Wigged out about central apneas

[pjwalman]

I think this is one of those classic examples of a little information being dangerous. I received a copy of my sleep study from my DME tech (because I asked specifically for it, plus a copy of my prescription). Let me preface what follows by saying that my study ended up being a split study because of the number of events. What the study shows is that, of the total events pretreatment in nonREM sleep, my AHI was 51.7 for central apneas while nonsupine ( 65/90 ), 45.3 AHI for obstructive apneas ( 10/46/47/88 ). While supine, 77.6 AHI for centrals ( 22/85 ) and 31.8 for obstructives ( 9/88 ). I'm not sure if it's worthwhile to mention REM sleep since it was a whopping 1.5 minutes , but to give the whole picture, my AHI while nonsupine was 120.0 ( 3/93 ) for central and nothing for obstructive. Supine there were no apneas. After they put the machine on me, nonREM was 19.7 central ( 26/91 ) and 15.2 ( 2/93/18/96 ) obstructive. None while supine. (I'm assuming that's 'cause I never rolled onto my back during that 1.5 minutes.)

You know, before reading the sleep study, I never knew there was such a thing as central apnea, always assumed apnea was just an airway thing. Now that I've read the few articles I can find about central apnea, it scares the crap out of me that I have them, period, and that I had so many of them in my one night of study. I mean, it ain't pretty what they talk about possibly being the cause of centrals: Congestive heart failure, tumors, neuromuscular diseases. I of course am rooting for idiopathic.

I don't get to see the sleep doc until the end of the month to get further explanation, and now I'm wishing I'd never seen the damned sleep study 'cause it's freaking me out. So I'd like to hear from anyone that has some knowledge about or experience with central apneas. Do I have tons of awful tests to look forward to now? Is the sleep doctor going to say we have to look into the cause of centrals or are they really no big deal in the world of apnea? I mean, I guess I tend to think, if it really was as serious as it feels like it might be, then the doctor wouldn't be waiting until the end of the month to see me. Right? Then, on the other hand, I think maybe doctors are so busy that he just looked at the front and said, "Yeah. Write up a prescription for CPAP" and that was it. I've read that some machines are better than others for central apnea. Do I push it and ask the DME tech to approach the doctor about looking more closely at the study before my appointment...or do I assume he's fully informed already and considers it not a big deal or his office already would have contacted me about coming in sooner?

Since I know someone will probably ask , my pressure is 11, a 30-minute ramp starting at 6, and it's straight CPAP. The doc hasn't authorized an APAP, although my machine is capable of that function should that happen down the road.

Geez, I hope I'm not seeming like a snively, whiny, paranoid newbie here, but the thing is just kind of preying on my mind. I try to find information about it to give me some reassurance that it's no big deal, but almost everything I've read is saying it *could* be a big deal, so again I am just kind of wigging out and could use a little input here to relax...or not relax and be more proactive about getting some answers before the 28th.

Thank you in advance, kind CPAPtalk friends! Without you and this forum, I would be even more of a basket case than I am.

Peggy

Key to numbers in parens: ( apneas/apnea, minimum SaO2/hypopneas/hypopnea, minimum SaO2 )

[NightHawkeye]

Think Complex Sleep Disordered Breathing, Peggy, sometimes called simply complex apnea. You should be able to find useful information if you search on that. not necessarily the same thing as Central Apnea.

FWIW, I seem to recall that OSA sometimes triggers CSA and treating the OSA then helps the CSA.

[Goofproof]

No need to get too excited, I didn't get a copy of my study or a script up front, but I was AHI 150 for the 3 hours I slept. You have made it to this point in life without XPAP, from here it only gets better. check your P.M. Jim

[pjwalman]

Thank you for giving me the right term to look up, NightHawkeye. I Googled it and read up on it. When I go to the DME Friday and they print out the report from my SmartCard, will that break down all the events so I'll know if the centrals are still popping up? I hope I don't have the Complex Sleep-Disordered Breathing (did I get that in the right order?), 'cause it looks like that may mean a really expensive fancy machine (she says as if that's more important than the medical implications it has).

Appreciate you pointing me in the right direction!

