Underwent Modified UPPP & Tongue Coblation

[Air Jordan]

Your doc is an idiot.

OMG.

[So Sincere]

I have returned to my old self: struggle to get up, sleeping 10+ hours to compensate, etc.

I was just listened to Car Talk this morning. They said when you take your car to a carburetor specialist, most likely a problem will be found with your carburetor. All kidding aside, this could apply to medical problems, too, so you might consider other causes of your hypersomnia. It happened to me. I was sleeping 12 to 14 hours a day, so I had a sleep study done 8 years ago. My AHI was 75. I have been using a BiPAP machine ever since, and my AHI is now less than 1, but it did nothing for my hypersomnia. Only after I took myself off of a particular medication this last spring did my hypersomnia go away. Immediately. Now I sleep 7 to 8 hours a night and feel much better. I still use the BiPAP machine because I really need it, but my hypersomnia had nothing to do with sleep apnea.

[Sir NoddinOff]

I agree with the consensus and think OSA and CSA are reasonably defined by the machine but 'sleep wake junk' tends to mess things up depending on individual circumstances (but not in a lab when the raw data is scored correctly). That's a good point about sleep labs not allowing some people to get their typical night's sleep... or so my experience tells me.

[Jay Aitchsee]

So, nearly everyone agrees to some extent about CSA detection.

But, what do you think about Simpy's charts a few posts up?
viewtopic.php?f=1&t=109362&st=0&sk=t&sd=a#p1044047

Maybe we can get someone else to chime in with their thoughts.

viewtopic.php?f=1&t=109362&st=0&sk=t&sd=a#p1044095

[Too tall]

I'm told by the sleep doctor that it's impossible to detect CA with just CPAP data. They say you need to be hooked up to all the sensors to the head etc..

Your doc is an idiot.

It's not 100%, but pretty much if the CPAP says CA, it's a CA. It may flag some CA's as obstructive, but they can do a pretty good job with detecting CA's.

You may not show your normal breathing problems when you are in a lab, in a strange bed, nervous, with wires all over you, sleeping badly, perhaps not in your normal sleep position, sleeping badly, etc. Even if the CPAP machine isn't as "accurate" in some sense, it's not measuring your "real" sleep pattern.

The other thing a CPAP machine can't do is tell if you're asleep, and some people show "false" apneas if they're awake.

I'm an idiot but my doctor is not. This forum is most critical of sleep test and doctors so I can see why you feel that way. I'll stay clear of name calling.

[Too tall]

I'm told by the sleep doctor that it's impossible to detect CA with just CPAP data. They say you need to be hooked up to all the sensors to the head etc..

Well I bet that the machine manufacturers might disagree with your doctor's statement.
Here's one manufacturer's documentation on how reliable their central detection is.
http://www.resmed.com/fr/assets/documen ... -paper.pdf
I imagine Respironics has similar findings.
They didn't just pull this central detection stuff out of their behinds. Lots of research went on behind the scenes.

Sensors on the head are usually for documenting sleep stages and not necessarily whether an apnea event is central or obstructive.

Pugsy,

I'm not saying anyone pulled anything out of their ass. I'm simply told that, to diagnose CA properly, a sleep study is needed. I read your pdf link, I come away with the impression that once CA is diagnosed, a machine, using algorithms (formulas) can properly treat CA.

[chunkyfrog]

But what about sleep-wake junk?
I always get a tiny bit of OA reported, but the timing indicates likely wake events.
---IMO.
I'm tempted to have a nice margarita before bed (or two) and see if there is a difference.

[Simpy]

Simpy, I understand your concern. It looks like you have a lot of CSA events. But, looking the total number vs hours slept, I'm guessing your AHI is only around 2.0, actually not too bad. Also, I'm not sure your breathing (flow) is all that suppressed. Could be just a matter of scale. The graph limits are +/- 250 which tends to make the waveforms look small. In the example you've shown, it looks like the flow rate min is still up around 10L/min or so.
Hard to tell about the CSA events. They could be actual or just disturbances where you've moved, or rolled over or something, and caught your breath for a few seconds. It looks to me as if you missed the actual events in the navigation panel so that they're not shown in the detail panel. Sometimes, the start of an event can provide a clue. For example, a few deep breaths just prior to the event could signal a disturbance rather than an actual CSA. In looking at the 10 hour flow detail (DEC 1), it does look like a number of events coincide with a sharp increase in flow rate. However, It will probably take a lab setting to determine for sure.
I think your Flow limitations are still a bit high, though it may not matter. Some here have suggested that anything over .04 is worrisome and many of yours would seem to exceed that, but I'm not sure there's much agreement as to the effect, even if they are high. There is very little evidence of obstructive events, except for the Flow limitations and some snores which seems to be the driver of your auto pressure. It is possible the pressure fluctuations are disturbing, but it doesn't really look like it. But to rule that out, you might want to try a constant pressure around 9, or so.
As you say, it is possible you have something going on that cpap can't fix. Did your last sleep study mention any disturbances due to PLMD? If you have bed partner, have they mentioned any unusual leg movements or thrashing? How about sleep hygiene, and/or caffeine use, or Meds?
Maybe we can get someone else to chime in with their thoughts.

