Central v. Ostructive Sleep Apneas

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 10:18 am

Hi All:

I pulled out my 2001 sleep study in anticipation of having to show it to my regular doc in anticipation of lobbying for an APAP machine. I was somewhat surprised to read the results with a more educated eye, and I was wondering if one particular finding was significant. That is, most of my apneas were central sleep apneas, whereas my hypoapneas all were obstructive. Can anyone tell me whether this means anything? I had 14 apneas, of which 12 were central and only 2 were obstructive I had 19 obstructive hypoapneas and no central hypoapneas. This all worked out to an apnea/hypoapnea index of 5 during REM & NREM; index of 11 during REM only.

Can you data gurus or dme folks interpret?

Thanks.

Caroline

NightHawkeye · Post by **NightHawkeye** » Tue May 30, 2006 10:52 am

Caroline, I think there could be several possibilities. Kinda depends on what's causing it. I take it your sleep doc didn't investigate the CSA?

Also, you didn't say whether whether this was during your titration. If it was, then the possible explanations change.

Regards,
Bill

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 11:33 am

Bill--

This data was during the primary sleep study, not the titration. My major complaint going into the sleep study was excessive daytime sleepiness, which the MSLT said was "severe/excessive" but "cannot be substantiated in the presence of sleep apnea syndrome/increased upper airway resistance syndrome."

No, the sleep doc did not investigate the CSA. I only remember him asking me if i had any kind of chronic pain syndrome, such as fibromyalgia, i thought because of the alpha-delta sleep. But as I do cursory research on CSA, it may have been because of that, because I read that CSA usually means that you are ill in some other way. I believe that I had told him/written down my prior history with chronic fatigue syndrome, but he shrugged that off. Chronic fatigue syndrome is not a real disease for a pulmonary guy, and I was surprised that in 2001, he regarded fibromyalgia as real. I didn't say anything because in 2001, my fibromyalgia symptoms had long since passed.

Does this help? How do they check out CSA? Does it result in anything actionable, or just some nice-to-know info and the result is the same?

Thanks.

Caroline

NightHawkeye · Post by **NightHawkeye** » Tue May 30, 2006 12:00 pm

chdurie2 wrote:Does this help? How do they check out CSA? Does it result in anything actionable, or just some nice-to-know info and the result is the same?

Caroline, OSA and CSA together is characterized as Complex Sleep Disordered Breathing. The best info I've seen on it is over at the ASAA website. Sleepy Dave has a thread about a zillion pages long on it. It will show up in a Google search on CSDB.

Also, RG will probably come along any moment now and send you to talk with Sleepy Dave. .

Regards,
Bill

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 1:17 pm

Hi Bill--

I did a google search and did not find Sleepy Dave's thread, only somehow a post on rested gal's three day sleep study run by sleepy dave? I also did not find any info on the ASAA website? Can you or rested gal please be more specific?

Actually, I'm not sure I can read a zillion-page long thread. I think I would benefit more from bottom-line conclusions.

I found a reprint of a scholarly 2005 article on talkaboutsleep forum, and i think the article concludes this is a crazy disorder to treat -- that cpap may make it worse, that you need to have some sort of complex understanding of the factors present/causing this, and even then you well may not be successful, and i dunno if i even have enough CSAs to be included in this thing, and i have no idea if these findings are regarded as credible.

so is the bottom line here, given that most of my apneas are csa's, even though all my hypoapneas are osa's, that i really do belong back in a sleep lab, starting again, i guess from almost scratch? or just give me the apap machine, sleep doc or any other doc, and we'll take it from there?

(p.s. I posted another thread here asking for advice on the fact that when i called my old sleep doc to see if i could get an apap, the assistant told me that most likely, the doc would want another sleep study because my data is 5 years old and i'm complaining about insufficient pressure. Ycch! Or I can just give my regular doc the one-page summary of the old sleep study, which doesn't even get into these issues, and see if he'll prescribe an APAP. What do you think?)

thanks.

caroline

roztom · Post by **roztom** » Tue May 30, 2006 1:22 pm

The issue of Centrals is very interesting. Centrals are not typically a problem (IMHO) unless they lead to Oxy Desat.