Peggy

[dsm]

Peggy,

From reading your reported stats, the best person to make a meaningful comment has to be SAG so I hope he catches on to this thread.

I think he has the best grasp of what the numbers mean that you are quoting as they are strange to me (I can't recall seeing a PSG reported in such terminology in relation to Centrals).

Cheers

DSM

[NightHawkeye]

Thank you for giving me the right term to look up, NightHawkeye.

You're welcome.

When I go to the DME Friday and they print out the report from my SmartCard, will that break down all the events so I'll know if the centrals are still popping up?

Maybe. The Respironics algorithm isn't capable of fully differentiating between central and obstructive apneas. If there are enough central apneas close together, then it provides a Non-Responsive flag. If you see that, it would be a real strong clue. If there aren't any NR flags recorded, then I would assume the central apnea component to be under control.

I hope I don't have the Complex Sleep-Disordered Breathing (did I get that in the right order?), 'cause it looks like that may mean a really expensive fancy machine (she says as if that's more important than the medical implications it has).

You'll be the envy of the message board!

Appreciate you pointing me in the right direction!

That's what folks do here. DSM also pointed out SAG to you. If you haven't stumbled across any of his posts yet, he's also known as (aka) StillAnotherGuest (or maybe he puts spaces between the words, I don't remember) He's also got some other aliases (but don't let that scare you too much, though). He's posted more on the subject of CSDB than probably anyone else on the internet.

Regards,
Bill

[Julie]

Hi, I went through the same thing as you at the beginning (and as far as I know now, 4-5 yrs later, don't have central apnea). TItration studies are notorious for being all over the place and reports often show many centrals, but they indicate ... just an unstable study (which is more normal than otherwise!), and unless you go on to find out in future that you're one of the very rare people who really do have 'it' after a lot of treatment, I wouldn't worry right now at all.

[pjwalman]

I will hope SAG stumbles upon my posting then and will also keep a lookout for him so maybe I can steer him in my posting direction and impose on him for his knowledge and wisdom like I have done with all of you.

And, until then, I will try not to worry about it now, as Julie suggests (knowing that not worrying is not one of my strong suits, but I will definitely try to just mellow)!

Thanks again, all of you!!

Peggy

[sehvinn]

"FWIW, I seem to recall that OSA sometimes triggers CSA and treating the OSA then helps the CSA."

Thanks, Nighthawkeye!

This is what my doc had explained to me and one reason he was not getting all in a wad! He said that many times what seems like a complex problem upon diagnosis will get significantly improved, or, disappear with treatment. That made me feel better!

[GumbyCT]

Peggy,
Rested Gal (RG) once pointed out - OSA or CSA what's the diff - either case you are not breathing!!! how true eh?
So don't panic - not sure how old you are but you have lived with it this far - right? It's just now you know about it - it bothers you.

Not sure if I had Centrals per se - but for sure as my pressure goes up, I have more events. Can't exactly tell from Encore but I'm not breathing so what's the diff?

With persistence AND a good doc AND the help of these wonder folks - I think I've got a grip on it - not sure others agree but who cares, right!

Good Luck,
GumbyCT

[pjwalman]

You are exactly right, Gumby. No matter what you call it, you're not breathing, period, and the CPAP will help. It's the bad s*** that causes the central apnea that has me kind of freaked out...but that is just me, always worrying about impending bad stuff. Sometimes I wish I could have a "worry center lobotomy" -- it sure would make life easier. But thanks for putting it into perspective by passing on what Rested Gal had said. I've survived this so far (and I just turned 50, BTW), and now I have a weapon to fight it. It's just that ignorance was bliss and now I don't have the luxury of being the ostrich with my head in the sand anymore.

Peggy

[jules]

I guess I admit to being confused on what you wrote.

Centrals do pop up occasionally on everyone and do like to pop up during titration studies.

What was the diagnosis given at the end of the report?

If you have mixed apneas or get a diagnosis of central sleep apnea or complex sleep apnea, you have to demand to see a specialist. I don't know if you went to a lab in Salem or went up to Portland, but in either case you want to find out who is the best sleep doc you can easily get to.

