Any Last-Minute Words of Advice?

Hi everybody, my husband had his sleep study and I'm unable to upload his results on our Mac. I'll list them below. He had been using a SleepStyle 200 set at 9 cm. After the study his pressure was set at 14. Then we got a call from the doctor's nurse who said the doctor had just read the study in depth and was faxing a new order to set pressure at 11. My husband feels awful, despite the new chinstrap. He's having so many arousals, leaks, and still the centrals. Would some of you please give us your last-minute words of advice? Tomorrow he meets with the doctor & thinks he will get a second study with a Bipap. We have begun to think the Bipap Auto SV with heated humidifier and EncoreViewer and Card Reader (available through cpap.com) is his ticket to health. The doctor mentioned possibly doing this study with a Resmed VPAP Adapt SV and we had been thinking it too might be good for him, but now we find out it's not available through cpap.com and we've learned through you that Resmed makes it hard to manage your own therapy. The purchase will be our Christmas/Birthday/Anniversary present for the rest of our lives and that's appropriate since the machine might give him back his life! Please help us avoid the pitfalls. I'm not asking you to treat him but just to help with tips or thoughts. We're a little afraid that he will be put on medicine; I haven't had time to research that on the board yet.

We are going in believing that people with Centrals, too, can manage their own therapy!

I know I'm posting too much info here. Please let me know what I should post in future (not that I intend to post results constantly!) Thank everyone on this board for every single post. I will be reading forever and learning forever. You are each one a Godsend.
AHI 38.5. Mean SAO@ was 92.7% with a low of 84%. No hypoventilation or Cheyne-Stokes. Total Recording Time 213.2. Sleep Period Time 3:19:57. Total Sleep Time Minutes 132.5. Sleep Efficiency 62.2%. Awakenings 41. REM Periods 0. WASO: 67.4. N1 0. N2 27.5. N3 44. R n/a.
Diagnostic Portion:
TRT 270.1
SPT 3:29:10
TST 194.2
Efficiency 71.9%

Sleep Latency 1:00:55
Total Stage Changes 44
Awakenings 13
WASO 15
N1 0
N2 6.
N3 31.5
R 43.5

REM periods 2
REM latency 0:43:30
REM latency less wake time 0:41:00

Respiratory Events:
Central Apneas 37
Obstructive 0
Mxd 0
Hypopnea 7
Total Apneas 37
Apnea +Hypop 44
RERA 9
All Events 53

Index per hour 11.4
Hypop per hour 2.2
Total apnea per hour 11.4
Apena + hypopnea 13.6
RERA 2.8
All Events per hour 16.4

Mean duration:
Centrals 23.2
Hypopnea 19.7
Total Apneas 23.2
Apnea + Hypopnea 22.7
RERA 17.3
All Resp Events 21.8

Longest Event:
Central 38.4
Hypop 24.5
Total apnea 38.4
RERA 25.1

REM count:
Centals 11
Hypop 6
Total 11
RERA 6
All events 23

REM Index:
Central 8
Hypop 4.3
Total 8
Apnea + Hypop 12.3
RERA 4.3
All events 16.6

Non-REM index
Central 14
Hypop .5
Total 14
Apnea + Hypop 14.6
RERA 1.6
All Events 16.2

Supine 194.2 minutes. [Says "0" time on side, but the box for "right side" is blacked in. Doctor note says patients slept both supine and laterally. EKG showed bradycardia. PLMS were rare. EEG within normal. SAO2 nadir 85%. Patient was still having sleep onset centrals during the final pressure. Snore scale 8 (out of 10).

As I know next to nothing about treating Centrals, I can't give any advice. However, I did want to say Hi and Welcome. Best of luck to you and your husband!

Thank you so much, Millich!

Oh honey, puh-leese. There is no such thing as TMI when it comes to your sleep data! Ask Wulfman and 6ptstar!

Not that I'm capable of answering ANY of your questions, or evaluating your data, but WELCOME!!! And hopefully this will bump you up to the attention of someone who CAN give you helpful advice!

Cheers,
B.

Welcome to the forum. I'm still a newbie, so can't answer any of your questions. But, there are lots of knowledgeable people here, and lots of different opinions. One thing I might suggest is the book Sleep Apnea, The Phantom of the Night, by Johnson, Broughton, and Halberstadt. I bought it from amazon.com, but perhaps your local library has a copy.

Can't say with certantity what is going on, as I am not a doctor. But based on what I have learned here, looking at the ASV machines is probably a step in the right direction.

FeistyWifey wrote:Tomorrow he meets with the doctor & thinks he will get a second study with a Bipap. We have begun to think the Bipap Auto SV with heated humidifier and EncoreViewer and Card Reader (available through cpap.com) is his ticket to health.

Hi,

It is not uncommon for folks who have central events to be on BiPAP. I use a BiPAP, but because of a high pressure, and not due to centrals. The machine is very easy to use and it took me very little time to adjust to it.

It sounds like your husband has it all, a mix of obstructive, positional, and central events. It can be a challenge for a doctor and sleep center to get that sorted out. In my case, I had 3 different sleep studies on different machines before finding a combination that would work. Once the doctor got it dialed in, it was like a miracle cure. Let your husband know that it is worth the effort to get to the root of the issue, and I think that he is lucky to have someone like you that is so supportive.

-john-

I entered the results of the Split Study that Feisty Wifey posted into a spreadsheet. This spreadsheet is shown here in 3 images, part1, part2, and part3, for anyone interested in reviewing, analyzing, and offering assistance to FeistyWifey regarding the results of FeistyWifey's husband's split study. The highlighted numbers are the ones that most concern me and all appear to be related to the High Number of Central Apneas. A BiPAP or something more capable definitely seems needed to address this high # of Central Apneas. Note that there were no Obstructive Apneas during the Titration part of the Sleep Study. Anyone spending 10% of their sleep time experiencing SDB events has to feel like crap afterwards!