Did your report indicate Desaturation with the Centrals?

Tom

NightHawkeye · Post by **NightHawkeye** » Tue May 30, 2006 1:49 pm

chdurie2 wrote:I did a google search and did not find Sleepy Dave's thread, only somehow a post on rested gal's three day sleep study run by sleepy dave? I also did not find any info on the ASAA website? Can you or rested gal please be more specific?

http://apneasupport.org/post-8055.html& ... =csdb#8055

I didn't find the thread I remembered, but this one page thread gives probably more than you'll ever want to know about the subject of CSDB. (Considering the way ASAA operates they could have pulled the entire thread SleepyDave had been carefully putting together.)

Of course, this may be the one you already read though.

chdurie2 wrote:(p.s. I posted another thread here asking for advice on the fact that when i called my old sleep doc to see if i could get an apap, the assistant told me that most likely, the doc would want another sleep study because my data is 5 years old and i'm complaining about insufficient pressure. Ycch! Or I can just give my regular doc the one-page summary of the old sleep study, which doesn't even get into these issues, and see if he'll prescribe an APAP. What do you think?)

I think that you already know how you want to pursue this, Caroline. Talk with your physician and tell him how you want to proceed. You can ask for his advice, but tell him in simple direct terms what you want to do. If you want to get an APAP and monitor your therapy with that, then tell him that. You're already diagnosed, so I can't imagine he'd have a cow about it. He might recommend a sleep study, but it strikes me that it's really your choice to make. He also might want you to promise to come back to review the APAP data or for another sleep study if you don't like the APAP data.

My recommendation is to deal with him as you would any other business person. The biggest problem I've ever had with physicians is getting useful information from them. Treated like normal folk, they respond like normal folk (usually). It's just that when they don't know much, they can't provide much information.

Regards,
Bill

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 2:01 pm

Tom:

there's only a desat/desat index measure with reference to total event summary, and the desat was zero. the sleep tech also noted that i had "low SAO2 desaturations without respiratory events." Overall, the O2 baseline saturation was 96%; the lowest O2 saturation was 86%. duration of less than 90% was 53 minutes. I don't know if it matters but i had 13 awakenings, only two of which were apnea-related, and 10 were ideopathic (one was pmls.)

so that means whether the apneas are central or obstructive is irrelevant, and we're back to cpap as the best therapy?

Also, the bit of reading that i did on csa said that cpap frequently doesn't work for csa because csa people are incredibly pressure-sensitive. In 2001, 7 felt nice, but after a week, i was begging for more. so they changed it to 8. now i've been doing 8 for a while and as i've said before, it often feels like nothing before i go to sleep.

thanks for your help.

caroline

rested gal · Post by **rested gal** » Tue May 30, 2006 2:23 pm

NightHawkeye wrote:Caroline, OSA and CSA together is characterized as Complex Sleep Disordered Breathing. The best info I've seen on it is over at the ASAA website. Sleepy Dave has a thread about a zillion pages long on it. It will show up in a Google search on CSDB.

I think the thread you have in mind, Bill, is this one, started by frequenseeker. It's on the TalkAboutSleep snoring and apnea forum, not the ASAA site. Dave participated in it quite a bit and fondly calls it the MOAT (Mother of All Threads) because of its zillion pages.

November 06 2005 subject: Sleep Disordered Breathing - a New Category. Excellent artic

NightHawkeye wrote:Also, RG will probably come along any moment now and send you to talk with Sleepy Dave.

Not a bad idea.

Actually, Caroline, since you live in New Jersey, you're not all that far away from the accredited sleep lab that Dave manages in Connecticut. You might want to talk to him for sure...especially if another sleep study may be in your future. The expertise of people doing a study (hooking up the wires, placing the respiratory effort belts on you, doing the data acquisition, doing the scoring, doing the interpreting) could matter a lot. Even more so when it comes to the possibility of something other than plain old garden variety OSA.

