1 mo. CPAPer/mild apneac with doubts & detailed PSG resu

I've been using a CPAP for 3 weeks and an auto for 1 week and have been sleeping very poorly. Baggy, racoon eyes, & very sleepy during the day. Without CPAP I was certainly functional. Depressed, but functional. One complicating factor is that I'm taking Effexor for the depression so I it's hard to determine what's repsonsible for what. In any case, I recently received the detailed results of the two sleep tests I had back in 2003 (Sept and Nov) when I was first diagnosed with mild sleep apnea. (btw, I'd given up CPAP after a few days and stuck it in the closet and only recently have decided to give it one last chance).

I was originally told over the phone that on the first test, I had a *TOTAL* number of 39 arousals. Divided by a Total Sleep Time of 7 hours, I had an AHI score of 5.6. However, when I actually got a hard copy of that first test, the "39" was written over a crossed out "24". Looking at the sleep tech's scoring, I did have only 24 events total: 1 central/1 obstructive/ 22 hypopneas (which would mean an AHI of 3.4). My mean O2 sat level was 95.5%. The lowest I hit was 92%. Looking at the hand-writing and darkness of the marks, it looks like it was the doctor who received these test results who crossed out the "24" and put "39". I can figure out what most of the data means, but cannot sort out how he came up with "39". Unfortunately he's no longer there so I can't check with him. I plan to send the results to the new doctor to see what he says.

My second sleep test where I subjected to CPAP titration suggests an increase in the number of centrals and apneas but a lowering of hypopneas, as the pressure was increased. At 4cm (49.5 mins) I had 1 central/0 obstructives/29 hypopneas = AHI 33.9; at 5cm (142 mins) I had 2 centrals/2 obstructives/20 hypopneas = AHI 10.1; at 6cm (200.5 mins) I had 4 centrals/11 obstructives/28 hypopneas = AHI 12.3. My O2 sat levels went up: 97.1%, 97.7% and 97.8% respectively. There is no indication that pressures more than 6cm were tried. My minimum desat was 95.5%. So during the 2nd test, I got more oxygen but woke a lot more.

Now, at home with my Resmed Auto Spirit and Reslink, my Oxygen sat levels are about the same with and without the CPAP. 95-96% with one or two dips into the low 90's.

Anyone have any thoughts based on the above stats? I don't think there's enough data to make a conclusion other than well, just give it the good ole college try (but what do I know). Is it possible that PAP treatment is causing more centrals and obstructives? My current sleep doc, who has only seen the summary report, says that that I should give the aPAP another 2 months and if I am not feeling better, I should do a home sleep test. I'm thinking now though, that I should send the detailed reports to him (bypass the frickin Kaiser red tape), tell him of my concerns and push for an at home sleep test now, preferably over several days to get a better idea of my average sleep night.

Thanks for reading the semi-rant, but I'm starting to get frustrated.

If slightly increased pressure is inducing central apneas, you need to demand another sleep study. As much as I hate to say it, the study should be done in a lab with a lab tech watching the central apneas. Central apneas can worsen with increased pressure. But I hate sleep labs so I am the last one to give advice. But if I were having central apneas, I would want an explanation. So you need to find a new doctor and a new sleep lab - which we know is really easy! Or you can also bypass all this crap and see a neurologist. You need to know if the centrals are just the normal ones experienced by a majority or if they are a real cause of concern. I understand your frustration. It is not an easy road. You need to know the pressure settings on the Auto - I would not like to think that the pressure increase is so large that it causes more and more centrals. Move forward with caution but please do investigate. I understand the depression and being on CPAP does not undepress us. Also, some meds can increase apneas. So make a list of questions, bring an updated meds list and your sleep studies, alist of concerns and do not let them blow you off!!!!!!!!!!!

thanks listless. My sleep doc is actually a neurologist. I am compiling a list of questions for him now actually and will talk to him about another sleep test. I can't afford a sleep test outside of my provider so I'm stuck with what I got. However, he did say that their sleep lab now has had their equipment updated twice since 2003.

As far as my apap setting goes, it's 5-11cm (based on a prescribed cpap pressure of 7cm)

Noah,

Based on those results, why did the Doc prescribe a 'PAP? Seems to me that you might not expect to acheive results much better than you were getting without the 'PAP. Have you looked at data for the week you've been on the auto or are you guessing about the increased centrals. The pressure range you are using is so low that I would think the chance of pressure induced centrals is not likely.

