaps more later. (a glance at the graphs did not see many problems).

[djhall]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.
If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.
Any suggestions to what I should say and how to go about it?

http://s1262.photobucket.com/user/fastf ... t=3&page=1

It might help if you told us what you are trying to accomplish. Are you trying to get them to agree you have SA? If so, is that so they will help you treat it, or so insurance will pay for equipment and supplies, or just for validation? The medical community has a process and procedures involving sleep labs, reports, target numbers, etc, for diagnosing sleep apnea. It is very possible for a borderline case to slip through, even if the therapy may be beneficial, but the medical community is not likely to be receptive to any involvement with someone who is self-treating using "controlled" medical equipment.

If all you want is assistance with CPAP therapy, you are likely to get better results learning from here than you will using a doctor. Your numbers should look quite good running auto with 6cm minimum and, say, 8 or 9cm maximum. However, you seem to be going the other direction and lowering your pressure instead. I can't tell if that is because you want to see if your numbers are bad enough at low pressure for diagnostic reasons, if you just feel more comfortable at lower pressure, or if you think you are going to get better AHI numbers that way.

[tired57]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.
If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.
Any suggestions to what I should say and how to go about it?

http://s1262.photobucket.com/user/fastf ... t=3&page=1

My first impression is that you would make better progress by working with a dietitian and personal trainer for three years. Which I would recommend regardless.

Perhaps more later. (a glance at the graphs did not see many problems).

I am 5'8" 155 lbs not over weight.
I believe I have Central SA more so than OSA

[tired57]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.
If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.
Any suggestions to what I should say and how to go about it?

http://s1262.photobucket.com/user/fastf ... t=3&page=1

It might help if you told us what you are trying to accomplish. Are you trying to get them to agree you have SA? If so, is that so they will help you treat it, or so insurance will pay for equipment and supplies, or just for validation? The medical community has a process and procedures involving sleep labs, reports, target numbers, etc, for diagnosing sleep apnea. It is very possible for a borderline case to slip through, even if the therapy may be beneficial, but the medical community is not likely to be receptive to any involvement with someone who is self-treating using "controlled" medical equipment.

If all you want is assistance with CPAP therapy, you are likely to get better results learning from here than you will using a doctor. Your numbers should look quite good running auto with 6cm minimum and, say, 8 or 9cm maximum. However, you seem to be going the other direction and lowering your pressure instead. I can't tell if that is because you want to see if your numbers are bad enough at low pressure for diagnostic reasons, if you just feel more comfortable at lower pressure, or if you think you are going to get better AHI numbers that way.

I am dealing with the VA.
I had my best night last week with lower pressures but seam to be getting worse so I tried increasing the pressure but didn't work.

[djhall]

I believe I have Central SA more so than OSA

Interesting... I didn't see that answer coming. What leads you to think you have Central Sleep Apnea? I wen't back through all your graphs and I honestly don't see it, except for one small possible thing. One of the CA lines looked a bit thick, which could indicate a fairly long or severe event, but other than that you show no signs of CSA. CA events events are extremely common when we are awake and when we are in a "wakeful state" like when you roll over or adjust position in bed. CA events also commonly occur in small numbers (like what you show) when someone is relatively new to CPAP or when they make even minor changes to their settings. Something about change itself tends to trigger small numbers of CA events. The graph of someone with CSA looks very different.

To "have" OSA you would need an AHI > 5. I don't know what your untreated AHI is, and outside a sleep lab we can't tell since the machine won't go below 4cm pressure and even that can have beneficial effects in borderline cases, which you almost certainly would be. However, take a look at your VS2 line... those events are vibratory snores, which are warning indicators that the conditions for OSA events are starting to form. RE events are restrictions in airflow not significant enough to be classed as a Hypopnea, but which appear to have caused a sleep disruption that resulted in a change in breathing pattern. H events are a 50% or greater reduction in airflow caused by a major collapse of the airway. And finally, OA events are complete cessation of breathing caused by total blockage/collapse of the airway. Your graphs at lower pressures show increases in VS2 and RE events, as well as H events and even some OA events. You may not have clinically significant OSA right now, but it looks like the conditions are there for it to develop as you get older if it hasn't already.

With your size and weight, I suspect you are one of the people who have an airway structure that is prone to blockage. That isn't usually discovered until someone gains weight which makes the symptoms become worse, which leads to a study and a diagnosis. The surprise comes when they lose weight and the OSA is reduced in severity but not eliminated. Then someone inspects their airway and discovers the root cause of their OSA. This happened to my mom. She is only 95lbs, but she had to have her turbinates and uvula trimmed to keep her airway from collapsing because of the way it was built even though she wasn't overweight.

