Clear Airway? Central Apnea? How likely is it?
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Clear Airway? Central Apnea? How likely is it?
I have one question...
My APAP dreamstation from respironics phillips machine says it can tell the obstructive apnea from a central one.
How accurate is that actually?
Can someone with more experience clear it up?
My APAP dreamstation from respironics phillips machine says it can tell the obstructive apnea from a central one.
How accurate is that actually?
Can someone with more experience clear it up?
Re: Clear Airway? Central Apnea? How likely is it?
It should be able to..
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Re: Clear Airway? Central Apnea? How likely is it?
Hi again... What will it take for you to stop obsessing about 'centrals'? There are so many other features and problems to worry about... why have you become so fixated on this one?
From what you posted of Oscar results and just said in general, there's no more reason to worry about centrals than anything else, and I'm almost worried you won't learn about other things because you can only think of those. They are just one of many things to consider and in fact, not half as worth your time now as the others and we've explained over and over to forget about them for now (and probably forever).
From what you posted of Oscar results and just said in general, there's no more reason to worry about centrals than anything else, and I'm almost worried you won't learn about other things because you can only think of those. They are just one of many things to consider and in fact, not half as worth your time now as the others and we've explained over and over to forget about them for now (and probably forever).
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Re: Clear Airway? Central Apnea? How likely is it?
Hello Julie, I am a medical student final year so I have general interest in this topic.Julie wrote: ↑Sun Jun 07, 2020 5:26 pmHi again... What will it take for you to stop obsessing about 'centrals'? There are so many other features and problems to worry about... why have you become so fixated on this one?
From what you posted of Oscar results and just said in general, there's no more reason to worry about centrals than anything else, and I'm almost worried you won't learn about other things because you can only think of those. They are just one of many things to consider and in fact, not half as worth your time now as the others and we've explained over and over to forget about them for now (and probably forever).
I agree with you actually 100%
I spend nights reading about this and I got polysomnography diagnostic devices and electrodes.
Considering how common sleep problems are, I realized this is something I am willing to learn about extensively about.
I asked about centrals because text books from pathophysiology speak very little actually, nothing about how good new APAP machines are. It's not a focus of their content.
On the other hand, I can imagine that being a prevalent question for many patients and it came to my mind.
Since I am learning about EEG and how to do proper sleep study I wondered?! How accurate would the APAP machine be to begin with.
The better I learn, the better I'll be able to help others in the future hopefully.
It's just my nature to question, think, read, investigate and hopefully learn.
Re: Clear Airway? Central Apnea? How likely is it?
I wonder about those text books... how old are they?
Apaps can do a pretty good job of diagnosing and treating obstructive apnea and other types such as UARS and patients with RERA, etc... but there is no EEG or O2 built in of course, though if someone knowledgable sees Oscar results with certain problems, they may suggest getting a lab PSG to confirm (or rule out) problems. It's interesting to talk to you because for many years I worked in offices of neurologists and n-surgeons in Montreal and Toronto, not particularly 'sleep' doctors, but certainly they knew about apnea, even if it was a few decades ago!
Apaps can do a pretty good job of diagnosing and treating obstructive apnea and other types such as UARS and patients with RERA, etc... but there is no EEG or O2 built in of course, though if someone knowledgable sees Oscar results with certain problems, they may suggest getting a lab PSG to confirm (or rule out) problems. It's interesting to talk to you because for many years I worked in offices of neurologists and n-surgeons in Montreal and Toronto, not particularly 'sleep' doctors, but certainly they knew about apnea, even if it was a few decades ago!
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Re: Clear Airway? Central Apnea? How likely is it?
Since in medschool we don't specialize anything yet. ONly after you get a residency spot you learn more specifically about certain topics.
The books are general pathophysiology books and content tought in second/third year medschool here. They explain how certain common diseases manifest and develop but they do not explain therapy extensively, yet alone technical apsects of machines in those therapies.
I will try to get some more literature tomorrow (monday) specifically on sleep disorders.
