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I was recently diagnosed with sever sleep apnea by using a home diagnostic PSG.

I have to be honest and say that even though I have had 2 studies conducted and am currently undergoing a CPAP trial I'm in denial. I haven't got any of the risk factors and generally go to bed at night, fall asleep and wake in the morning feeling as though I have just slept for a good 8 hours. I do wake feeling like I have been hit by a truck. I feel very tired during the day and cannot maintain focus or concentrate. Reading is definiately out of the questions.

Here are my stats:
Age: 36
Height: 181cm
Weight: 78kg
Body Fat %: 10
Blood pressure: 105/60
Resting Heart Rate: 45-50 bpm.
Non Smoker
Non drinker
No medications
Many supplements
Shift worker

I am a young moderately-highly active person. I train in the gym 3 times per week and run 3 times per week. I pretty much exercise everyday. My diet is mainly vegetarian and very healthy. So what the hell is going wrong??

Here are the result of my first study (before CPAP trial) Date: 15/03/2007
Sleep Latency: 4.5 minutes
Sleep Efficiency: 81.9%
Total Arousal Index: 26.9/hr
Respiratory events: SaO2 baseline: Awake=96-98% Asleep = 95-98%
Cyclical in phase hypopnoeas were observed during NREM and REM sleep, in particular in supine REM (Supine REM RDI: 44.5/hr). These events were observed occasionally in association with leg movements, oxygen desaturation and arousal

Average oxygen desaturation: NREM 2%, REM 2%
Oxygen desaturation range: NREM 0-4 %, REM 0-4 %
SaO2 Nadir: NREM 89%, REM 94%
RDI: Total 36.2/hr NREM 35.6/hr, REM 37.6/hr

Periodic Leg Movement: Occasionally associated with arousal and respiratory events
Snoring: mild
ECG: dominant rhythm is sinus with and average of 50bpm. No arrhythmias were present
Conclusion: Severe Sleep Apnea


NOTE: as mentioned I was in denial with these results. I was at the sleep specialist to simply discuss my shift work and they recommended a sleep test and I took it. Initially I thought the test results were just an artifact cause by the bad nights sleep I had with all the equipment attached however the people at the sleep lab told me that the test was technically acceptable and you can obviously see that I go through the various sleep phases (3 supines REM, 4 consolidated SWS with several short wake periods)

Anyhow I just ignored the inital test until I was flicking through an old physiology text book. I'm a PhD student you see and on occasions teach med students. I read that it's quite common for younger people to deal with the sleep apnea because they adapt and have a great physiological reserve. Over time though this changes because the oxygen desaturation and loss of sleep takes toll on the cardiovascular system. Hence I started to reconsider my test results and decides to do a trial on CPAP. Here are the results of my CPAP trail test:

test 2
Here are my stats:
Age: 36
Height: 181cm
Weight: 78kg
Body Fat %: 10
Blood pressure: 105/60
Resting Heart Rate: 45-50 bpm.
Non Smoker
Non drinker
No medications
Many supplements
Shift worker

Here are the result of my first study (before CPAP trial) Date: 05/12/2007
Sleep Latency: 8.5 minutes
Sleep Efficiency: 84.2%
Total Arousal Index: 24.6/hr
CPAP Treatment: SaO2 baseline: Awake=98% Asleep = 94%
CPAP titrated between 4-15cmH2O. Despite CPAP pressure central apneas persisted throughout the study. These were associated with arousal and oxyheamoglobin desaturation. It would appear pressures greater than 10cmH2O are required to control obstructive components, however anything over 12-13cmH2O elicits a significant degree of continuous central events. Response does not seem to be positional or stage dependant. May require review at CPAP clinic to assess for mask/mouth leakage

Average oxygen desaturation: NREM 4%, REM 3%
Oxygen desaturation range: NREM 2-9 %, REM 2-7 %
SaO2 Nadir: NREM 85%, REM 92%
RDI: Total 44.0/hr NREM 43.7/hr, REM 46.3/hr

Periodic Leg Movement: Nil
Snoring: Nil
ECG: dominant rhythm is sinus with and average of 53bpm. No arrhythmias were present
Conclusion: CPAP at 10-11cmH2O appears satisfactory for the control of snoring and obstructive respiratory events. Oxygen saturations are improved on CPAP. Higher pressures are associated with arousals and central events (some post arousal)

NOTE: So at higher pressure I am experiancing central events. This makes sense because I seem to wake at the higher pressures as it seems as though the CPAP at higher pressure is causing me to hyperventilate. Hyperventilation blows of CO2 which lowers [CO2] and hence removes the drive to breath resulting in the central apnea.

I'm really finding it hard to tolerate the CPA and most nights I wake up with the mask off my face. I do remember taking it off but I always try to put it back on but fall alseep. Kind of like when you doze off during the day. You don't quite want to fall asleep but before you know it it's 2 hours later and you can't remember wanting to go to sleep.

I've had all sorts of people giving me advice and I've just been leaving it in the hands of the specialists. My girlfriend does not believe it. For some reason she believes that there is too much room for error with the home sleep tests. I disagree. Some people have said that it could be the shift work and some say that it could be psychosomatic i.e in my head or stress related. I'm a fairly grounded and stable guy so I do not think that's the case.

Anyhow.......any advice would be greatly appreciated. If you know of a similar case please feel free to refer me onto that post.

I look forward to the response(s)

Kind Regards
Zoolander

Zoolander wrote:CPAP titrated between 4-15cmH2O. Despite CPAP pressure central apneas persisted throughout the study. These were associated with arousal and oxyheamoglobin desaturation. It would appear pressures greater than 10cmH2O are required to control obstructive components, however anything over 12-13cmH2O elicits a significant degree of continuous central events.

Resmed wrote:Complex sleep apnea (CompSA) is a specific type of sleep apnea where patients exhibit obstructive sleep apnea events, but upon application of positive airway pressure therapy demonstrate persistent central sleep apnea events. This central apnea is most commonly noted while on CPAP therapy, after the obstructive component has been eliminated.

The complex sleep apnea patients also had fewer complaints about waking up after initially falling asleep than those with central sleep apnea (32 percent vs. 79 percent).

...interface problems were more common in CompSAS patients, especially air hunger/dyspnea (0.8 vs. 8.8%) and inadvertent mask removal (2.6 vs. 17.7%) (all P<0.050). CONCLUSION: CompSAS patients have more CPAP interface problems and require more follow-up than OSAS patients but with intervention may have similar treatment results compared to patients with OSAS.

CompSA is characterized by the following:
• The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared.
• CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour.
• With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA (described below).

zoolander wrote:I'm using a Medium Resmed Full Face Mirage Ultra at Pressures 10-12cm H20 AutoCPAP with A-flex.

It looks as though (on the pressure-flow curve) that the mask that I am using allows a vent flow rate of 33-38 cm H20 at pressures 10 and 12 respectively.

zoolander wrote:thanks for your advice guys. yes the caps are sealed.

I'm trying to work out how to dissemble the mask but am afraid that I'm going to break the valve.

I'll run side by side CPAP and pulse ox tonight and post the results