[robysue]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.

Have you seen the full sleep study report including the summary graphs? You really need to see that in order to understand why the sleep center said you don't have SA. You need to know what your diagnostic AHI was and what the other data showed about your sleep during the night you had the sleep test.

If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.

Pardon my cynicism, but I don't think the machine's data will convince time they missed a proper SA diagnosis.

[djhall]

I had my best night last week with lower pressures but seam to be getting worse so I tried increasing the pressure but didn't work.

Well, that depends on what you are trying to reduce. OA & H events should go down in number with adequate pressure (as well as VS2 and RE events). You aren't going to reduce CA numbers like yours with pressure changes. Trust me, I spent MONTHS trying every possible option. However, changing pressures around will cause the CA events to increase, so changing pressures around trying to reduce the number of CA flags is about the worst thing you can do.

If you intend to continue CPAP therapy, we can help you set your pressure based on driving the OA and H events down to just a couple and then leaving it unchanged for at least a couple months to allow you to acclimate to a stable pressure which is the only thing that will reduce your current CA events.

[SeekSleep]

Your graphs look pretty good to me. I know with my central apnea, it showed up in my first sleep study in the results prior to their trying me on a cpap to reduce the obstructive apneas I also had. The pressure from the CPAP actually resulted in more CA's so I had to come back for another sleep study, this time with a BIPAP. The results on that machine were a considerable improvement from no machine, but I eventually came back for a third titration study to get my AHI down under 10. The ASV machine makes a huge difference in how I feel, but I would really like to find a better way. It seems folks with Obstructive sleep apnea tend to like the asv machines if they can get one from what I've seen. If you actually have central apneas, the machines tend to ramp way up which makes mask leaks almost inevitable as they max out on pressure. This can tend to cause interrupted sleep as well. They're an improvement but come with problems of their own.

Good luck. In my active duty days, they said it was common to stop breathing someone to stop breathing while they slept, and since it didn't seem to be causing me any significant issue to not worry about it. Later on in life the docs seemed to think maybe it was a problem after all. Guess that's why they call it "Practicing" medicine.

[tired57]

I had my best night last week with lower pressures but seam to be getting worse so I tried increasing the pressure but didn't work.

Well, that depends on what you are trying to reduce. OA & H events should go down in number with adequate pressure (as well as VS2 and RE events). You aren't going to reduce CA numbers like yours with pressure changes. Trust me, I spent MONTHS trying every possible option. However, changing pressures around will cause the CA events to increase, so changing pressures around trying to reduce the number of CA flags is about the worst thing you can do.

If you intend to continue CPAP therapy, we can help you set your pressure based on driving the OA and H events down to just a couple and then leaving it unchanged for at least a couple months to allow you to acclimate to a stable pressure which is the only thing that will reduce your current CA events.

What pressures work better with CSA, you say higher pressures increase events. So do you think I should try constant a 4 vs 4.5-7-5?
My settings are A-Flex 3
mode-auto
ramp time -45
resistance-1

[tired57]

For those that do not know I'm self treating my apnea.
I am going to call the place that gave me the sleep test that said I do not have SA.
If they want to see my SD card I'll bring that.
I thought about telling them that I am borrowing a friends extra CPAP and mask so if they are convinced that I do have SA they will set me up with a machine.
Any suggestions to what I should say and how to go about it?

http://s1262.photobucket.com/user/fastf ... t=3&page=1

It might help if you told us what you are trying to accomplish. Are you trying to get them to agree you have SA? If so, is that so they will help you treat it, or so insurance will pay for equipment and supplies, or just for validation? The medical community has a process and procedures involving sleep labs, reports, target numbers, etc, for diagnosing sleep apnea. It is very possible for a borderline case to slip through, even if the therapy may be beneficial, but the medical community is not likely to be receptive to any involvement with someone who is self-treating using "controlled" medical equipment.

If all you want is assistance with CPAP therapy, you are likely to get better results learning from here than you will using a doctor. Your numbers should look quite good running auto with 6cm minimum and, say, 8 or 9cm maximum. However, you seem to be going the other direction and lowering your pressure instead. I can't tell if that is because you want to see if your numbers are bad enough at low pressure for diagnostic reasons, if you just feel more comfortable at lower pressure, or if you think you are going to get better AHI numbers that way.

Yes, I am trying to get them to realize that I have SA.
They will pay for equipment and supplies.
I have not seen the results but will ask for copy's.
To me this is NOT borderline as I haven't slept well for 4-5 years, just thought I was getting old.
Even during the daytime if I am at the computer of sitting still I have caught myself exhaling and not breathing until I will gasp for air.

