CPAPtalk.com

archangle wrote:Your doc is an idiot.

Simpy wrote:I have returned to my old self: struggle to get up, sleeping 10+ hours to compensate, etc.

Jay Aitchsee wrote: Maybe we can get someone else to chime in with their thoughts.

archangle wrote:

Too tall wrote:I'm told by the sleep doctor that it's impossible to detect CA with just CPAP data. They say you need to be hooked up to all the sensors to the head etc..

Your doc is an idiot.

It's not 100%, but pretty much if the CPAP says CA, it's a CA. It may flag some CA's as obstructive, but they can do a pretty good job with detecting CA's.

You may not show your normal breathing problems when you are in a lab, in a strange bed, nervous, with wires all over you, sleeping badly, perhaps not in your normal sleep position, sleeping badly, etc. Even if the CPAP machine isn't as "accurate" in some sense, it's not measuring your "real" sleep pattern.

The other thing a CPAP machine can't do is tell if you're asleep, and some people show "false" apneas if they're awake.

Pugsy wrote:

Too tall wrote:I'm told by the sleep doctor that it's impossible to detect CA with just CPAP data. They say you need to be hooked up to all the sensors to the head etc..

Well I bet that the machine manufacturers might disagree with your doctor's statement.
Here's one manufacturer's documentation on how reliable their central detection is.
http://www.resmed.com/fr/assets/documen ... -paper.pdf
I imagine Respironics has similar findings.
They didn't just pull this central detection stuff out of their behinds. Lots of research went on behind the scenes.

Sensors on the head are usually for documenting sleep stages and not necessarily whether an apnea event is central or obstructive.

Jay Aitchsee wrote:Simpy, I understand your concern. It looks like you have a lot of CSA events. But, looking the total number vs hours slept, I'm guessing your AHI is only around 2.0, actually not too bad. Also, I'm not sure your breathing (flow) is all that suppressed. Could be just a matter of scale. The graph limits are +/- 250 which tends to make the waveforms look small. In the example you've shown, it looks like the flow rate min is still up around 10L/min or so.
Hard to tell about the CSA events. They could be actual or just disturbances where you've moved, or rolled over or something, and caught your breath for a few seconds. It looks to me as if you missed the actual events in the navigation panel so that they're not shown in the detail panel. Sometimes, the start of an event can provide a clue. For example, a few deep breaths just prior to the event could signal a disturbance rather than an actual CSA. In looking at the 10 hour flow detail (DEC 1), it does look like a number of events coincide with a sharp increase in flow rate. However, It will probably take a lab setting to determine for sure.
I think your Flow limitations are still a bit high, though it may not matter. Some here have suggested that anything over .04 is worrisome and many of yours would seem to exceed that, but I'm not sure there's much agreement as to the effect, even if they are high. There is very little evidence of obstructive events, except for the Flow limitations and some snores which seems to be the driver of your auto pressure. It is possible the pressure fluctuations are disturbing, but it doesn't really look like it. But to rule that out, you might want to try a constant pressure around 9, or so.
As you say, it is possible you have something going on that cpap can't fix. Did your last sleep study mention any disturbances due to PLMD? If you have bed partner, have they mentioned any unusual leg movements or thrashing? How about sleep hygiene, and/or caffeine use, or Meds?
Maybe we can get someone else to chime in with their thoughts.

Simpy wrote:

Jay Aitchsee wrote:Simpy, I understand your concern. It looks like you have a lot of CSA events. But, looking the total number vs hours slept, I'm guessing your AHI is only around 2.0, actually not too bad. Also, I'm not sure your breathing (flow) is all that suppressed. Could be just a matter of scale. The graph limits are +/- 250 which tends to make the waveforms look small. In the example you've shown, it looks like the flow rate min is still up around 10L/min or so.
Hard to tell about the CSA events. They could be actual or just disturbances where you've moved, or rolled over or something, and caught your breath for a few seconds. It looks to me as if you missed the actual events in the navigation panel so that they're not shown in the detail panel. Sometimes, the start of an event can provide a clue. For example, a few deep breaths just prior to the event could signal a disturbance rather than an actual CSA. In looking at the 10 hour flow detail (DEC 1), it does look like a number of events coincide with a sharp increase in flow rate. However, It will probably take a lab setting to determine for sure.
I think your Flow limitations are still a bit high, though it may not matter. Some here have suggested that anything over .04 is worrisome and many of yours would seem to exceed that, but I'm not sure there's much agreement as to the effect, even if they are high. There is very little evidence of obstructive events, except for the Flow limitations and some snores which seems to be the driver of your auto pressure. It is possible the pressure fluctuations are disturbing, but it doesn't really look like it. But to rule that out, you might want to try a constant pressure around 9, or so.
As you say, it is possible you have something going on that cpap can't fix. Did your last sleep study mention any disturbances due to PLMD? If you have bed partner, have they mentioned any unusual leg movements or thrashing? How about sleep hygiene, and/or caffeine use, or Meds?
Maybe we can get someone else to chime in with their thoughts.

Hi, Jay

Thanks for the interesting response. It seems the thread had derailed a bit, lol.

In any case, I have never had a bed partner so can't answer that. I do believe my last sleep study didn't reveal I had any PLMD issues though. I will have a sleep study in January and will discuss my results with my doctor. At this point, I really feel like my issue isn't just the OSA anymore. But who knows.

Out of interest, does anyone know what else *could* be going on? Is there anything that could account for my current state based on anything anyone knows? I like to know as much as I can to discuss it with my doctor because they often won't bring things up otherwise.

Thanks

Simpy wrote: For the last week now, I have returned to my old self: struggle to get up, sleeping 10+ hours to compensate, etc.

....

Out of interest, does anyone know what else *could* be going on? Is there anything that could account for my current state based on anything anyone knows?

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.