[Diagnosis] Central Apnea Diagnosis

[Stuzz]

Good Morning Apnea Board,

I was diagnosed with central sleep apnea a few months ago. 30 AHI was confirmed and noted that I slept better on my back as per an in lab sleep study. I originally went in for the test as I could not function at my job and was always extremely tired. It was also brought to my attention that I was not breathing well in my sleep and suffering mental distress/irritability as a result of the poor quality of sleep. 

Fast forward a year after my original suspicion I have received an APAP (ResMed Airsense 10 Auto) with a nasal mask. 3 weeks of therapy have resulted in no noticeable improvements and quite often I am in a state of so little energy/brain fog I cannot do anything I enjoy or take care of myself well. Some days are better than others but even during most days I am noticing shallow / cessation of breathing while awake. 

My doctors/vendor mostly ignore me so I have turned to this forum for some advice about getting the most of my therapy. I currently only have one day of full OSCAR data as I just bought a SD card but it appears my AHI is all over the place (confirmed by myAir App). Some days are less than 1 AHI, with a high of 43 AHI. Of the 3 weeks, it has been mostly between 7-12 AHI. I have noticed sometimes feeling that the pressure is to much 5-15 and sometimes I wake up startled by it. I have had issues adapting 100% even though mostly with or without my APAP on I usually fall asleep quite quickly. Additionally, I have been forcing myself to sleep on my back and changing pillow positional height but I have noticed little difference in wakefulness depending on position. Sleeping on my side is much easier though.

Some additional information: I am on medications that cause restlessness, irritability, Drowsiness, Akathisia and clenching which I do experience quite often sleeping or not. I am looking into reducing and finding a balance with these medications.  I do have a deviated septum but rarely have issues breathing through my nose (as far as I can tell). 

Thanks for reading.
Ryan

[SarcasticDave94]

Welcome to the Apnea Board, all things Apnea and coffee.

I've got a 2 part question. Do you have or can you get your copy of the script? And do you have or can you get your copy of the detailed sleep study and titration? If you can get those, post the redacted detailed report. These are also useful to file into your personal health folder.

I myself am most interested to see the segment on events type and count. Sometimes we have to mine the info or of the write up section as well.

I'm after seeing what info we glean to type your CA. I suspect you're a candidate for ASV. OK specifically ResMed AirCurve 10 ASV. Meantime let's see if we can get your current better. Posting this but looking at your chart again and will post a new reply in a bit.

[SarcasticDave94]

OK quick repost. Kill the Ramp. I'd consider bumping 5 to 6 on the pressures to get you a bit more pressure. Your median low number is 7.92 and I'd like to get you closer to that.

If the above passes the scrutiny of pressure gurus, then act on this edit. Homework is make a therapy diary of the symptoms and complaints in your PAP therapy. Fatigue, untreated CA as seen here, such like. You're going to take your diary info to the doc and say your CA are not well treated and ResMed ASV is the answer.

[Sleeprider]

Stuzz, you realize of course you need an ASV. We have a very high regard for the Resmed Aircurve 10 ASV, and much less for a Philips Dreamstation BiPAP Auto SV. Please read our wiki on justifying advanced PAP http://www.apneaboard.com/wiki/index.php...P_Machines

It is going to be up to you to self-advocate to get the therapy you need. We can help you to understand the purpose and function of the different types of machines, and hopefully steer you clear of the bilevel ST fiasco. A really good way to start your education on ASV and why that is used for central and complex apnea is to read the Resmed Cliinical Titration Protocol. https://document.resmed.com/en-us/docume...er_eng.pdf

I don't know the extent of your understanding about ASV or if you are even aware that is what you need. Please ask any questions you have. We have many members that use the ASV with great success. If you have a copy of your sleep study and diagnostic summary, please post a copy with personal information redacted. It is common for individuals with central apnea to actually be diagnosed with obstructive sleep apnea. Once you have been educated in what you need and how to get it, you will be contacting your doctor to ask what his plan is to move you to ASV (adaptive servo ventilation). It will require a titration test that will fail CPAP, BiPAP and demonstrate efficacy for ASV. If your insurance is high deductible or poor coverage, we can discuss how to obtain a machine out-of-pocket. The Canadian health system varies from one province to another. We need to know which one you are in to discuss options.

[Stuzz]

Thanks so much for the quick replies guys. Attached are my Sleep reports. I will be looking into ASV as I know very little about it.

Thank you very much for your help! I will try my best to address what needs to be done and record as much information as I can.

Looking into ASV as I post this. I will reach out if I have any questions. Hope you all have a nice day!

Ryan

[SarcasticDave94]

I'm seeing CA and Hypopnoea and no Obstructive. Time for ASV, surprisingly doc noted ASV probability.

Note down the ResMed ASV as your choice. It's easy enough to do setup. We can fix this CA mess in a few minutes.

[Sleeprider]

That helps a lot!  As we can see, your doctor is already on board and you probably have a follow-up scheduled.  That is your opportunity to button-hole him on the ASV issue and his plan to get you there.  I would not argue against trying to get that follow-up scheduled sooner than later. His notation that your central apnea is not associated with significant oxygen desaturation is reassuring your health is not at significant risk.  You are not going to improve on CPAP, but at least you have used it. That is part of what he will look for, is your commitment to solving the problem.  Do read the Titration Protocol linked above, and when it comes time to selecting the new machine, remember our members using the Resmed Aircurve 10 ASV have generally done much better than those with Philips.  The groundwork has already been laid, and I expect this doctor has a path to success in mind. It would be a good idea to get that cardiac screening scheduled now to move things along.