The book I have is:
Klinische Pathophysiologie (Siegenthaler)
Interestingly not every sleep apnea is the same.
Depending on the anatomy, small number of events of obstructive apneas can have more impact on ones body, sleep and mental condition than dozens of mild apneas.
For example let's say you're a skinny person yet have very small lower jaw bone with a huge tongue and somewhat pronounced kyphosis with neck particularly being flexed.
In such cases, one would expect fewer events yet once they happen they can be complete obstruction.
In someone who is obese, there would be a constant stream of events that gradually change.
Because of this, how sleep apnea affects brain and function can be different in my opinion.
So if someone does not experience extreme panic attacks at night, does not wake up gasping for air, does not feel EXTREMELY tired in the morning, it doesn't mean his O2 levels are still not wiggling there somewhere -5 or -6 where they shouldn't be and thus slowly over the years ruining sleep of that person.
Simple number 5 or 15 or 30 events per hour, does not describe the clinical manifestation of the condition. Each person is unique. I really hate medicine without properly understanding personal needs of everyone and just focusing on the number. Some people whey they miss their sleep they just swear a lot and give you angry looks and become agressive. Others start crying and become too depressed to even think anything. Some are bad drivers already and then this only adds to the issue so they make car accidents and die eventually.
So 5 number will never properly describe how sever oxygen level drops, more importantly how severly that person survives and experiences that and how much toll it takes and even less it will describe how much daily functioning of a person will be influenced.
So especially in those sleep conditions I want to understand very very very well how things develop and how it can influence peoples lives. If I don't have such approach and understand the disease for what it is, biologically and psychosocially, then just learning the number 5 or 10 will get me my degree faster. I am later 2 years with my diploma anyway... but I just don't see diseases as that nor humans as numbers. It always irritated me when my friends passed exams so easily without thinking. I sort of have to, get under patients skin and walk in his shoes, to understand that there is a whole living being and a human with his life behind that number "5"
I always do that with every condition I study about
The books are general pathophysiology books and content tought in second/third year medschool here. They explain how certain common diseases manifest and develop but they do not explain therapy extensively, yet alone technical apsects of machines in those therapies.
I will try to get some more literature tomorrow (monday) specifically on sleep disorders.
The book I have is:
Klinische Pathophysiologie (Siegenthaler)
Interestingly not every sleep apnea is the same.
Depending on the anatomy, small number of events of obstructive apneas can have more impact on ones body, sleep and mental condition than dozens of mild apneas.
For example let's say you're a skinny person yet have very small lower jaw bone with a huge tongue and somewhat pronounced kyphosis with neck particularly being flexed.
In such cases, one would expect fewer events yet once they happen they can be complete obstruction.
In someone who is obese, there would be a constant stream of events that gradually change.
Because of this, how sleep apnea affects brain and function can be different in my opinion.
So if someone does not experience extreme panic attacks at night, does not wake up gasping for air, does not feel EXTREMELY tired in the morning, it doesn't mean his O2 levels are still not wiggling there somewhere -5 or -6 where they shouldn't be and thus slowly over the years ruining sleep of that person.
Simple number 5 or 15 or 30 events per hour, does not describe the clinical manifestation of the condition. Each person is unique. I really hate medicine without properly understanding personal needs of everyone and just focusing on the number. Some people whey they miss their sleep they just swear a lot and give you angry looks and become agressive. Others start crying and become too depressed to even think anything. Some are bad drivers already and then this only adds to the issue so they make car accidents and die eventually.
So 5 number will never properly describe how sever oxygen level drops, more importantly how severly that person survives and experiences that and how much toll it takes and even less it will describe how much daily functioning of a person will be influenced.
So especially in those sleep conditions I want to understand very very very well how things develop and how it can influence peoples lives. If I don't have such approach and understand the disease for what it is, biologically and psychosocially, then just learning the number 5 or 10 will get me my degree faster. I am later 2 years with my diploma anyway... but I just don't see diseases as that nor humans as numbers. It always irritated me when my friends passed exams so easily without thinking. I sort of have to, get under patients skin and walk in his shoes, to understand that there is a whole living being and a human with his life behind that number "5"
I always do that with every condition I study about
Re: Clear Airway? Central Apnea? How likely is it?
