Jewel's Therapy Thread

[jewelsav]

INTRO

I'm a new member and this is my first Oscar post. Thank you very much for sharing your experiences and advice. Honestly, my sleep doctor has been of no help, and all the information I've gathered on sleep apnea has come from your beautifully moderated forum.

I've probably had sleep apnea for years, and can't remember when I last got a good night's sleep. It has now materially impacted my health. Last week I went to the emergency room with an irregular and rapid heart rate. I was diagnosed with atrial fibrillation in large part due to sleep apnea. I am determined to learn all I can, acclimate to CPAP therapy, and take an active role in my own good health. 

POLYSOMNOGRAPHY RESULTS
I was recently diagnosed with sleep apnea during a polysomnography sleep study. Was the data from the first half of the test so limited (20 minutes), that I should request another study? Does the AHI of 147 seem reasonable?

Brief results:

Sleep Test with no CPAP
Total sleep time: 20 minutes
Sleep latency: 28 minutes
Sleep efficiency: 15%
SpO2: 93% (low 88%)
Snoring: Moderate

AHI: 147, AHI w/4% Criteria: 114
Apneas: 24, Index 72

Obstructive Apneas: 6, Index 18
Mixed Apneas: 9, Index 27
Central Apneas: 9, Index 27
Hypopneas: 25, Index 75
RERAs: 0

Sleep Test with CPAP (full mask)

Total sleep time: 231 min
Sleep latency: 62 min
Sleep efficiency: 70%
SpO2: 93% (low 88%)
Snoring: NA

Apneas: 7, Index 1.8
Obstructive Apneas: 1, Index 0.3
Mixed Apneas: 0
Central Apneas: 6, Index 1.6
Hypopneas: 44, Index 11.4
RERAs: 0

CPAP and MASK
Until I receive my Resmed Airsense 10 or 11(2-6 months), I am borrowing a Resmed S9 from a trusted friend who used it just 1 night. It seems to work perfectly. I am using the F&P Evora mask from the sleep study, and replaced the climate control heated hose. I have now used the CPAP machine for 8 nights. 

OSCAR DATA
Attached are OSCAR screenshots from an average night (Dec 13) and from last night (Dec 16).

I felt fine with the CPAP machine and mask during the first screenshot. But last night I had a hard time getting to sleep, felt my mask was leaking a lot (which the data don't confirm), then was screaming loudly until my husband woke me up around 3.40 AM. I didn't get back to sleep for an hour or two, and didn't put the mask back on.

Do the data yield any useful insights? 

I would welcome your advice on all topics, including:
--Airflow and other settings, and a strategy to find the optimal settings
--Whether the leaks are due to an ill-fitting mask or mouth breathing

Thanks so much!

[dataq1]

Do you know what pressure ranges were tried during your mask-on sleep study?  
Superficially it looks like your central apneas predominate - do you understand that pressure changes may not impact your central or clear airway apneas.
FWIW, a 20 minute look-see sans mask is of little value - but that's just my opinion.

BTW, did your Dr say that sleep apnea caused your AFib, or (the other possibility) an existing AFib condition has been exacerbated by sleep apnea ? 

(My Cardiologist- Electrophysologist says my AFib has been exacerbated by sleep disorders - that is the AFib was already present, and became worse with disordered sleep, while my sleep doctor insists that sleep disorder in and of itself caused AFib.)

[SarcasticDave94]

Something to consider is the diagnostic info first. You had 9 each Central and Mixed with 6 Obstructive and 25 Hypopnea. Admitted none of these are very high, but there's enough to ruin your sleep, rest, and comfort.

Hypopnea can be either Central or Obstructive events, and I'd rather think there's both in the mix. Given that you have Central Apnea/CA without PAP, you're pre-dominant on these CA.

These recent charts have CA in varying degrees each night. That's a common trait with CA and makes it hard to nail down. We call this consistently inconsistent.

I think your best solution is discuss the CA with doc and add in the failings you've got with therapy. You need to ask doc to help you test your CA and get an ASV Titration, and then replace your CPAP with a ResMed AirCurve 10 ASV. This will eliminate CA and all other events will be well controlled.

[jewelsav]

@ dataq1, 

Do you know what pressure ranges were tried during your mask-on sleep study?
The pressure range tried during my mask-on sleep study was 5 to 10 cm of water.

Superficially it looks like your central apneas predominate - do you understand that pressure changes may not impact your central or clear airway apneas.
I thought that higher pressures might cause central apneas.

FWIW, a 20 minute look-see sans mask is of little value - but that's just my opinion.
A cardiologist has reviewed the data and concurs that the 20-min test without CPAP was not reliable data. She is trying to get my insurance company to authorize a re-test.

BTW, did your Dr say that sleep apnea caused your AFib, or (the other possibility) an existing AFib condition has been exacerbated by sleep apnea ?
I don't know, since the sleep doctor hasn't communicated with me, even to explain the test results or answer any questions. Would treatment be different in one case or the other?

Thank you for responding so quickly. 

[SarcasticDave94]

PS I just noticed the short diagnosic time duration. Yes, I would ask for a retest, possibly in a lab due to the CA.

[dataq1]

Re treatment for AFIB.
Medications such as Amiodarone  (very effective but carries a lot of potential dangerous side effects), Dronedarone (avoids most of the ill sides of Amiodrone - but is expensive), Tikosyn ( very effective where others have failed - requires 3 day hospital observation to titrate and determine tolerance and is expensive)
Surgical - ablation , with or without Watchman implant  (if you are going to puncture the septal wall for the ablation, might just as well insert the watchman that might avoid clot formation).

And of course you should be on an anti-platelet or reduced clotting factor medication (coumadin or dofetilde or similar) regardless !

[jewelsav]

Thank you Dave and dataq1 for responding with useful information.