AHI 89.6

I had a sleep study done a few weeks ago and they told me in the 2 hours prior to hooking me up to the CPAP I had 54 "incidents" per hour and my Blood Ox dropped to 77%. Accordingly, they told me I have severe sleep apnea. I use the VA for healthcare and they had me do this study at a local clinic because I live 2 and a half hours away from the nearest VA Hospital. The VA set me up with a Dreamstation and nasal mask. The Dreamstation has bluetooth, so I've paired it to my phone and use the app to review my sleeping.

It's been a bit of a chore to get used to, but I'm doing it. The problem is, I'm still not sleeping very well. For instance, my most recent sleep period lasted 3 hours 35 minutes with an AHI of 89.6. That consisted of 195 Clear Apneas, 120 Obstructed Apneas and 6 Hypoapneas. I don't have an oximeter to measure that, so I don't have a clue how well that was doing.

My background is that I'm 44, 6'1", ~255lbs. I'm disabled with lower back and leg pain(morphine twice a day with nerve pills), depression from all the pain and really poor sleep. I can't lay out in a bed due to my back/leg pain and spend my time, day and night, in a recliner. I live alone on $1100/mo disability.

I really want to make the most of my CPAP machine and get my sleeping under control because I think that will help me deal with the constant pain better and "brighten" my mood. Are there any services or additional equipment/accessories I should be looking into? Will the VA pay for them or are there organizations that donate or have payment plans for that kind of stuff?

Thank you very much for your time and sleep on!

David B.

EDIT: They found that a pressure of 9 "fixed" my problems during the sleep study and that is what my machine is set for. I'll see if I can get a copy of the report. It may take a while because I can't drive and I'm sure I'd need to sign something for them to give it to me.

Hello and welcome. Did you get a copy of your report from the sleep study? If not, you should. You need to know if centrals were noted both during the diagnostic portion and during the titration. The events you mention would concern me. If centrals were seen in the first part of your study, I'd wonder if they are related to some of the meds you are on. If centrals didn't show up until you were being titrated on the machine, they could be pressure induced. The meds could still influence that I would think. Also, check your report to see if the tech was able to successfully titrate you, meaning did they find a pressure that effectively treated your events? I'm not familiar with your machine, but someone will come along and talk to you about your data. To be honest, with the numbers you are reporting, I'd be hesitant to use the machine until someone can tell you why your numbers are worse when treated than in your diagnostic portion of the study. I'll defer to others more informed than I on this kind of thing. If necessary meds are causing you to have centrals, you may need a more advanced machine to manage your breathing issues, but let's let some others weigh in. I may be over reacting.

The 'centrals' at the beginning of the study could just be the usual 'sleep-wake junk' that happens then - not necessarily meaningful, but the report will show what's what.

I'd look carefully at what meds you're taking for everything as some may interfere with sleep and you could ask your MD about potential substitutes and/or time of dosages.

You may want to download SleepyHead as it may give you more data and you can
post the graphs here for the experts to see. One thing I noticed is you said you slept
in a recliner. I assume they didn't have a recliner for you to use in the sleep study so
you had to use a bed. I believe some people have noted that sleeping in a recliner was
a lot better for there sleep apena . So I am wondering if sleeping in a recliner you may
need a different pressure ? Did they give you a DreamStation or a DreamStation Auto ?

kd0pls wrote:morphine twice a day

You may need a different machine because of likelihood that the centrals are from the pain meds suppressing respiration.

195 clear airway events...that's Respironics term for central apneas...in 3 1/2 hours of sleep is way too many to blame on SWJ.
Your machine can't deal with centrals...but it can deal the obstructive apneas.

Get SleepyHead and let's see what's going on.
https://sleep.tnet.com/equipment

I don't know if the cpap pressure is tipping the scales to cause the respiratory imbalance to trigger the centrals or if you would have the centrals anyway. You really need an in lab sleep study hooked up to a machine.
But watch this...no matter what the cause (cpap pressure or your pain meds)...with so many centrals you likely have complex sleep apnea
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

Woody wrote:I assume they didn't have a recliner for you to use in the sleep study so
you had to use a bed. ...Did they give you a DreamStation or a DreamStation Auto ?