You are going to be one terrific doctor! 

Re: Clear Airway? Central Apnea? How likely is it?
I'm not sure about Respironics, but I think that Resmed says that their FOT (Forced Oscillation Technique) method of differentiating centrals vs obstructives is, I think, 90%ish compared to sleep tests with chest and abdomen bands.Fejsbukpejdz wrote: ↑Sun Jun 07, 2020 5:10 pmI have one question...
My APAP dreamstation from respironics phillips machine says it can tell the obstructive apnea from a central one.
How accurate is that actually?
Can someone with more experience clear it up?
Get OSCAR
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Re: Clear Airway? Central Apnea? How likely is it?
That nice that you might decide to specialize in sleep medicine.
I like my sleep doctor because he's pretty smart, but I think he could improve by not jumping to conclusions and could maybe be a little more curious. He was very interested when I showed him Sleepytime/Oscar charts because apparently (in my midwest town) none of his other patients use those programs or ever look at their SD card data. Although he seemed mildly interested in the Oscar charts, he admitted he never looks at my SD card (or transmitted) data or any charts at all, only looks at the average AHI for the past few weeks, if the AHI isn't good, he probably would then look at some average statistic about central apneas or leaks also. I assume if a patient had a terrible AHI, he would dig in further and maybe actually look at some charts. But he would not spend time looking at charts of a person with an AHI of 4 or 5 to see if they could tweak to improve. I wonder if someone's AHI was really bad, does the DME monitor it and notify the doctor? Or would the patient suffer for months until it was time for their next doctor appointment?
Also, the first time I walked into his office (before my sleep lab PSG), he took one look at me and said 'you don't have sleep apnea' because I was a skinny underweight woman, in my 40's with low blood pressure and cholesterol. My sleep lab indicated I did have an AHI of about 20.
So as a doctor, it is better not to be so quick to judge based on a patient's age or appearance (thin teenagers can have apnea), and it is better to keep up on what is going on with patients, maybe even read forums. My doctor had never heard of an apnea patient using a cervical collar when sleeping so I told him how wearing one greatly decreased my AHI. If he had read Cpaptalk forum, he would have known that a cervical collar can help some patients.
My doctor at first prescribed me a AutoPap pressure setting of 4cm-8cm. I felt like I was starving for air. He wanted me to give it a few more days, but I found this forum, changed my settings and after a few days realized I needed a minimum of at least 10cm but preferably 12-13 cm. I suspect again because I was so thin and a female, he just assumed I must need only a teeny delicate amount of pressure.
Also my wonderful Yale trained primary care doctor did not know very much about sleep apnea but she was well trained in most areas of internal medicine (e.g. if you had heart problems or diabetes, etc..). I had complained about nocturia during every annual physical for 10 years and she had sent me to a bladder specialist who found nothing after ultrasound and an internal visual probe with a scope. After I finally suspected sleep apnea, asked for a sleep test (she never suggested one, it was me), and then I started on CPAP, my nocturia disappeared. Now I only have to get up in the middle of the night to pee if I have been drinking a large amount of liquid close to bedtime, before it was every night. Apnea can increase the production of urine. I went to a urologist again recently due to blood found in my urine and I asked that urologist if he knew that nocturia could be caused by sleep apnea. Nope, he had no idea. I think most medical schools don't teach doctors much about apnea unfortunately.
I hope you never stop being curious.
