Central vs OSA

So I haven't really been seeing all that great a result from CPAP. I'm still always tired and falling asleep. I keep thinking that I just need to give it time, and give my body time to make up the sleep deficit (which is HARD to do in college!) But I got to wondering the other day...

When I did my sleep test, I only got 30 minutes of REM, total. I barely slept at all. And they titrated me at 6, which is WAY off of where the auto stays (around 11/12) so they obviously didn't know what they were doing.

Is it *possible* I might have Central instead of Obstructive Sleep Apnea? The sleep tech even remarked that my neck is not quite big enough to usually qualify.

I asked my mom about my sleep habits as a child, and this is what she said:

My Mama wrote:You snored I think from about day 1...or shortly thereafter....

I didn't think that much about it cause both of your parents did, and
grandparets on my side, and probably the other side too.....

Yes, occasionally you would stop breathing for one or two breaths, but
not always, just enough so that I would stay awake....maybe only once a
night or that was all I could stay awake for...

No, you never seem to be choking and only gasped for air when your nose
was clogged when you had allergies or a cold or both....

Is this something I should bring up with my sleep doc? What do you guys think? Might I have Central rather than OSA?[/quote]

I am not familiar with what the Encore software show, but I the 420e with SilverLining viewing the event log will let you know if it believes the events are Central or Obstructive in nature. If the pressure is bopping around from 6 to 12, that might be enough to produce a micro-arousal. I would definitely be inclined to up the base pressure to 8 or 9 and see what data looks like then.

Personally I my titration study suggested I find another form of treatment, so I got my doc to write a scrip to replace my friends RemStar with a 420e, and right now I am trying 8.5cm of pressure, but I think I need to bump it up a bit more.

But it does take time. I have a well deserved reputation of being able to sleep through anything. When I lived at home, my room was in the basement, at the other end was the clothes washing stuff and a mini shop. I've slept through many a load of laundry and my Dad running his table saw!

With that said, I've been attaching the swift mask to my face for a little over three weeks now and I am just starting to really get back to my "deep" sleep through air plane crash stature. Still not there.

But as I am learning to sleep better with the equipment, I am finding that my need for pressure seems to be rising. To me this makes perfect sense, as I get more relaxed and sleep better my throat muscles are going to also get more relaxed, and thus need more pressure to be kept open.

BTW, three days in a row where my BP has been under 140/80 with out medication, last night after dinner it was 132/73

In general, and of course I am not a doctor, so any advice should be taken with the value paid for it, but you might need to raise the baseline pressure.

This all can be pretty frustrating, as any average week is going to have 7 data points to figure things out, and when it can take 3 to 6 just to let things settle down, and maybe more than 20 or 30 to be able to draw real conlcusions about how one sleeps, it can take a lot longer than us impatient people want

I really want to find a spO2 recording solution that is relatively affordable. It is just a really fine line from what I can tell what needs to have FDA approval. After talking to my expert friend, if you base treatment on the device that it, for the most part does. Of course those off the shelf BP measurement devices don't, I don't think. I am going to have to do some more research. I'll let y'all know what I find. From what I understand there are two good measures of the quality of sleep, spO2 and presence of REM sleep. Sorry for the partial hijack of your thread. But as you all can see sometimes I think too much for my own good.

cheers,
Tom

CollegeGirl, What happened when they increased your pressure during your titration? I am also titrated at 6 because at higher pressures, I had difficulty breathing. I also didn't sleep a whole lot. They finally had to give me an Ambien at 1:00 a.m., then got me back up at 5:00 a.m. to drive home (stupid on their part). Good thing I scheduled a the next day off work!

Anyway, did you see your report? Mine said that I may have possible central apnea. So far, I am feeling ok, but there are days that I don't feel as well as others and I sometimes think that I also need a higher pressure. My report also said that I am a possible candidate for a trial of BiPAP due to possible central apnea. Have you discussed the way you are feeling with your DR? If you are not more alert with CPAP, I would definitely discuss this with him and ask for a copy of your report. It is your right to do so.

Sorry, My computer logged me off last night and I didn't realize it. The "guest" is me, Snoozie.

