Sleep lab results csa

How do i obtain the full results. Can they fax it?

You have to request all the full details and they could fax it but you lose quality sometimes and they might not even want to fax it.

Should be 8 or 9 pages at least in length for the detailed report.
Summary report is usually a page to 2 pages.

Ok ill see if they can fax it. At least that would be something. Thanms

Clinte89 wrote:Ok ill do that i read over them a little and dont quite understand so maybe they will.

A couple of years after I was placed on CPAP I was severely assaulted and robbed. After this I experienced severe ventilatory instability while using CPAP. Apparently the stress of the Post Traumatic Stress (PTS) from the assault raised my respiratory control system gain such that my breathing while using CPAP, the pressure of which is also a plus factor in respiratory gain, became unstable.

If the respiratory gain is too high there will be times when you breath too little and too much. During the times that you breath too much your blood carbon dioxide levels drop causing vascular constriction, frustrated oxygen transport, and if the blood carbon dioxide levels fall below the apneic threshold hypocapnic central apnea will result. By rebreathing just a bit of the air most rich in carbon dioxide it tends to prevent the vascular constriction, frustrated oxygen transport, and central apnea which would result if the little bit of carbon dioxide had not been present.

The use of EERS close to the anniversary of the assault and robbery has very much eased those times for me. It works and works well for me.

Everyone seems to understand how obstruction causes apnea. But few seem to understand how respiratory gain, carbon dioxide levels, and arousal threshold affect sleep apnea[3]. CPAP can help with the obstruction issues but tends to exacerbate respiratory gain issues and arousal threshold issues as well.

EERS[1,2] is cheap and easy to implement. Which is probably why it has not been studied further. Right now they are trying to make super smart super expensive CPAP machines deal with respiratory gain issues. Silly them[4].

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721
[3] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC
[4] Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC, Goldberg R. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. SLEEP 2014;37(5):927-934 Related article (commentary):833

Your data shows periodic breathing and flow waveform signs that your breathing is unstable. This is likely due to high respiratory control loop gain[1,2]. Your arousal threshold may also be low. I think that both arousal threshold and loop gain could be related to a too low or too high vitamin D3 level. Where I live we get no UVB from the Sun from about August to April. Vitamin D levels drop all that time.

Those who are working with the D3 hormone (A.K.A. Vitamin D3) (e.g. Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All believe that a level lower than 50 ng/mL is not good and Dr. Stasha Gominak recommends 60-80 ng/mL for good health.

It would probably be wise to check your vitamin D3 levels. See “The Vitamin D Council” for assay details and what to do about them if they are off.

[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[2] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

Hello again. I went today to see my doctor and he reviewed my recent test results and said they tried me on an asv machine and it kept my o2 levels in the 90s but didnt stop my centrals so it wasnt worth switching to the asv machine so he just upped the nuvigil to 250mg because im on 150 and still exhausted. He wants me to see a nurologist but already they said my ct was clean so not sure whta that will do. It just seems his solution is meds and later maybe stimulants and aparently there is no way to get centrals under control. Im looking at getting a second opinion but its hard to get a referel for some reason. Npt sure what to do. Any odea would be great.

Refresh my memory as I am too tired to go searching for the answer but
How low did your Oxygen levels go without the ASV machine being used?

It would drop a little they said into the lower 80s

ASV machines don't stop central apneas. They treat them so you don't suffer the effects that would normally occur.

The doc's comment is ......!

You really need to see the complete sleep titration study to see the number of times the ASV machine switched to ventilation mode during a central and breathed for you. That's exactly what ASV machine does. That's why your SpO2 numbers stayed up.

Lower 80s isn't a "little" drop...it's a fairly substantial drop especially if you stay there long. Below 88% for not horribly long is enough for Medicare to pay for added Oxygen line...I forget the exact time required but it isn't very long.

What is your regular normal daytime Oxygen level? mid 95s to 98 or 99%?
If so that's a substantial drop and should be a factor in determining needs.

Did you ever get a chance to even use a regular machine that wasn't a brick to see if you could maybe find suitable pressure that could treat the OSA well enough and not cause horrible number of centrals?
How many centrals are we talking about anyway? I forget.

Pugsy:

Here is the link to the Medicare rules for SpO2 levels that call for oxygen supplentation.
5 mins while sleeping and not continuously.

http://www.bcbsnc.com/assets/services/p ... oxygen.pdf

JDS74 wrote:Here is the link to the Medicare rules for SpO2 levels that call for oxygen supplentation.
5 mins while sleeping and not continuously.

Thanks, I knew it wasn't very long but couldn't remember exact length of time.

Wonder if we need to make a phone call to Sludge in this OP's situation. I don't understand any of the reasoning going on here as to why they give up on ASV just because the centrals didn't respond but let O2 levels in the low 80s slide by when they are improved on ASV and why push wake up drugs instead of trying to deal with the underlying issue.
Or is the doc just an idiot?

Calling Sludge....any idea what might be going on behind the scenes here that might explain the doctors reasoning?

I never got a chance to get a machince with data because he wont write a script for it. He said bascially since there is no benefit since this machine fixs my hyponeas and such.

How about getting a second opinion from a different sleep doctor (and someone with zero affiliation with this current doc)?

Im trying to but its difficult to get a referrel. Ive asked my general doc anf he doesnt seem interested in refering me. Im gonna call and try again today