I like my sleep doctor because he's pretty smart, but I think he could improve by not jumping to conclusions and could maybe be a little more curious. He was very interested when I showed him Sleepytime/Oscar charts because apparently (in my midwest town) none of his other patients use those programs or ever look at their SD card data. Although he seemed mildly interested in the Oscar charts, he admitted he never looks at my SD card (or transmitted) data or any charts at all, only looks at the average AHI for the past few weeks, if the AHI isn't good, he probably would then look at some average statistic about central apneas or leaks also. I assume if a patient had a terrible AHI, he would dig in further and maybe actually look at some charts. But he would not spend time looking at charts of a person with an AHI of 4 or 5 to see if they could tweak to improve. I wonder if someone's AHI was really bad, does the DME monitor it and notify the doctor? Or would the patient suffer for months until it was time for their next doctor appointment?
Also, the first time I walked into his office (before my sleep lab PSG), he took one look at me and said 'you don't have sleep apnea' because I was a skinny underweight woman, in my 40's with low blood pressure and cholesterol. My sleep lab indicated I did have an AHI of about 20.
So as a doctor, it is better not to be so quick to judge based on a patient's age or appearance (thin teenagers can have apnea), and it is better to keep up on what is going on with patients, maybe even read forums. My doctor had never heard of an apnea patient using a cervical collar when sleeping so I told him how wearing one greatly decreased my AHI. If he had read Cpaptalk forum, he would have known that a cervical collar can help some patients.
My doctor at first prescribed me a AutoPap pressure setting of 4cm-8cm. I felt like I was starving for air. He wanted me to give it a few more days, but I found this forum, changed my settings and after a few days realized I needed a minimum of at least 10cm but preferably 12-13 cm. I suspect again because I was so thin and a female, he just assumed I must need only a teeny delicate amount of pressure.
Also my wonderful Yale trained primary care doctor did not know very much about sleep apnea but she was well trained in most areas of internal medicine (e.g. if you had heart problems or diabetes, etc..). I had complained about nocturia during every annual physical for 10 years and she had sent me to a bladder specialist who found nothing after ultrasound and an internal visual probe with a scope. After I finally suspected sleep apnea, asked for a sleep test (she never suggested one, it was me), and then I started on CPAP, my nocturia disappeared. Now I only have to get up in the middle of the night to pee if I have been drinking a large amount of liquid close to bedtime, before it was every night. Apnea can increase the production of urine. I went to a urologist again recently due to blood found in my urine and I asked that urologist if he knew that nocturia could be caused by sleep apnea. Nope, he had no idea. I think most medical schools don't teach doctors much about apnea unfortunately.
I hope you never stop being curious.
_________________
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Mask: ResMed AirFit™ F20 Full Face CPAP Mask with Headgear |
Humidifier: DreamStation Heated Humidifier |
Additional Comments: IPAP 15 EPAP 13.5 |
Re: Clear Airway? Central Apnea? How likely is it?
I have a question for you (soon to be) Dr Fejsbukpejdz, about at what value I should worry about my oxygen SpO2 level. Also, I'd like feedback from the experts on this forum. I suppose maybe I should create a new thread if you moderators want me to, but since the Dr-to-be made the statement above, I was quite curious what numbers he thought was bad and he (or she?) is right here, so.....Fejsbukpejdz wrote: ↑Sun Jun 07, 2020 6:57 pm
So if someone does not experience extreme panic attacks at night, does not wake up gasping for air, does not feel EXTREMELY tired in the morning, it doesn't mean his O2 levels are still not wiggling there somewhere -5 or -6 where they shouldn't be and thus slowly over the years ruining sleep of that person.
I had not worn my pulse oximeter overnight for a few years but I just wore it overnight a couple nights ago and got these statistics: (this was a great night for me with AHI of 1, so only about 6 apnea events the entire night)
Minimum : SpO2 %: 91.00
Average SpO2 % 94.19
SpO2 Drop Index 4.07
% of time in SpO2 Drop 5.41%
From the Oscar SpO2 chart, it looked like usually I was about 94-95%, sometimes 96%, rare max of 99%, occasionally dipping to 92%. I don't know if my oximeter is accurate. When I'm awake, it seems to read about 96% but varies between 95-97%.
Does this look OK, or is it worrisome? My twin sister is on oxygen when sleeping in addition to CPAP because hers was dropping way below 80% (I can't remember but it might have been 60 or 70%).