The treatment for centrals can be quite different than that for OSA. That is where you need to best you can find. It might be a fancy bipap, meds, added oxygen, all of the above, none of the above.

Your current machine settings (fixed pressure) aren't going to help you find out if you have more centrals during the night as the software will label a flow pattern it has been programmed to score as an apnea as just that - no adjective.

[Snoredog]

.....um do you have the experience to know HOW to read a PSG report and interpret its results?


If this is your first PSG and you are just picking up your machine, I doubt that you do. Doctors get upwards of $570 bucks from insurance just to take your PSG read it and tell you what it means, its called interpretation.

How it is worded or not knowing what something means on the report can easily cause you to skew the results and make something out of nothing.

There are other items and detail on that report (if included) which paint a picture of your disorder, unless that is put into context for you by someone experienced with reading it, you may be just spinning your wheels.

If you had half as many centrals as you claim your report shows, I doubt you would have even gotten to REM sleep much less stay there for 1.5 minutes.

Next if your CA was as bad as you indicate without the machine I doubt they would have continued on with the titration unless they were fully equipped to do so and the tech experienced enough to titrate you for it.

FYI: they perform a split-night study because insurance is cheap, first 2 hours is diagnostic (if you sleep) second half of study is titration portion (again if you get to sleep and things settle down and you reach REM).

I think you need to chill out and wait for the doctor visit and have him/her interpret the PSG results for you and make a recommendation from there.

My other guess is the DME tech was probably flipping burgers last week and will be seeking a new position at Wienerschnitzel once your sleep doc learns he gave you PSG results prematurely.

[rested gal]

Rested Gal (RG) once pointed out - OSA or CSA what's the diff - either case you are not breathing!!!

Well, it wasn't exactly me who said something like that. And not quite in those words, if I did say it...lol!! Probably you saw me quoting christinequilts at some time, Gumby.

It was christinequilts who said something like that (not quite in those words) and, yes, you did pass along the essential meaning, Gumby.

Below is the quote from christinequilts, who has almost exclusively Central Sleep Apnea:

christine wrote: Oveall it seems like to me a lot of people panic when they hear they a central event. It probably has to do with the whole 'forgeting to breath'- O-My-Gosh- how could I forget to do something that basic! In reality is it any more scarey then having your airway blocked during an obstructive event? Both obstructive & central apneas result in not getting O2 in and disruption of sleep.

christine finished by saying: You might want to check this older thread out on CSA- http://cpaptalk.com/viewtopic.php?t=1056

Peggy, a split-night study's titration part is considerably shorter than it would be if they had given you a full night of titration only. Even with the shorter titration you got, your centrals and obstructives were reduced dramatically. By plain CPAP.

I think if you had some dread thing causing centrals, I doubt if cpap would have put much of a dent in them at all. So, yeah, go with "idiopathic" and forget the brain tumor. If you had congestive heart failure, I think your doctor would have already had you going to see a cardiologist.

Likewise, if you had CompSA (Complex Sleep Apnea) you would have been getting (as I understand it) MORE, not fewer, centrals after they started CPAP during the titration at the sleep lab.

With that kind of improvement during the CPAP titration, chances are good that CPAP or BiPAP will treat you ok.

No, the SmartCard is not going to reveal if centrals are still happening. At best it might suggest they are, if (as NHE mentioned) "NR" (Non-Responsive...not improving with additional pressure) events show up on the data. But the machine can't really identify "centrals" per se. If you had short ones, they wouldn't even rate an "NR" as a possible central.

I believe I'd talk to the doctor about the results of the split night titration. If based on the split night titration you already had....if your doctor thinks you still might have a significant number of centrals in addition to obstructives, I'd ask him about the advisability of having another titration night. This time, a full night titration. With the Respironics BiPAP Auto SV machine. A machine designed to treat both, if you need an exhale pressure higher than 8 to handle the obstructives.

Links to Central Apnea discussions
viewtopic.php?p=22702

[pjwalman]

I will most certainly talk to my doctor about it -- I just wanted to make sure it wasn't something important enough that I should try to get in sooner then the 28th. Sounds like I'll be fine just keeping the planned appointment, and that is what I was hoping to hear.

Thank so much for the input!!!

Peggy