how good is good enough?

So I've been on CPAP since last September. No question it has made for a big improvement, but has it done enough? My energy levels are up and I can concentrate better, but my memory is still not nearly as sharp as it used to be or should be. And I think I still have residual other symptoms, but it's so hard subjectively to know for certain-- I think I could be better, but I've lost track of what is normal for energy levels, tiredness, etc. so I just can't say.

Anyway. I've been tracking my AHI numbers, and here's the thing. They are usually below the (probably arbitrary) "normal" threshold of 5. But they aren't always-- at the end of December, I had an 8.8, and 5/6 isn't that uncommon. It is very rare that I get something under 2. And all my events are centrals. During my first sleep study, I had nearly all obstructives (very few centrals) and an AHI of around 25 altogether, but on treatment, I get these centrals popping up. Overall, under 5 is a vast improvement, but I do think I feel better when that number is not just hovering around 5 but is lower. My understanding is that fiddling with my settings (8 cm) isn't going to affect the centrals. Not sure what, if anything, can be done to get more improvement? Has anyone else had to figure out how to get more benefit from treatment, especially for residual centrals?

wolewyck wrote:it's so hard subjectively to know for certain-- I think I could be better, but I've lost track of what is normal for energy levels, tiredness, etc. so I just can't say.

You have expressed so well the dilemma many of us face, especially when one has had longstanding untreated OSA. How far back was normal? And how much aging and/or health changes have taken place since? Maybe we have to trust our gut on this. If we feel like "is this all there is?" maybe it's because we somehow know there should be more.

My knowledge of centrals is minimal, so give more weight to about anyone's input than mine on this. On your titration, was there a marked increase in centrals at a particular pressure? I have read on here where a couple people have been sensitive even to lower pressures and developed centrals. If you have no obstructive events in your data and no hypopneas, I'm wondering if dropping your pressure a half point at a time might pinpoint a balance-point pressure. Of course, that's just if the centrals are pressure induced. Although your numbers are neither alarming nor negligible, I'd be as concerned about the duration of those centrals and if there are any desats of concern.

Nothing wrong with wanting your treatment to be the best it can be. I don't think it's unrealistic to expect improvement. Just my opinion.

wolewyck wrote:I've been tracking my AHI numbers, and here's the thing. They are usually below the (probably arbitrary) "normal" threshold of 5. But they aren't always-- at the end of December, I had an 8.8, and 5/6 isn't that uncommon. It is very rare that I get something under 2. And all my events are centrals. During my first sleep study, I had nearly all obstructives (very few centrals) and an AHI of around 25 altogether, but on treatment, I get these centrals popping up.

It's very possible that many, or even all, of the "centrals" you see on reports from our therapy machines (like the ResMed S9 or a Philips Respironics System One) are normal centrals. Especially if there are a mere handful each night and especially if there was not a problem with centrals in your sleep study. From the way you describe your usually low AHI -- comprised mostly of machine reported "centrals" -- that would qualify as a mere handful, imho, but I'm not a doctor.

I agree with Kathy:

kteague wrote:Nothing wrong with wanting your treatment to be the best it can be. I don't think it's unrealistic to expect improvement.

I don't think the amount of centrals your machine is reporting is holding back the degree of improvement you hope for. Again, I'd stress that some of them are quite likely "normal" centrals.

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

You might try to get an oximeter, and check your oxygen saturation levels. What you want to see is as flat a line as possible, with a number >90++%. I believe with the S9 , you can then chart your central episodes with your oxygen sat line to see if any correlation.

There were nearly no centrals all night in the first sleep study-- they did pop up, however, in the titration study, and the doc's notes mentioned the possibility of complex apnea. Unfortunately, that doctor then apparently left for medical reasons herself, and the one remaining (whom is the only one I'd actually spoken with) has, shall we say, not impressed me at all with his clinical knowledge, despite being a sleep specialist.

I will have to go back and look at my sleep study to see if I can figure out if there was a specific pressure at which point the centrals increased... if I can read the study that well, anyway! Interesting thought, as is the one about the oximeter. Does it matter which oximeter to get-- are certain ones only compatible with certain machines, for instance? Thanks!!

wolewyck wrote:There were nearly no centrals all night in the first sleep study-- they did pop up, however, in the titration study, and the doc's notes mentioned the possibility of complex apnea. Unfortunately, that doctor then apparently left for medical reasons herself, and the one remaining (whom is the only one I'd actually spoken with) has, shall we say, not impressed me at all with his clinical knowledge, despite being a sleep specialist.

Well, that's too bad that the first doctor is no longer there. Since she noted from the titration part of the study, the possibility of CompSAS (Complex Sleep Apnea Syndrome) it sounds like she would have been pretty savvy about looking into your concerns now.

As I understand it, some people who exhibit the signs of possible CompSAS in the titration (when CPAP is used at the sleep study) do eventually have those centrals subside after using CPAP therapy for more time. Days, weeks, perhaps months. You've been using CPAP for over a year now. IF the centrals your machine is reporting are, indeed, true "centrals" and not just "turning over" or "sleep onset" centrals, it might be worth pursuing to see if an ASV (adapt servo ventilator) might suit you better. Perhaps you could wangle a PSG titration night on an ASV machine, but I'd do some serious inquiries first to be sure the sleep lab (the sleep tech, in particular) is very experienced in ASV titrations.

Using a recording pulse oximeter while sleeping would be a good way, as dtsm suggested, to at least get a look at how things are going, O2-wise, while asleep, at home.

Some discussions about recording pulse oximeters:

viewtopic.php?p=481920#p481920

viewtopic.php?p=442989#p442989

viewtopic.php?p=370113#p370113

viewtopic.php?p=451571#p451571