[CPAP] Cheyne Stokes Respiration

[TALBERTC]

I heard back from my Doctors office and he said I only have sleep apnea when I'm on my back. I already knew that so I always sleep on my side.  I sent that message waiting for a response.

[Sleeprider]

The thing is, this is not obstructive sleep apnea. Can you send them a chart showing the problem? It could be your doctor does not have any expertise in central sleep apnea or CSR. He may not be aware that your stroke may have fundamentally changed the nature of your sleep disordered breathing. Give him a fair chance, but don't hesitate to find someone competent in CSA and CSR.

[SarcasticDave94]

You have Cheyne–Stokes respiration (CSR) breath patterns. ASV is the best answer. If Dr. Dolittle won't help, listen, investigate ASAP, fire and replace.

You do not just have sleep apnea. Figuratively, beat this info into docs head.

[stevew168]

"Dr. Dolittle", good one!  I'll have to remember that.  It applies to many doctors regarding sleep apnea, unfortunately.

[TALBERTC]

Thank you to all who have responded to my question about CSM's. My primary care doctor in South Carolina referred me to a sleep specialist where I live part of the year but it was scheduled for 6 months later. My SC home is near the coast so close to sea level. I'm now in the North Carolina mountains at an elevation of 3700 feet, where I'll be until November. I wonder if that change can make a difference. I'm making contact with a neurologist here. Hopefully, I won't have to wait too long to get an appointment.

A little more detail about my history. I have been dealing with extreme day time sleepiness since my late teens. I was once diagnosed with narcolepsy and prescribed amphetamines after trying Ritalin. After taking amphetamines for a while, the more I researched Narcolepsy, the more I was not convinced. I stopped the amphetamines due to the stigma and I didn't believe I had narcolepsy. About 15-20 years ago, maybe longer, my doctor told me about other medications I could try. Provigil, Nuvigil, etc. I have been taking Armodafinil since it became available. I wonder if all of this is related? I've often thought my sleepiness may be related to my breathing.

I've been told that my apnea is mild and only when I sleep on my back. I knew that so I sleep on my side. If that's the case why am I having such high AHI's? Is that a signal that it's not obstructive apnea but prossibly central apneas? Why would that have not shown up on my sleep study I had last summer?

Do you think it would be better to work with a doctor online who specializes in sleep apnea?

Thnk you for the opportunity to explore this issue.

[Sleeprider]

Elevation changes, usually above 5K feet can increase central apnea and periodic breathing in sensitive individuals. I have seen remarkable results using Diamox (Acetazolamide), with high altitude sickness and central apnea, but under 4K feet is a bit unusual. Worth a brief try if you doctor will call it in as an experiment.

Sleep doctors are unfortunately not well trained in CSR and central apnea, and normally we would suggest using a cardiologist or pulmonologist with awareness of sleep medicine and ASV therapy. Many members have acquired ASV therapy without prescription by buying from DotMed or Craigslist. ASV is not a complicated positive air pressure therapy. There are only 4 settings and the machine is completely automatic, so titration is just a waste of time and money.

[SarcasticDave94]

Do you have a good doctor patient relationship with your primary? Ask them to script an ASV. They can script it default settings, we can help with settings. No big deal there. They don't need to do much except incorporate a block of a few minutes discussion about the ASV therapy to count as the face to face.

Yes, elevation can play a part in Central Apnea. Again ASV will help this too.

[TALBERTC]

I found a Resmed Aircurve 10 ASV. I hope to complete the purchase today.

I got a copy of my sleep study. It says I have mild OSA when sleeping on my back, which I never do. So if that's the case my CPAP isn't doing anything for me but recording my sleep sessions. So the only thing I see in the data is not OSA events. Could using the CPAP at a pressure of 8.6 be causing the problem with CSR and what appears to be Central Apneas?

[stevew168]

Yes, it's certainly not helping. It's good to hear you're getting an ASV!

[SarcasticDave94]

I would not think the CPAP is causing CSR or centrals. It is likely this may have been in your sleep study report, and you can choose to post it.

This Obstructive while on your back just sounds like a lazy, incompetent medical quack not understanding about Apnea.