P.S. Dave posts as "sleepydave" on the ASAA board (you might want to keep an eye on the "Sleep Studies Forum" over there -- apneasupport.org ) and as "deltadave" on this board and at talkaboutsleep.

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 2:25 pm

Bill:

No, actually I don't know how I want to go.

I have an appointment with my regular doc next Tuesday (need thyroid check and prescription nose stuff in any event) and I was thinking of just asking him for the prescription for the apap, which i dunno if he would give, or seeing the topline report for regular docs, just send me back to the sleep center. I also have an appointment with the sleep guy, and I guess we'll see.

Yes, I'll try to persuade him to prescribe APAP without the sleep study, but it's not like the sleep center needs my business to book sleep studies--the assistant told me they're now doing sleep studies on weekends to try to fill the demand, so theoretically i could get in and out faster than i did five years ago. yes, it is my decision whether to undergo a sleep study, but the sleep doc also doesn't have to give me an apap if i won't do a sleep study.

i plan to bring a suitcase with my machine, various masks, ayr gel, saline solution, breathe-rite strips, vaseline and prescribed nose stuff to show him i understand the parts of the puzzle and i'm working on cpap compliance. but he may conclude i'm trying to build the house without the foundation--since the foundation may have changed. i doubt it, but maybe it has. and maybe the assistant is wrong--together we can just play with settings. i'd just like to be as well prepapred as possible to persuade him not to re-invent the wheel if it's not necessary.

thanks.

caroline

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 2:36 pm

Thanks for all, Rested Gal.

Yes, maybe I will PM Sleepy Dave about my sleep center. I think he'll probably say it's top-notch. The work-up they gave me in 2001 was superb, complete with echocardiagram and a bunch of other tests besides the sleep stuff. It was a hell of a lot better than the one I got in 1998 from a nationally known sleep center, renown before sleep centers became chic. Only that to say I think reputation only goes so far. But it probably would be a good idea to ask Dave.

Maybe a new sleep study might be a good idea if there's a reasonable chance new technology can divine the unknowns in my last study.

Btw, I didn't catch the rationale behind your new picture, if you ever told us here. Which one is the real you? The new picture looks substantially different than the old, if you don't mind my saying.

Thanks again.

Caroline

rested gal · Post by **rested gal** » Tue May 30, 2006 3:28 pm

chdurie2 wrote:Btw, I didn't catch the rationale behind your new picture, if you ever told us here. Which one is the real you? The new picture looks substantially different than the old, if you don't mind my saying.

Thanks again.

Caroline

No particular rationale, other than it's just a more recent picture. This one was taken earlier this month (May 2006). The previous one -- http://www.tnlc.com/Lara/laura/osa/Laur ... t_2005.jpg -- was taken in Oct. 2005. Up at Dave's sleep lab, as a matter of fact.

And the one before that (probably before you came to this message board) was from 2002: http://www.tnlc.com/Lara/laura/laura-57yrs-2002-b.jpg

If you're not talking about one of those pictures, I dunno which picture you have in mind.

Oh! Wait! Just thought of something....I hope I didn't confuse things with this picture:
http://www.tnlc.com/Lara/laura/osa/pignose.jpg

That ain't me (although I wouldn't mind looking like her, I'd be making an appointment right away for a nose job!) LOL!! It's been a lonnnnng time since I was her age. I'm 61. That was just a picture I found on a Halloween costumes site and posted back when someone said her doctor refused to prescribe nasal pillows masks because they would cause "pig-nose". I trot it out every once in awhile just for the fun of it.

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 4:02 pm

rested gal:

your new pic makes you look a lot younger, imo, than the oct. 2005 one. i think the problem with the oct. 2005 one is the lighting, whatever it was.

but you look a lot younger than 60--i guess a lot of people must have told you that! (I'm no youngster myself, at least chronologically.)

good new pic choice.

Caroline

roztom · Post by **roztom** » Tue May 30, 2006 4:21 pm

Yes, RG is very youthful.

My photo looks like "Tales From The Crypt." I need an upgrade.

Tom

chdurie2 · Post by **chdurie2** » Tue May 30, 2006 6:31 pm

Tom:

I think you look terrific!

Caroline

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