I find the numbers of your first sleep study interesting. If you TOTAL arousals were only 39 in 7 hrs with an AHI of around 5, thats seems very mild. With tweaking my auto I just got a few months ago, I m lucky to be around 8. I set my auto at a straight 10 pressure that my first machine, a cpap was set at and my ahi went to 25. Are you sure it wasn t 39 per hour?

If you are causing centrals, you probably need a bipap...

wader, as far as I know, the Autoscan software for the AutoSpirit doesn't distinguish between central apneas and obstructive apneas. My guess about the increase in centrals due to cpap is based on the 2nd PSG I had where the results do distinguish between the two. And based on that first study, I do wonder why I was prescribed a pap and not talked to about the what the results meant and what the options were. Not to be cynical, but is it possible the doctor wanted to justify the expensive sleep test?

My new sleep doctor said that having a total of 93 events during the 2nd test just goes to show the variability of the number of events one will have during any given night and that 93 is definitely a number to indicate cpap treatment. But again, he's just seen the summary. I just can't help wondering how many more events I had due solely to the cpap titration during the second PSG. In any case, the new doctor will soon have a copy of both detailed reports for his own analysis.

loonlvr, yes, I'm sure about the number of total events during the night. And I agree with you. From what I know, that number seems to be pretty darn low.

From what I understand, you can't cause Obstructive Apneas from CPAP. You can only cause centrals. So, your initial study vs the titration don't seem to jive. I would think that something changed from the first to the titration study...

the only thing I could immediately think of was that I was titrated during the 2nd test. However, I just read another post from littlebaddow about sleep position. So I looked at my detailed results and interestingly enough, I slept more on my back during the 2nd test. It's hard to tell from the printouts though whether the events correspond to the position as there's no timeline (that I can see) for the events themselves. Either that is stupid or I am. ; )

Noah,

Even the AHI 14 during your second study is less than the 15 events normaly required for treatment. In my case I had an AHI of 12 and had to get special approval to get treated (due to other concomitant illnesses) I have been lucky enough to have very successful treatment witha residual AHI of 1 or 2. My understanding is 5 or under is considered good.

wading thru the muck! wrote:Noah,

Even the AHI 14 during your second study is less than the 15 events normaly required for treatment. In my case I had an AHI of 12 and had to get special approval to get treated (due to other concomitant illnesses) I have been lucky enough to have very successful treatment witha residual AHI of 1 or 2. My understanding is 5 or under is considered good.

Wader, thought the second study was during titration, so he was getting treatment?

It should also be noted that difficulty in sleeping is a side effect of effexor. Have you been using effexor for a while before you started with the cpap? How was your sleeping before the cpap?

Allan

Anonymous wrote:It should also be noted that difficulty in sleeping is a side effect of effexor. Have you been using effexor for a while before you started with the cpap? How was your sleeping before the cpap?

Allan

Side sleeping difficulty is a side effect? Effexor can cause difficulty in sleeping in general, but never heard/read about side sleeping specifically.

Also, his AHI was lower sleeping on his side vs. on his back...

mikesus, the comment was that a side effect of effesor was trouble sleeping, not sleeping on your side. You got a little liam in ya

I've been on and off Effexor for almost 8 years now - I'm a veteran. Up through my 20's, I thought I was a champion sleeper. I could sleep anywhere, anytime. I was big on naps as well, 1-3 hours when I could get it. 1/2 hour if I was at work. I rarely felt fully rested or "on the ball" though, unless I was fired up on coffee.

As I passed into my 30's, I realized I was more sensitive to noises and would wake more often, though usually I'd be able to go back to sleep. One of the problems when the depression/anxiety got real bad (when I was off the meds), was that I couldn't sleep well at all. I even went through a bout of insomnia for a few months once, which was awful.

So in a nutshell, Allan, I used to sleep pretty well but in the last couple of years or so, I've been waking up a lot (usually able to get back to sleep). I live in a semi-noisy neighborhood (restaurants and bars around the corner) and wear earplugs. I can't remember the last time I slept through the night without waking though and not necessarily due to noise.

Mike, I can't determine for sure whether sleeping on my side corresponds with a lower AHI as there's no timeline for the arousal events to compare with the timeline for my body position. The only info I have is that during the first test, I spent less time on my back, and had an overall lower AHI as compared with the second test. But, it certainly would suggest that side-sleeping might lower arousal events in my case. I've got a fanny sack with tennis balls ready for tonight's session.

Wader, your case is one that makes me think that I could still benefit from cpap treatment and maybe it's still just a matter of getting used to it. So far though, no dice. What's the rig that you use? What are your settings? How long until you started feeling better?