Help with sorting all this out

Hi everyone,

First post for me, even though I've read many helpful things here on the forum. I thought perhaps some veterans here could give advice. Any help would be greatly appreciated.

I consulted a pulmonologist earlier this year after ongoing struggles with extreme fatigue/malaise, never feeling rested after sleep, and a host of other common apnea issues with no other medical explanation. Quality of and outlook on life were poor.

Based on our talk, and some things he saw with the anatomy of my tongue and soft palate, he was pretty sure I was having apnea issues. I was able to get in for a full sleep study, which astoundingly showed no problems. However, it took me over 2 hours to fall asleep and I only slept about 3.5-4 hours max before they woke me: not my usual night's sleep. I do have a severely deviated septum on one side, and suffer from allergies. That particular night I wasn't having any issues.

Because of summer travels, I haven't been back to see the pulmonologist for a follow up. However, I continued to struggle with feeling awful. I spoke with my physician and he suggested that sometimes sleep studies don't reveal everything; since insurance won't pay for it anyway, I was able to obtain an auto-cpap (Philips System One Auto CPAP with humidification and Nuance pro nasal mask).

I've educated myself on how to set it to auto-trial, use the comfort features (a-flex 2), and how to set the initial pressure for comfortable breathing (settled on 7 so I don't feel like I'm suffocating). I've used it 100% for the past 6 nights and have felt a great deal of difference. My mood is vastly better, my outlook on life and energy levels for exercise are already up. I've attached a sample of last night's Sleepyhead report. The data from the other 6 nights shows similar patterns, although the attached date is perhaps the best it's performed in terms of AHI and TTIA.

Here are my questions:

First, would the cpap show results like this if I didn't have these problems? Am I simply creating the problem by using CPAP? Should I be able to approach my pulmonologist with this data and not feel like a crazy person?

Second, I realize the data shows a certain percentage of central apneas, and very low obstructive. The machine I have is not designed for treating centrals, but is there any validity to what it is reading? The total time in apnea showed 12 minutes for this data set. Based on what I've read, this is not so good.

Thank you so much for any input you could give. I'm not sure how to proceed from here.

Sincerely,
Paul

welcome to the forum!

i'll just type in some opinions for you to read while someone more knowledgeable comes along to directly answer your concerns.

first thing is, how do you feel? do you feel better sleeping with cpap than you did without it?

second thing is, it's my understanding that centrals, in and of themselves, aren't that big of a deal when the cpap user first starts out.

i could be wrong about that and if i am, someone will be along to correct me!

good luck!
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Hi, your 'centrals' (clear airway events) don't seem to be meaningful - maybe more like what we call sleep-wake junk. so I wouldn't worry much about them now.

I would like to ask if you've tried a soft cervical collar - it keeps your head up (relative to on your chest... realizing I have no idea how you sleep of course), and therefore your airway more open (flow rate is high on your graph), and your jaw relatively closed, if not lips, though you don't appear to have a leak issue. Many here use one and find it helpful.

Might help ease your mind a bit about the centrals if you took a crash course in figuring out if they are real or not.
Some are probably real and some probably aren't. Even if they were all real you aren't having enough of them to raise an alarm with the doctor...they wouldn't even raise an eyebrow unless you were seeing an average of 5 per hour centrals ...every hour all night long and even if you did the first thing they would probably suggest is "give it time" because sometimes they do reduce with just time.

When you have time watch the videos here. They will help get a feel for asleep breathing vs awake or post arousal breathing and for the centrals to be real you have to be asleep. Awake events of any kind don't count and we have to mentally remove them from the evaluation process.

http://freecpapadvice.com/sleepyhead-free-software

Much appreciated - thank you!
Paul