Recently diagnosed with Central Sleep Apnea, but doc refusing treatment. Need help (UK)

[Pugsy]

The WatchPat is a type 2 home sleep study device
https://www.itamar-medical.com/
It does measure sleep stages which is how it can report RDI. It collects a lot more data.

Most of the time when doctors "treat" for UARS based on RDI they are sort of throwing crap up on the wall and hoping it will stick because nothing else has stuck. The only definitive test for sure...is a sleep study done with a Pes device and since that is hard to get even without Covid screwing up things...they opt for a "try it and see if it helps" approach because the only real options is CPAP anyway for UARS.

As to why so many centrals flagged at the beginning of the night and not later....remember to earn any apnea flag the event must last at least 10 seconds. It wouldn't be impossible for you to have a 9 second sleep onset central apnea and it not be flagged but it could sure bounce you out of sleep.

So I am not totally convinced that those repeated awakenings which in turn cause a need for more transitions from awake to sleep aren't triggering central apneas that would be sleep onset centrals.
The fragmented sleep from the arousals from having a bunch of 9 second central apneas that don't earn a flag, is just as harmful to sleep quality as a 10 second apnea. You simply don't stay asleep long enough for them to get worse in numbers or duration to earn flags.

I had this problem with my OSA...sort of because my OSA is worse in REM sleep. Like 5 times worse in REM than in non REM and it was hard for me to get a diagnostic sleep study really measuring my AHI during REM because I simply didn't stay in REM long enough to get many apnea events flagged. I would enter REM and a truckload of OSA events happen and I would wake up within a very short time.
The same thing can potentially happen with sleep onset centrals.

It also wouldn't be impossible for you to have 2 problems....sleep onset centrals and maybe UARS.

Find someplace that will give you a WatchPat type 2 in home sleep study...it's more comprehensive for sure and a better starting point.

[CentralApneaUser909]

CentralApneaUser909 wrote:

"If I get my sleep report from the NHS, do you think if I posted it here, you or someone else could tell me whether UARS is likely? I am assuming that there Is a way to spot RERAs on the graph."

Well, first, I think you should get a copy of your sleep study and any letters that go with it, even if no attempt was made to diagnose UARS from it. It's what I and the others on this forum have been saying for several posts.

Get a copy of your sleep study. It may not tell us everything – but it would most likely tell us more than what we know now.

Second, I for one don't know enough about UARS, so I can't and won't offer an opinion.

What I do know is that, in terms of diagnosis, and what can and should be treated, the more important question is: what's happening to O2 sats?

I don't know what happens in general to O2 levels during suspected UARS. We do know in general what happens to O2 levels in Central apneas.

Which brings us back to your sleep-study results.

I thought overnight as to how I put it above. You don't need to make a written, formal subject access request to get a copy of your report. It should be enough that you ask it. And anybody who tries to fob you off is breaking the law.

The main reason you might say to people 'Or do I have to make a subject access request?' is to remind them them that it IS the law.

Actually putting together the paperwork, and enclosing your passport, etc, is the back-up legal process that, hopefully, you never have to use.

Yep I will get the sleep report. The clinic is closed on weekends so I have to wait until Monday to call them.

As to why they have been so reluctant to give me it, I have no idea. I don't know why it bothers them so much, and the secretary was very rude. I will ask them but remind them.of the law. They have made things very hars for me.

As for UARS, fair enough. Well, UARS often doesn't involve oxygen dips at all. And I had average dips of 1% per hour from my oximetry test. Also on my.home test, oxygen was fine.

[Pugsy]

A word about the nocturia. We all know it is a common symptom of sleep apnea because of the stress hormone produced by the heart that goes to the kidneys and the kidneys then kick into over drive and produce copious amounts of urine.
It wouldn't be impossible for a bunch of 9 second centrals to be a factor here.

So between the full bladder awakenings and the arousals frequently from the maybe sleep onset centrals that don't earn a flag...it's no wonder you feel like crap ...you simply aren't getting good quality sleep.

PS....I still would get you an ASV if you were my family member...it treats everything and doesn't do anything if nothing needs to be done.
I know a sleep doctor here in the US that has OSA and he says he would give everyone an ASV if possible because of how it functions.
If you don't have a central it does nothing and works like a regular apap machine but it can treat centrals if it needs to.

The 1% reported oxygen dips....is this from just a simple overnight pulse oximeter? Home sleep studies will need either 3 or 4 % drop before they will even flag it. Percent amount depends on the parameters set up. 1 percent is nothing....it's normal for O2 levels to drop a bit during sleep anyway. Sometimes as much as 4% from baseline.

[ChicagoGranny]

On the chance, that Central is a wrong diagnosis, and your problems are primarily obstructive, it might be helpful to entirely avoid sleeping on your back during this interim period.

Obstructive problems tend to be worse when back-sleeping due to gravity pulling the tongue and soft palate directly into the airway. Stomach-sleeping and/or side-sleeping gives many people some relief.