Hi, Jay

Thanks for the interesting response. It seems the thread had derailed a bit, lol.

In any case, I have never had a bed partner so can't answer that. I do believe my last sleep study didn't reveal I had any PLMD issues though. I will have a sleep study in January and will discuss my results with my doctor. At this point, I really feel like my issue isn't just the OSA anymore. But who knows.

Out of interest, does anyone know what else *could* be going on? Is there anything that could account for my current state based on anything anyone knows? I like to know as much as I can to discuss it with my doctor because they often won't bring things up otherwise.

Thanks

[Jay Aitchsee]

Simpy, I understand your concern. It looks like you have a lot of CSA events. But, looking the total number vs hours slept, I'm guessing your AHI is only around 2.0, actually not too bad. Also, I'm not sure your breathing (flow) is all that suppressed. Could be just a matter of scale. The graph limits are +/- 250 which tends to make the waveforms look small. In the example you've shown, it looks like the flow rate min is still up around 10L/min or so.
Hard to tell about the CSA events. They could be actual or just disturbances where you've moved, or rolled over or something, and caught your breath for a few seconds. It looks to me as if you missed the actual events in the navigation panel so that they're not shown in the detail panel. Sometimes, the start of an event can provide a clue. For example, a few deep breaths just prior to the event could signal a disturbance rather than an actual CSA. In looking at the 10 hour flow detail (DEC 1), it does look like a number of events coincide with a sharp increase in flow rate. However, It will probably take a lab setting to determine for sure.
I think your Flow limitations are still a bit high, though it may not matter. Some here have suggested that anything over .04 is worrisome and many of yours would seem to exceed that, but I'm not sure there's much agreement as to the effect, even if they are high. There is very little evidence of obstructive events, except for the Flow limitations and some snores which seems to be the driver of your auto pressure. It is possible the pressure fluctuations are disturbing, but it doesn't really look like it. But to rule that out, you might want to try a constant pressure around 9, or so.
As you say, it is possible you have something going on that cpap can't fix. Did your last sleep study mention any disturbances due to PLMD? If you have bed partner, have they mentioned any unusual leg movements or thrashing? How about sleep hygiene, and/or caffeine use, or Meds?
Maybe we can get someone else to chime in with their thoughts.

Hi, Jay

Thanks for the interesting response. It seems the thread had derailed a bit, lol.

In any case, I have never had a bed partner so can't answer that. I do believe my last sleep study didn't reveal I had any PLMD issues though. I will have a sleep study in January and will discuss my results with my doctor. At this point, I really feel like my issue isn't just the OSA anymore. But who knows.

Out of interest, does anyone know what else *could* be going on? Is there anything that could account for my current state based on anything anyone knows? I like to know as much as I can to discuss it with my doctor because they often won't bring things up otherwise.

Thanks

Yes, it did (get off track).

You may very well have something going on besides OSA. Have you googled Long Sleep? Here's my results: https://www.google.com/?gws_rd=ssl#q=long+sleep some interesting things included. You need to look through and see if any might pertain. One possibility is depression.

Out of curiosity, what were the results of your first sleep study in terms of untreated AHI? OAI vs CAI ? In your first post of this thread, you talk of needing such a high pressure (14+)...to what? What was the goal? To eliminate or reduce obstructive events or just sleep shorter and feel better? To me, from your most recent chart, http://i.imgur.com/5w7QGWn.jpg , it looks like your sleep is disturbed based on the number of CA events and the many large variations in Flow - Cause unknown. You mention central sleep apnea, but even though you have some events, I don't think so. Your CAI is only around 2. Your obstructive events seem to be controlled at these pressures with just a few hypopneas, but the Flow limitations are worrisome. They could be the source of disturbance. You might try increasing the minimum pressure along with turning off EPR (if used) to see if it helps reduce the flow limitations and hypopneas.

Is the therapy itself disturbing? Maybe. Is your untreated AHI high enough to warrant treatment - the reason for the initial question? There is such a thing as UARS http://www.sleep-apnea-guide.com/upper- ... drome.html , the symptoms of which somewhat fit your situation, but I'm not familiar enough to say.

One the other hand, we have a member/advisor who is fond of saying, "you can't fix bad sleep with cpap".

[ChicagoGranny]

For the last week now, I have returned to my old self: struggle to get up, sleeping 10+ hours to compensate, etc.

....

Out of interest, does anyone know what else *could* be going on? Is there anything that could account for my current state based on anything anyone knows?

Yes, there is a myriad of factors that could be causing your struggles. Here is a basic checklist.

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.

Believe it or not, the failure rate on this checklist is higher than the failure rate on CPAP.