Complex sleep apnea and EPR

JV1967 wrote:My sleep doctor told me she's going to put me on an ASV, because I have "slightly worse onset and waking centrals than normal." She scared the p**p out of me while showing me my report and pointing to it; she is mailing the report to me. My central score was 5.1, is that low? I know very little about all of this stuff, as I am a total noob. She told me I have complex apnea. The overnight tech freaked me out a bit too, during the study, when he said "One central is too many centrals. You have complex apnea."

Yes, your central index is consider "low" in terms of number per hour but that doesn't mean it is automatically insignificant or not worth dealing with. Remember this is a per hour average over the whole sleep session...let's use an 8 hour sleep session as an example..and 5 AHI (or central index if all a person had was centrals) would mean 5 times 8 or 40 centrals over the 8 hours.
Rarely are they spread evenly through the night. Most of the time they come in groups or clusters and this would be especially true of someone who is having primarily sleep onset centrals and not many the rest of the night. Sleep onset centrals are considered normal and are not normally that big of a deal unless there's so many of them that oxygen levels drop and/or the person having them keeps bouncing out of sleep and has a hard time actually getting past that little bit of sleep stage transition where they are occurring. So they can still mess with a person's sleep quality and cause oxygen level desats.

Also...remember this is a per hour average and without seeing exactly when or where these 40 centrals (using that 8 hour times 5 per hour example) but I bet that the bulk of them were actually during sleep onset stage...so you might have had 20 of them in 30 minutes and that would give you 40 per hour and thus the index of 5.
5 doesn't sound bad but if you have all 40 in one hour when you are trying to go to sleep then it gets your attention.

So there's more to evaluating how severe a person's sleep apnea might be and this is true of plain obstructive sleep apnea or complex sleep apnea or central sleep apnea
But the medical profession has come up with the AHI standard to go by initially...while on the back burner we really need to also evaluate when these events are happening and are they in nasty clusters and are they causing oxygen level drops and are they seriously impacting sleep quality itself.

For me my OSA is worse in REM stage sleep where my AHI was 50 something and in non REM sleep my AHI wasn't horribly exciting at 12 per hour BUT in non REM sleep I was having some massive long apnea events and my oxygen level dropped to 73%...so while 12 per hour may not be "bad" by the AHI standards it was sure bad from an oxygen standpoint.
Then when I would go into REM stage sleep those long apnea events totally trashed my sleep architecture and kept waking me up.
No wonder I woke up a gazillion times a night and had some killer headaches in the AM and had to pee every hour on the hour during the night.

So try not to dwell too much on just that 5.1 central index...sounds like your doctor is also seeing the other stuff that can impact your sleep and overall health and feels it needs fixing and the ASV machine was determined to be the best way to address your problem.
I imagine that there is more to your sleep study that needs fixing than just that overall hourly average....either numerous wake up which prevent your getting the needed sleep stages...or maybe desats or maybe so close together it is a problem or maybe all of the above.

Pugsy wrote:

JV1967 wrote:My sleep doctor told me she's going to put me on an ASV, because I have "slightly worse onset and waking centrals than normal." She scared the p**p out of me while showing me my report and pointing to it; she is mailing the report to me. My central score was 5.1, is that low? I know very little about all of this stuff, as I am a total noob. She told me I have complex apnea. The overnight tech freaked me out a bit too, during the study, when he said "One central is too many centrals. You have complex apnea."

Yes, your central index is consider "low" in terms of number per hour but that doesn't mean it is automatically insignificant or not worth dealing with. Remember this is a per hour average over the whole sleep session...let's use an 8 hour sleep session as an example..and 5 AHI (or central index if all a person had was centrals) would mean 5 times 8 or 40 centrals over the 8 hours.
Rarely are they spread evenly through the night. Most of the time they come in groups or clusters and this would be especially true of someone who is having primarily sleep onset centrals and not many the rest of the night. Sleep onset centrals are considered normal and are not normally that big of a deal unless there's so many of them that oxygen levels drop and/or the person having them keeps bouncing out of sleep and has a hard time actually getting past that little bit of sleep stage transition where they are occurring. So they can still mess with a person's sleep quality and cause oxygen level desats.

Also...remember this is a per hour average and without seeing exactly when or where these 40 centrals (using that 8 hour times 5 per hour example) but I bet that the bulk of them were actually during sleep onset stage...so you might have had 20 of them in 30 minutes and that would give you 40 per hour and thus the index of 5.
5 doesn't sound bad but if you have all 40 in one hour when you are trying to go to sleep then it gets your attention.

So there's more to evaluating how severe a person's sleep apnea might be and this is true of plain obstructive sleep apnea or complex sleep apnea or central sleep apnea
But the medical profession has come up with the AHI standard to go by initially...while on the back burner we really need to also evaluate when these events are happening and are they in nasty clusters and are they causing oxygen level drops and are they seriously impacting sleep quality itself.

For me my OSA is worse in REM stage sleep where my AHI was 50 something and in non REM sleep my AHI wasn't horribly exciting at 12 per hour BUT in non REM sleep I was having some massive long apnea events and my oxygen level dropped to 73%...so while 12 per hour may not be "bad" by the AHI standards it was sure bad from an oxygen standpoint.
Then when I would go into REM stage sleep those long apnea events totally trashed my sleep architecture and kept waking me up.
No wonder I woke up a gazillion times a night and had some killer headaches in the AM and had to pee every hour on the hour during the night.

