Bad titration results,double AHI on BI/CPAP.what's next?

[arburtus]

Well, it seems that I will not be able to become committed hosehead, after one of my worst nights in my live a week ago, my titration results are in.

They are as followed:
AHI: 19.8
HI: 18.9 (I believe those are central HI's)
OSA. 1 (in total)
CSA 1 in total (this one was incredible.... 77 sec long!)
Mixed 1 in total
RERA (respiratory related arousals) index : 40.4 !!! (what are those about?)
Respiratory arousals: index 43.87!
PLMD 30 /hrs
Oxi sat 95 (mean)-87 (min)
Cpap titration from 4-12cm, then bibap from 13/9 increased for the presence of hypopneas.PT had trouble tolerating highest pressures.

No Rem sleep that night, a total of 220 min sleep time.

In contrast,
My original study had only an AHI of 10, mostly obstructive and hypopneas.
However, I had a enormous arousal rate of 33. Perhaps the RERA's or and PLMD are to blame.
I unsuccessfully used a CPAP without titration for a week prior to titration , the data indicated a central apnea index of 8 .

I suffer from post concussion syndrome and many of the related symptoms such as daytime fatigue, brain fog and sleepiness are similar to that of OSA.
A successful treatment of my OSA (complex?) may help me to improve the symptoms mentioned above.


Not sure what to do next, surgery (ENT mentioned I could be a candidate), ASV, dental device...?

[avi123]

Who did the titration? You can not titrate yourself and get results if hypopneas were obstructive or centrals. You need a nightly test in a clinic with an attendent to decide if the hypopneas that you got were obstructives or centrals.

From Resmed:

What is complex sleep apnea?

Complex sleep apnea (CompSA) is a form of sleep apnea in which central apneas persist or emerge during attempts to treat obstructive events with a continuous positive airway pressure (CPAP) or bilevel device.


CompSA is characterized by the following:

•The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared
•CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour
•With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA (described below)

A diagnosis of central sleep apnea (CSA) requires all of the following:

•An apnea index > 5 [Apnea index (AI) - the number of apnea events per hour]
•Central apneas/hypopneas > 50% of total apneas/hypopneas
•Central apneas or hypopneas occurring at least 5 times per hour
•Symptoms of either excessive sleepiness or disrupted sleep



If you have centrals, you should not be placed on an auto unit (as yours) as that can make the centrals worse. To get an Rx for the correct machine you need an Rx from an Md or other expert.

[70sSanO]

I think you HIs are Hypopneas not Centrals.

If that is the case you may want to search this forum and get some info on Hypoponeas and what others have done.

John

[arburtus]

My titration was done at an overnight sleep lab.
The hyponeas were not differentiated ( 'central' vs 'obstructive' ) by the technician or physician, i am not sure if this is common practice.

wouldn't a proper classification of central hypopneas lead automatically to another titration with an AVS?

I

[70sSanO]

I'm sure someone can correct me, but if you have Hypopneas you just have very shallow breathing... maybe partially obstructed.

Centrals are when you are not obstructed, but your brain decides it doesn't feel like breathing, so to speak. I get more CA numbers than anything else. I have tried to use that as an excuse for things when I am awake... It wasn't my decision, I was having a central and my brain didn't feel like taking out the trash... so far that hasn't work.

Centrals can happen for a lot of reasons, one of which is when you turning over and don't breathe for more than 10 seconds. Having just 1 that is 77 seconds long sounds really bizarre, almost like the wrong classifcation; or someone, other than you, asleep at the wheel. I think there could also be issues with oxygen desaturations, but I don't know enough about that.

John

[avi123]

[quote="arburtus"]Well, it seems that I will not be able to become committed hosehead, after one of my worst nights in my live a week ago, my titration results are in.

They are as followed:
AHI: 19.8
HI: 18.9 (I believe those are central HI's)
OSA. 1 (in total)
CSA 1 in total (this one was incredible.... 77 sec long!)
Mixed 1 in total
RERA (respiratory related arousals) index : 40.4 !!! (what are those about?)=check this list: wiki/index.php/Category:CPAP_DefinitionsRespiratory arousals: index 43.87!
PLMD 30 /hrs
Oxi sat 95 (mean)-87 (min)
Cpap titration from 4-12cm, then bibap from 13/9 increased for the presence of hypopneas.PT had trouble tolerating highest pressures.

No Rem sleep that night, a total of 220 min sleep time.

**************************************************************

What is their diagnosis and prescription?

[arburtus]

What is their diagnosis and prescription?[/quote]

The docs are holding back at the moment, there could be an neurological cause, but surgery may be explored as well. I am going to see a range of physicians in the upcoming weeks.
As a bottom line, everyone is a little puzzled...

Today I realized that there may be a 'garden variety' cause to this. If I relax my jaw I can barley breath. Little snoring but a noticeable contraction in my airways that cause labored breathing.If I move my jaw a fraction to the front (1cm) my airways open up, I am not even able to simulate snoring in that position!

Still wondering what all those centrals are about.

[arburtus]

I'm sure someone can correct me, but if you have Hypopneas you just have very shallow breathing... maybe partially obstructed.

Centrals are when you are not obstructed, but your brain decides it doesn't feel like breathing, so to speak. I get more CA numbers than anything else. I have tried to use that as an excuse for things when I am awake... It wasn't my decision, I was having a central and my brain didn't feel like taking out the trash... so far that hasn't work.

Centrals can happen for a lot of reasons, one of which is when you turning over and don't breathe for more than 10 seconds. Having just 1 that is 77 seconds long sounds really bizarre, almost like the wrong classifcation; or someone, other than you, asleep at the wheel. I think there could also be issues with oxygen desaturations, but I don't know enough about that.

John

I agree with you , that central event was bizarre, I woke up and thought I suffered from a major heart attack.

[BrianinTN]

My titration was done at an overnight sleep lab.
The hyponeas were not differentiated ( 'central' vs 'obstructive' ) by the technician or physician, i am not sure if this is common practice.

wouldn't a proper classification of central hypopneas lead automatically to another titration with an AVS?

I

It is common for hypopneas not to be differentiated. Was there a particular reason or paragraph from your PSG results that led you to think they are central in nature?

There are a lot of reasons why they may have decided not to do an ASV titration yet. We could spitball some here, but my advice would be to ask your doctor exactly why they didn't think it was appropriate yet. Their answer to that may yield other answers about the root of your hypopneas, among other things.

[arburtus]

My titration was done at an overnight sleep lab.
The hyponeas were not differentiated ( 'central' vs 'obstructive' ) by the technician or physician, i am not sure if this is common practice.

wouldn't a proper classification of central hypopneas lead automatically to another titration with an AVS?

I

It is common for hypopneas not to be differentiated. Was there a particular reason or paragraph from your PSG results that led you to think they are central in nature?

There are a lot of reasons why they may have decided not to do an ASV titration yet. We could spitball some here, but my advice would be to ask your doctor exactly why they didn't think it was appropriate yet. Their answer to that may yield other answers about the root of your hypopneas, among other things.

I underwent a home test with chest /abdominal belt and a nasal device. With that study I had mostly central apneas, and apparently central hyponeas. In retrospect I vote the overnight study to overwrite the home test.

Unfortunately I did not have a lengthily discussions about the 'very' specifics yet. Frustrating....