Hopefully, someone experienced with Centrals will jump in and offer their expert recommendations on how to proceed and what equipment would be the most promising to address FeistyWifey's husband's central apneas. All my apneas are obstructive so I am a "dummy" when it comes to "centrals" and what advice to offer.

cinco777 wrote:I entered the results of the Split Study that Feisty Wifey posted into a spreadsheet.

Dang, Cinco. You Are GOOD.

Two additional observations on the Sleep Study Titration results.

1) Note that the AHI +RERA/hour numbers for REM sleep and for non-REM sleep are, for all practical purposes, the same (about 16/hour). FeistyWifey's husband has the same # of SDB events in REM as in non-REM. Many forum members with obstructive apneas report much higher AHI #s during REM sleep and have added difficulty dealing with improving their REM sleep vs their non-REM sleep.
2) Note that he slept on his back for the entire Titration (something that the Sleep Clinic people like us to do because it is usually the worse case for experiencing SDB events). I wonder what his numbers would be for side sleeping? We don't know since there was no slide sleeping at all, not even 10 minutes worth. My obstructive apnea count goes way up if I sleep on my back (20+X). I don't know if back sleeping has this same effect for some who experience Central Apneas (I think not). Can someone with Centrals comment on their experience with Back vs Side sleeping? Is there Positional Sleep Apnea for centrals?

Since the cpap did not make any difference in the oxygen desaturations I suspect the bradycardia may be a problem as well as OSA. The report did not say how low the pulse rate dropped but I would find out. I had bradycardia as well as OSA. My pulse rate fell to around 34/35 beats/min when I slept. The fix for this (unless there is some medication problem) is a pacemaker which I now have and now my pulse rate stays above 55 beats/min and I no longer have any oxygen desatrations and my blood oxygen level stays around 96%. Below 90% is not a good thing. I was put on 2 ltrs of oxygen input into the cpap at first. Once my pulse rate stayed up I did not need the oxygen.

The BiPap SV would be a good place to start and see how big a problem the centrals (brain induced not obstruictive) really are. Often when no side sleeping is in the test it can really run the pressure up. Sleeping on your back if you have OSA is not a good thing. You can often get by on a lot lower pressure which increases your comfort level a lot.

I am not a doctor either and the opinions are just my observations.

Good luck in your quest!!!!

Jerry

Great job, Cinco.

Recently, sleep staging has been changed so that stager III and IV have been joined into one.

when introducing herself FeistyWifey wrote:The cpap world has changed so much that we will need your help. I got a copy of his records and here is what was going on with him in March of 2000: he had 148 apneas including 65 central, 83 OSAs, and 47 hypopneas so his AHI was 42.6. His lowest saturation was 68%. Snoring was mild to moderate. Severe sleep fragmentation with 32.3 brief arousals per sleep hour, the majority secondary to respiratory events. Limb movement index was 39.1 but most were not associated with arousals. EKG showed sinus rhythm with brief tachycardia/brady pause in the respiratory events. Sleep architecture was characterized by sleep efficiency of 59% with increased percentage of stage 1 and 2 sleep, and normal stage 3 and 4 with reduced sleep percentage. (from doctor's report)

Don't set your mind on a specific machine. We have had people who were given a chance at both SV's reporting an extremely different response to them. Your husband needs good therapy - whichever the machine. It is my impression ResMed software can be ordered from Australia. Furthermore, if you get your doctor to co-operate, then she (is it still she?) can add the software to the script, or even order it for you and the perhaps sell it to you. I would let the doc start out with the machine she knows /prefers and try to get the software if it turn out the ResMed gives you good therapy. If it doesn't work, then you can suggest another type of machine. I would not buy either machine without having tried it -- if the machine's algorithm isn't right for your husband, all the software tweaks in the world will not fix it.

O.

Thank you so much Babette!

Wow, Cinco777! You are amazing! I do not know how to express my gratitude for making sense of my post with Spreadsheets! Such a lot of work you did for us (plus putting out a call to someone with centrals to answer with specific advice), and you are right on the mark about the Centrals. Thank you thank you thank you for everything! I'm so awed!
Husband did not receive any sleep medication for the test. In addition, he did force himself to lie on his back but after the mask was put on, he allowed himself to turn onto his right side (his favored position). He can't sleep on his side(s) long because of rotator cuff pain. I don't know why the study doesn't show the time he slept lying on his side.

"Don't set your mind on a specific machine. We have had people who were given a chance at both SV's reporting an extremely different response to them. Your husband needs good therapy - whichever the machine. It is my impression ResMed software can be ordered from Australia. Furthermore, if you get your doctor to co-operate, then she (is it still she?) can add the software to the script, or even order it for you and the perhaps sell it to you. I would let the doc start out with the machine she knows /prefers and try to get the software if it turn out the ResMed gives you good therapy. If it doesn't work, then you can suggest another type of machine. I would not buy either machine without having tried it -- if the machine's algorithm isn't right for your husband, all the software tweaks in the world will not fix it.

O.[/quote]

Thank you so very much, Ozji. Your advice is wise and we will heed it. We don't know how the system works concerning trying different machines before buying but only that our insurance requires a big deductible and makes you rent until they say you've paid enough (usually about three times the online price of a machine in our experience). Thank you for letting us know there is a better way we hadn't known about. (We are so rusty!) People with Centrals report that Respironics works for some people and Resmed for others. We surely don't want to pay out a ton of money then find out a particular machine is not a good fit. Thank you Ozji!