[Julie]

You don't understand... central apnea is quite rare except for the handful so many of us experience (not consciously) when drifting off or being close to waking. They can be provoked by very high settings, e.g.15+, but not always. Lowering your pressure to 4-5 will do one thing and only one - make it almost impossible to inhale - for anyone. And 'regular' C- or autopap machines do not treat centrals, and only a few even report them, so a special machine (Vpap, ASV, etc.) would be needed to treat them in any case. Stop trying to DIY - you're not 'there' yet as far as basic info goes and you'll only make yourself cuckoo. You possibly have 'positional' apnea - e.g. register a few events if sleeping on your back, but not in other positions, so if that turns out to be the case you wouldn't need a machine anyhow.

Do you have any idea how many different conditions, etc. cause sleep problems? You need to see a neurologist and/or a respirologist/pulmonologist and not guess at what's wrong.

[djhall]

Yes, I am trying to get them to realize that I have SA.

Okay, well, the bottom line after looking at your nightly reports is that this will not help convince them. Even at the lowest setting your AHI is only half the severity necessary for a clinical diagnosis of any form of Sleep Apnea.

To me this is NOT borderline as I haven't slept well for 4-5 years, just thought I was getting old.

I agree, but the clinical definition requires > 15 AHI or > 5 AHI with documented sleep issues without CPAP and documented improvement with CPAP. You aren't going to document > 5 AHI with the machine, and you can't document anything without it outside of a sleep lab. You may well have severe sleep and breathing issues, but they won't call it SA unless it meets that criteria.

Even during the daytime if I am at the computer of sitting still I have caught myself exhaling and not breathing until I will gasp for air.

Ahhh, now I see why you think you may have Central Sleep Apnea. However, control over our breathing switches to a different part of the brain when we are fully asleep.
Waking CAs and sleeping CAs are completely different things, which often shows up as CA flags on our sleep reports just because we weren't fully asleep yet or we woke up briefly to roll over.

So, we can't prove you have Sleep Apnea at all. We really can't prove you have Central Sleep Apnea as the sleep data strongly indicates you don't. However, you do have a machine, you do have sleep related issues, and you do have some signs of sub-clinical levels of Obstructive Sleep Apnea in your data. If you want to try using the machine to get the most effective treatment you can from it as an experimental trial, you need to do the following things. Just remember, your data doesn't show clinical levels of OSA or CSA.

1. Underneath the calendar on the left side of your nightly sleep data you will see an AHI number and sub-numbers for several categories. Unless you see numbers > 3.0 for Central Apnea or > 3% for PB/CSR you need to just ignore those numbers for now as they don't mean anything significant when you are starting treatment. Expect to see Central Apnea numbers between 1 and 3 in the first few months... that doesn't mean anything except you aren't used to sleeping with a hose attached to a mask strapped to your face that shoves air down your throat.

2. Set your pressure to either 6.0 straight CPAP or 6.0 Minimum and 9.0 Maximum Auto and LEAVE IT ALONE FOR AT LEAST A WEEK unless you have numbers > 3.0 for the Obstructive Apnea or Hypopnea categories.

3. Again, DO NOT MESS WITH THE SETTINGS... fiddling with the settings just makes your sleep worse. After a week we can re-evaluate whether or not the pressure settings are optimal. Guidelines suggest three months regular use at stable settings before evaluating to see if the CPAP therapy is producing benefits.

[Todzo]

My first impression is that you would make better progress by working with a dietitian and personal trainer for three years. Which I would recommend regardless.

Perhaps more later. (a glance at the graphs did not see many problems).

I am 5'8" 155 lbs not over weight.
I believe I have Central SA more so than OSA

20% of those normal weight have OSA. 20% of those with fatty liver disease are of normal body weight.

Normal body weight is no proof of healthy metabolism.

but you have no proof

[49er]

Agree with RobySue about needing to see the full sleep study to see what was reported and that that these reports aren't going to convince the powers to be that you have sleep apnea. I didn't look at all of them but a few of the reports, I noticed what seemed to be a high flow limit which in some cases can indicate UARS. I would be curious if they tested for RERAS and whether that indicated you had a potential problem that might have been missed.

By the way, even though you were told you didn't have apnea, the reports could be an indication that with pap therapy treatment, that you do have sleep apnea. But unfortunately, as I previously mentioned, this isn't going to be the convincing evidence that you want.

I don't know how the VA works but is there is a procedure for requesting another opinion?

Best of luck.

49er