CollegeGirl,

Your sleep study would indicate if your apneas were "central" or not. They are able to tell this by measuring your respiritory effort. If you were having a central apnea, you would cease breathing with no effort to try to breathe. Based on your mother's description, it sounds as though your breathing difficulties were obstructive in nature.

If you are not feeling better on cpap, I would definately talk to your Doc to see why that might be.

Tom, the Encore Pro software makes no reference to Central or Obstructive apneas (at last not that I've seen). When I got my auto a few months ago, I raised my lower limit to 9. I can *barely stand* 9, and I feel like I'm suffocating until the machine ups itself to 10 (which usually only takes 2 or 3 minutes after I turn it on). Still, it does seem to spend part of the night at 9 after I"ve been asleep a while (though not much). I have my range set from 9-20. I tried narrowing it down to 9-14, but it didn't make any difference. The machine never goes over 13 anyway (and rarely goes over 12). I'm not impatient, really - I'm just trying to figure things out. My average AHI is 0.2 every night, but I'm still feeling awful.

Snoozie, I will absolutely be asking my sleep doc for a copy of my sleep study. The thing is, though, that I don't put a lot of faith in it. In my first study - the "determining if I have apnea" study - I only slept for *three* minutes. They really just based my apnea determination off the whatever-it-is drowsiness scale, I think. In my second - the titration study - as I said, I only slept thirty minutes. I felt like I didn't even sleep that much. And as I said, the titration was WAY off base. Both times, knowing I had a history of not being able to sleep during sleep tests, they STILL forced me to go without a sleep aid and refused to let me sleep in my usual position (on my stomach). It still makes me mad. If there's another sleep study, I'll be taking something whether they want me to or not. What good is a sleep study if you aren't sleeping?

Wader, thanks for the input. I definitely will be talking to him. I bet his answer will be "see an ENT," whose answer will be "You need surgery," and my answer will have to be "I'm going to Spain at the end of January." And of course all that will be so time consuming that I won't be able to get the surgery in before I leave. That means I'm just going to have to be this darn tired the entire time I'm in Spain. That makes me so sad.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, Encore Pro, AHI, auto

Laura and Lori - no two cents on this one?

-CG

Collegegirl, I agree with Wader. I'm no doctor, but I'd bet on your problem being plain old obstructive sleep apnea, not pure Central Sleep Anea, which is very rare.

Your Encore Pro software has a graph area labelled "NR". NR means non-responsive -- an apnea that doesn't "respond"...doesn't start showing correction in the airflow when the machine tries a few increases in pressure. If the apnea situation doesn't respond and get better after about three slight increases in pressure with a Respironics machine, the machine has no way of knowing, "hmmm, is this a central apnea, meaning there's no obstruction and more pressure isn't called for? Or, is it really an obstructive apnea that just isn't responding to pressure increase yet?"

When in doubt, the machine is going to do the safer thing...NOT increase the pressure more to no avail. In that case, it will mark the event as "NR" - Non-Responsive.

Any NR's you see on your Encore data charts are possible Centrals. If you haven't been seeing "NR" tick marks on your charts, you most likely do NOT have central apnea. It's normal, btw, for there to be some random NR's marked from time to time. People can have a brief central apnea just from turning over in their sleep. Can also have them normally while awake and doing something that you're concentrating on... we all tend to hold our breath occasionally when doing something. That's a normal occurrence of a "central apnea". No big deal.

For more about central apnea:

Links to Central Apnea

Thanks, RG. I didn't know about the "NR" situation - I've never even had one, so I guess that answers that question.

I guess I'm just unsure how to feel, wondering if maybe I've had OSA all along. My sleep doc better get back soon so I can talk it over with him.

Thanks again for your input!

CG,

LOL! Okay, if you insist...

What about other things like PLM's? I was told they may or may not be eliminated via CPAP and are definite cause for arousal. Did your sleep study show any on it? I had a lot and they seemed to disappear once I was on the machine. But if you had them at your study and are still not getting that rested feeling, you could be having your brain aroused by them although not being aware of them yourself.

That's a thought of mine.

CollegeGirl,
RG just told you what I was going to say, but she explained it much better than I. I had some "mixed apneas" on my sleep study. Not sure what they are except must be combination central and obstructive. I do still have some NR's show up but not a great deal so I assume they are ok. Hope you feel better soon.