Most of my family members get about 98% with my oximeter when they are awake (my circulation isn't as good I believe), except my daughter with medical issues was always in the 80's (with multiple fingers) which was scary until I had her wash her hands in warm (not hot) water, then it was 95%-97%, and I don't know what that means.
Perhaps the absolute value isn't as important as the drop. Is it normal that my sleeping SpO2 would be about 2% lower even though Oscar said I wasn't having much apnea that night. At least it looked that way to me, but Oscar said 'SpO2 Drop Index 4.07'?
Before I was on CPAP and having an AHI of 20, my oximeter showed me dipping into the 80's when sleeping.
I'm just trying to get an idea of what SpO2 number is too low where it would be "somewhere -5 or -6 where they shouldn't be and thus slowly over the years ruining sleep of that person"?
_________________
Machine: DreamStation BiPAP® Auto Machine |
Mask: ResMed AirFit™ F20 Full Face CPAP Mask with Headgear |
Humidifier: DreamStation Heated Humidifier |
Additional Comments: IPAP 15 EPAP 13.5 |
Re: Clear Airway? Central Apnea? How likely is it?
Your 02 is OK and yes, you should start a new thread and no, the 'Dr.' whose thread you are in should not be giving you advice (yet) as he is also a newbie and only beginning to learn himself (as smart as he might be
).

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Re: Clear Airway? Central Apnea? How likely is it?
lrob123 wrote: ↑Sun Jun 07, 2020 10:41 pmI have a question for you (soon to be) Dr Fejsbukpejdz, about at what value I should worry about my oxygen SpO2 level. Also, I'd like feedback from the experts on this forum. I suppose maybe I should create a new thread if you moderators want me to, but since the Dr-to-be made the statement above, I was quite curious what numbers he thought was bad and he (or she?) is right here, so.....Fejsbukpejdz wrote: ↑Sun Jun 07, 2020 6:57 pm
So if someone does not experience extreme panic attacks at night, does not wake up gasping for air, does not feel EXTREMELY tired in the morning, it doesn't mean his O2 levels are still not wiggling there somewhere -5 or -6 where they shouldn't be and thus slowly over the years ruining sleep of that person.
I had not worn my pulse oximeter overnight for a few years but I just wore it overnight a couple nights ago and got these statistics: (this was a great night for me with AHI of 1, so only about 6 apnea events the entire night)
Minimum : SpO2 %: 91.00
Average SpO2 % 94.19
SpO2 Drop Index 4.07
% of time in SpO2 Drop 5.41%
From the Oscar SpO2 chart, it looked like usually I was about 94-95%, sometimes 96%, rare max of 99%, occasionally dipping to 92%. I don't know if my oximeter is accurate. When I'm awake, it seems to read about 96% but varies between 95-97%.
Does this look OK, or is it worrisome? My twin sister is on oxygen when sleeping in addition to CPAP because hers was dropping way below 80% (I can't remember but it might have been 60 or 70%).
Most of my family members get about 98% with my oximeter when they are awake (my circulation isn't as good I believe), except my daughter with medical issues was always in the 80's (with multiple fingers) which was scary until I had her wash her hands in warm (not hot) water, then it was 95%-97%, and I don't know what that means.
Perhaps the absolute value isn't as important as the drop. Is it normal that my sleeping SpO2 would be about 2% lower even though Oscar said I wasn't having much apnea that night. At least it looked that way to me, but Oscar said 'SpO2 Drop Index 4.07'?
Before I was on CPAP and having an AHI of 20, my oximeter showed me dipping into the 80's when sleeping.
I'm just trying to get an idea of what SpO2 number is too low where it would be "somewhere -5 or -6 where they shouldn't be and thus slowly over the years ruining sleep of that person"?
I am definitely not experienced nor have been researching these disorders enough to be giving advice.
I am just 1 week or so into this.
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Re: Clear Airway? Central Apnea? How likely is it?