So try not to dwell too much on just that 5.1 central index...sounds like your doctor is also seeing the other stuff that can impact your sleep and overall health and feels it needs fixing and the ASV machine was determined to be the best way to address your problem.
I imagine that there is more to your sleep study that needs fixing than just that overall hourly average....either numerous wake up which prevent your getting the needed sleep stages...or maybe desats or maybe so close together it is a problem or maybe all of the above.

She told me one of my onset desats was at 83. I woke up this morning, tried to go back to sleep, and as soon as I felt myself falling asleep, I got a weird feeling. I looked at my wearable, wrist pulse ox, and it was down to 88.

At the lab, the first night, before my mask titration study; first night they did not wake me up to put a mask on, my overall AHI was 12.

I forgot to mention that the reason I've even gone on to the generic Klonopin, was because I had so many desats and sleep startles that I could not sleep. I have PTSD, anxiety, sleep issues, and early beginning of menopause, at 48.

JV1967 wrote:I forgot to mention that the reason I've even gone on to the generic Klonopin, was because I had so many desats and sleep startles that I could not sleep. I have PTSD, anxiety, sleep issues, and early beginning of menopause, at 48.

Well lets hope that when you have the sleep apnea issues well controlled that the other issues will become at least less intensive in how they affect you. We can't expect xpap therapy to fix issues unrelated to sleep apnea but often when at least the sleep apnea issue is well managed then the other things become also easier to manage.
Good luck with the menopause thing...it's a bitch and often we become one in the process I know I sure did.
I didn't do the hormone replacement thing due to maternal history of breast cancer in too many of my relatives...so I just toughed it out and there were times I swear I could have tackled a grizzly bear and won.

I have some other health issues unrelated to sleep apnea that of course the cpap couldn't fix but having the sleep apnea at least not making things worse it did enable me to handle the other issues a little better. I hope you have the same result.

88% desat is where people meet the criteria to get on oxygen ....I forget just how long it has to be at 88% (or below) but I suspect that your 83% desat is a big factor in your doctor's desire to get those sleep onset centrals reduced.

Pugsy wrote:

JV1967 wrote:I forgot to mention that the reason I've even gone on to the generic Klonopin, was because I had so many desats and sleep startles that I could not sleep. I have PTSD, anxiety, sleep issues, and early beginning of menopause, at 48.

Well lets hope that when you have the sleep apnea issues well controlled that the other issues will become at least less intensive in how they affect you. We can't expect xpap therapy to fix issues unrelated to sleep apnea but often when at least the sleep apnea issue is well managed then the other things become also easier to manage.
Good luck with the menopause thing...it's a bitch and often we become one in the process I know I sure did.
I didn't do the hormone replacement thing due to maternal history of breast cancer in too many of my relatives...so I just toughed it out and there were times I swear I could have tackled a grizzly bear and won.

I have some other health issues unrelated to sleep apnea that of course the cpap couldn't fix but having the sleep apnea at least not making things worse it did enable me to handle the other issues a little better. I hope you have the same result.

88% desat is where people meet the criteria to get on oxygen ....I forget just how long it has to be at 88% (or below) but I suspect that your 83% desat is a big factor in your doctor's desire to get those sleep onset centrals reduced.

I was at 83% oxygen in my blood, as opposed to 90something. Not sure if I mentioned it correctly. Meno hasn't made me a bitch, it's just made me shaky and nervous. It has raised my anxiety levels, so I might go on a low dose of hormone replacement. My mother had breast cancer, but didn't test positive for the gene, and no one else in my family has had it; knocks on wood.

Thank you for helping me out on here, Pugsy. It means a lot to me. I'm a total noob at all of this, and sometimes I get scared of it.

By the way, I'm thinking about talking with my neurologist about all of this, and considering an MRI.

By all means talk to whomever you feel you need to talk to in an effort to help resolve your questions.

About the menopause bitch thing...it varies widely among women...I was a sometimes bitch...my sister now...she was a full time bitch but then you would have to know her because my husband says she had a sizable head start. And he is probably right.
She elected to do the HRT and got a real rude awakening when we was told she had to stop it when she had a little heart attack...all those symptoms she was taking the HRT to prevent...came back with a vengeance when she stopped the therapy..she thought she would bypass the symptoms but instead just postponed them. My husband had a good laugh over that.

Pugsy wrote:By all means talk to whomever you feel you need to talk to in an effort to help resolve your questions.

About the menopause bitch thing...it varies widely among women...I was a sometimes bitch...my sister now...she was a full time bitch but then you would have to know her because my husband says she had a sizable head start. And he is probably right.
She elected to do the HRT and got a real rude awakening when we was told she had to stop it when she had a little heart attack...all those symptoms she was taking the HRT to prevent...came back with a vengeance when she stopped the therapy..she thought she would bypass the symptoms but instead just postponed them. My husband had a good laugh over that.

Scary about the heart stuff. This is why I'm going to the heart doc for a stress test. I already had the EKG. I'm still not sure if I'm going to do the HRT or not. It's a big decision. Sorry about having to deal with bitchery.