I did my sleep study in a recliner. It's a Dreamstation CPAP Pro with Humidifier.


I have downloaded Sleepyhead already. I can't figure out a way to transfer the data over Bluetooth and I suspect that Sleepyhead doesn't allow for that even though I have the CPAP machine paired to my PC. So, I'll have to dig out my card reader to see if I can import the data that way. I'll edit this post later on when I get that done.

SleepyHead is going to need all the files on that SD card via a card reader inserted into your computer.
There is another way but it involves a very special wi fi card.

Once you get the data in SH if you want to share with us what you are seeing...read these links.
https://sleep.tnet.com/reference/tips/imgur

and this one on how to organize..3 pages so read them all.
https://sleep.tnet.com/resources/sleepyhead/shorganize

and for examples of what we like to see..this thread
viewtopic/t103468/Need-help-with-screen-shots.html
We don't need each and every graph...just the basics. The AHI and statistics on the left side and on the right side graphs...events, flow rate, leak and pressure. You can get it all in one image.
Please note there will not be a flow limitation graph because your machine does not do a FL graph. It would flag them in the Events graph but only in auto mode which you may not be using.

I don't have any specific advice for you, unfortunately.

However, I can tell you that severe OSA (your case is extremely severe) isn't a side problem. It's as big as your other problems and it's making you other problems worse. It's very important to take care of your OSA!

I believe this is what you're wanting to see. let me know if it's not.

Your "Clear Airway" events are worse than your obstructive events. I would speak to your Sleep Doctor about Central (or mixed) Sleep Apnea. BTW, "mixed" simply means the Central and Obstructive variety occurring in the same patient.

Central and mixed are harder to treat than obstructive, but that doesn't mean impossible to treat!

Here's a zoom in on what looks like a typical section for the night to give you all a better idea of what's going on. Thanks again so much for helping me! So glad I found this forum.

You need to get in front of a sleep doctor and go over the sleep study results and the results from this machine.

If we are to believe the results (and there's no reason to doubt them)...the pressure isn't dealing with the OAs and it will never be able to deal with the centrals.

If they did a sleep study with you wearing the mask in an effort to find a suitable pressure I find it hard to believe that the centrals weren't rearing their ugly head during the sleep study.

They may or may not have been mentioned in the sleep study results (which you do need to get anyway).

Make an appointment to see a sleep doctor and one preferably who is familiar with pain meds likely impacting the respiratory system and suppressing respiration and central apnea therapy.
You most likely are going to need a machine that can treat both the obstructive apnea and the central apnea. Usual go to machine for both types of apnea is the ASV type of machine. Adapto Servo Ventilation.
The DME can't really do anything about it without a doctor's order...they might be able to help facilitate getting help for you as it running interference and getting the ball rolling as it should be painfully obvious to them that this machine isn't going to be able to handle your situation.

I have seen this before when people are on heavy duty pain medications. We don't know if you had centrals prior to cpap...you may or may not have and it might be that cpap tipped the scales or you might have had these centrals show up during the titration sleep study and they wanted to try this machine first. We don't have enough information without seeing the sleep study results but the simple fact is ...this machine isn't going to be able to do what you need done.

You need to get in front of a sleep doctor and discuss the OSA, the centrals, the pain meds and how to best fix all the problems.

Pugsy,

Thanks so much for your input. I'll definitely get in touch with the people that did my sleep study. They aren't affiliated with the VA, but they will likely know how I need to go about getting things taken care of.

According to the attachment, all "episodes" stopped at 8:30 PM and you slept through the rest of the night without incident! Did this really happen? I doubt it!

That just happens to be when I woke up from sleeping. My pain has been so disruptive for so many years that I just sleep when I feel the urge. I gave up trying to conform to a set schedule a few years ago because it just led me to feeling more depressed because I couldn't do it.