Here is a section of my June 2014 In-Lab Sleep Study at Stanford:
To go into more detail:
Despite being diagnosed with sleep apnea in 2014 from an in-lab study at the Stanford Sleep Clinic, (I sought a second opinion there after first being diagnosed with PLMD elsewhere; the medications I was given to treat it had side effects that I couldn't tolerate) I have been struggling with PAP therapy and have found that, more often than not, my AHI is almost never able to stay consistently under 5, and on bad nights will go up to the 10-15 range.
After going down a rabbit hole of research and follow-ups, I only recently (in March of this year) learned that I have a deviated septum and enlarged turbinates, which have contributed to frequent congestion from colds and allergies. When I was first given a PAP device in 2014, I started off with nasal pillows, but told Stanford that I couldn't use them anymore due to congestion, at which point they switched me to a full face mask.
Since then, I have been using BiPAP off and on with mixed success, to the point where I've abandoned for up to months at a time when my congestion was unbearable. Now that I understand that my therapy might be adversely affected by my inability to breathe through my nostrils (I've tried everything from allergy shots, nasal sprays, rinses/neti pots/Navage, nasal strips, mouth tape, etc, and none of them have really moved the needle) I am on a 5+ month waitlist for a septoplasty and hope that will make an impact.
I also had a WatchPAT sleep study done again through Kaiser in February as part of the process to get an ENT referral, as my insurance changed to Kaiser, and I was no longer able to be treated by Stanford. The WatchPAT study was, by its nature, not as comprehensive as my lab study, and showed an AHI of 15 and RDI of 16, but with limited additional details.
2026 WatchPAT study
This prompted me to try and retrieve the 2014 lab study.
When I was first diagnosed by Stanford, I had very little understanding of the nuances of sleep apnea, so I followed along with what they suggested and didn't really comprehend what was behind the decisions they made and the treatments that were prescribed. Now, because of my persistent struggles with fatigue that are worsening my daily functions and jeopardizing my career, I have spent a lot more time researching online in order to better understand and advocate for myself. This is what led me to request an ENT referral, and I'm incredibly glad I did -- spending almost 10 years without knowing that my septum was potentially affecting the quality of my treatment is hard to accept, and I wished I was a bit more forceful in advocating for myself in the past.
Looking at the sleep study now, I am curious about the distinction between Central and Obstructive events. My understanding was always that I had a narrow airway which was causing the classic OSA presentation, and that a deviated septum would exacerbate this issue. So I am trying to understand why the study from Stanford seems to indicate that I have an overwhelming amount of central apneas compared to obstructive events. Is there a kind of nuance in what is flagged as a central or obstructive event from the Stanford methodology? From what I've learned about interpreting OSCAR results, I've heard that "Clear Airway" events can be ambiguous -- they could be linked to central apneas, but from what I understand, a PAP machine wouldn't be equipped to determine that as a fact. Additionally, my understanding of central apneas is that they are more neurological than physiological.
I was put on BiPAP shortly after my study in 2014, but I am wondering if my sleep apnea would respond better to ASV or other types of treatment. I also recently set up a camera to try and monitor my movements in sleep and have noticed that I thrash around a lot, kicking my legs, folding them in odd ways, and even raising my arms up and down under the covers. I am unsure if there is residual evidence of PLMD, but I worry about trying the dopamine agonists again due to their side effects.
I'm looking for any thoughts or suggestions to better understand my situation holistically. I plan to ask my sleep clinic, but won't be able to speak to them until the end of the month, so any information that can help me better understand how I can target my questions and ask for alternative treatments would be helpful. I have been told by the sleep therapists at Kaiser that my apnea appears to be well managed, despite my AHI averaging easily 8 at minimum on a month-to-month basis, so I want to make sure I can present enough information to them that will help get me on the path to more effective treatment. I have not presented my original sleep study to Kaiser yet, but I am hoping that, when I do, it could provide an opportunity for me to pursue other treatments if they might be more effective.
I have also included a recent screenshot from OSCAR, as well as screenshots of my follow-up at Stanford in 2015 for a BIPAP titration.
Oscar from June 13
Feb 2015 Stanford In-Lab Titration:
I really appreciate any insights, and thank you very much for your time and help.