Folks here on this forum are very well educated on the topic. Especially in technical things about machines and so on... Waaay more than a regular primary care physician or a medical student like me.lrob123 wrote: ↑Sun Jun 07, 2020 9:48 pmThat nice that you might decide to specialize in sleep medicine.
I like my sleep doctor because he's pretty smart, but I think he could improve by not jumping to conclusions and could maybe be a little more curious. He was very interested when I showed him Sleepytime/Oscar charts because apparently (in my midwest town) none of his other patients use those programs or ever look at their SD card data. Although he seemed mildly interested in the Oscar charts, he admitted he never looks at my SD card (or transmitted) data or any charts at all, only looks at the average AHI for the past few weeks, if the AHI isn't good, he probably would then look at some average statistic about central apneas or leaks also. I assume if a patient had a terrible AHI, he would dig in further and maybe actually look at some charts. But he would not spend time looking at charts of a person with an AHI of 4 or 5 to see if they could tweak to improve. I wonder if someone's AHI was really bad, does the DME monitor it and notify the doctor? Or would the patient suffer for months until it was time for their next doctor appointment?
Also, the first time I walked into his office (before my sleep lab PSG), he took one look at me and said 'you don't have sleep apnea' because I was a skinny underweight woman, in my 40's with low blood pressure and cholesterol. My sleep lab indicated I did have an AHI of about 20.
So as a doctor, it is better not to be so quick to judge based on a patient's age or appearance (thin teenagers can have apnea), and it is better to keep up on what is going on with patients, maybe even read forums. My doctor had never heard of an apnea patient using a cervical collar when sleeping so I told him how wearing one greatly decreased my AHI. If he had read Cpaptalk forum, he would have known that a cervical collar can help some patients.
My doctor at first prescribed me a AutoPap pressure setting of 4cm-8cm. I felt like I was starving for air. He wanted me to give it a few more days, but I found this forum, changed my settings and after a few days realized I needed a minimum of at least 10cm but preferably 12-13 cm. I suspect again because I was so thin and a female, he just assumed I must need only a teeny delicate amount of pressure.
Also my wonderful Yale trained primary care doctor did not know very much about sleep apnea but she was well trained in most areas of internal medicine (e.g. if you had heart problems or diabetes, etc..). I had complained about nocturia during every annual physical for 10 years and she had sent me to a bladder specialist who found nothing after ultrasound and an internal visual probe with a scope. After I finally suspected sleep apnea, asked for a sleep test (she never suggested one, it was me), and then I started on CPAP, my nocturia disappeared. Now I only have to get up in the middle of the night to pee if I have been drinking a large amount of liquid close to bedtime, before it was every night. Apnea can increase the production of urine. I went to a urologist again recently due to blood found in my urine and I asked that urologist if he knew that nocturia could be caused by sleep apnea. Nope, he had no idea. I think most medical schools don't teach doctors much about apnea unfortunately.
I hope you never stop being curious.
Open the thread and just make sure when you post your data, don't post all the graphs. Post a complete screenshot of what you see without scrolling down in your OSCAR software. Make sure the summary from the side is included.
I am still puzzled how responsive folks here are and helpful.
You don't get that kind of support from people who get paid to help you you know...
Re: Clear Airway? Central Apnea? How likely is it?
Well, you know, some people are just in it for a paycheck.Fejsbukpejdz wrote: ↑Mon Jun 08, 2020 12:00 pmI am still puzzled how responsive folks here are and helpful.
You don't get that kind of support from people who get paid to help you you know...
Most people that are volunteering are doing it because they WANT to help.
Get OSCAR
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Re: Clear Airway? Central Apnea? How likely is it?
Thanks Julie and soon-to-be-Dr Fejsbukpejdz. You have answered my question about O2 Julie.
_________________
Machine: DreamStation BiPAP® Auto Machine |
Mask: ResMed AirFit™ F20 Full Face CPAP Mask with Headgear |
Humidifier: DreamStation Heated Humidifier |
Additional Comments: IPAP 15 EPAP 13.5 |