[Diagnosis] Surprised newbie with CSA/OSA -- Any words of wisdom?

[CLCCW]

Hello and glad to have found you all!

I am a 64 year old healthy female living at 5,500 ft. elevation (40 years here). Reported daytime drowsiness at my annual physical and was referred for home sleep testing and to a pulmonologist. Test revealed "severe" apnea! I was shocked. I don't snore (per my spouse), and no abrupt awakenings or shortness of breath or anything. I am a deep dreamer and love to sleep, actually. I do wake up and have trouble falling back to sleep, but thought it was just my age.

Had a titration test next and an echocardiogram (mild regurgitation in 3 valves, no concern to doctors -- and heart is good, no a-fib or anything). Blood pressure normal, get regular exercise, etc.

I've been prescribed an AirSense 11 with AirFit 40 mask (I tolerated it ok in the lab overnight... started with nose-only mask which worked at first, but I ended up mouth breathing a lot and they switched to the 40 which was weird at first, but I ended up sleeping with it... it was weird, I could notice them changing stuff around (pressure, how the air came/went). The tech said I was quite perceptive.  

Quick observation: The morning after the all-night titration test, I felt WAY energetic, a bit like I had had a couple cups of coffee. I don't drink caffeine, but remember it well. Took a few hours to wear off. What is with that??

I am about to order my machine and mask (thinking of a local brick & mortar supplier for starters), but I can ask questions about all that later.

I thought I'd share my tests (de-identified) and see if you have anything worth noting. Doc has ordered pressures from 5-8 (still learning all this lingo and concepts!)

       

[SarcasticDave94]

First, welcome to Apnea Board,

The test data didn't get into details, however of note is Central Apnea and ASV Titration were mentioned. This clues us in that CA are an issue. Include the echocardiogram as another hint, possibly the medicals ordered that recently as well. A guess on my part, but the echo is still pushed on us to get a green light qualifyer to get ASV.

Ask the doctor's office for the detailed sleep study reports, include all taken. This isn't raw data, but the processed detailed versus summary info. There ought to be an event breakdown splitting Centrals and Obstructive into separate lines.

Your higher elevation might be partial cause of CA, assumed they're what you're dealing with.

From a former ASV user, mask will be very important. I've used Fisher and Paykel full face successfully with ASV. They're loose wearing but seal better in my use.

[CLCCW]

Thanks "SarcasticDave!" I have the full charted/graphed results, but wasn't sure if it made sense to post those. Also, I don't understand a lot of it. I will also keep note of your mask recommendation.

[SarcasticDave94]

For myself, the detailed table stating the diagnostic events from the sleep study will be helpful. This will show the events count and type. You're probably going to see about a 50/50 split between Central and Obstructive Apnea, if the doctor is contemplating ASV.

The detailed recommendation page might also be useful.

As you see fit, put those 2 items up redacted of your personal info. Members here will certainly help decipher the info.

[CLCCW]

Here are some more attachments/images of results from the Home Test. Will follow with a post from the Titration test. All Greek to me at this time, but slowly learning. I have an acronym glossary at the ready!

           

[CLCCW]

.....aaaannd here are the overnight Titration Study results. I see no mention of "snoring" on this one! I think the home test "heard" my spouse sawing wood! I have the graph one too, but could only do 3 images.

The results had this text, too:

"*SCORING NOTES** Delayed sleep and REM onsets. Extended periods of wake throughout the study. Occasional periods offragmented sleep. Occasional central hypopneas, spontaneous arousals. Occasional leg movements with arousals. Occasional mild to moderate leak causing a wandering flow signal, events NOT scored during these times."

           

[SarcasticDave94]

OK, attachment 1 here has 75 pAHIc 4%. The c stands for Centrals. It doesn't seem like it's 50% to me, but there's not just a few Central Apnea involved.

You're on the AutoSet 11 currently correct? If you want, add a recent OSCAR to see how the therapy is doing. There's a few ways to help diminish, or otherwise avoid but not treat, Central Apnea with setting edits. It doesn't always work for those with Central Apnea, but you can try it.

Central Apnea are stubborn, called consistently inconsistent, and only ASV can actually treat them.

[CLCCW]

       
Update! My ResMed AirSense 11 (and F40 cushion) finally arrived via a local vendor. I am being treated by a pulmonologist who will be monitoring my results. I am at night 3 of my 30 day first-run.

1. I am finding the mask and machine tolerable, but have some "discomfort" awakenings at time. Super quiet!


2. Per pulmonologist, starting pressure settings are "EPAP min 5 and max 8, EPR 3." I don't notice any weirdness breathing at all, just annoyance at the dang mask on my face. I mouth breath occasionally, so got one the covers my mouth, too. The RT set ramp at 25 mins which I used first night, but I changed to 5 minutes, and may just turn off at this point. The pressure is just not bothering me.

3. I have 3 nights of data so far, each with progressively increasing CA's. I discount night #1 because I was awake a lot and getting situated, had to pee twice, etc. First night AHI 7.89, next night, 18, last night was 24. (I was diagnosed with severe apnea, and had like >30 per night in the test). Oddly, the best sleep night I perceived was last night (with the higher AHI).

4. Might my CAs be due to just restlessness or do the CA's cause the restlessness? I assume we watch for a trend a bit longer. Might my pressures need to be higher?

Here is last night's screen shot (I think I double posted it, sorry). I'd love someone's take on results. I am still learning to interpret.

[SarcasticDave94]

How did you feel with this? Any rest?

1. Rest and comfort will get better with more use as practice, if therapy is correct and tuned individually

2. Low pressure setting, Suspicious Dave thinks doctor is avoiding CA, or shall I say attempting, didn't work though

3. Mask is always the literal touch point, it'll be the influence on success or fail, excepting getting the machine itself

4. I don't think the CA here in CPAP will be a restless aspect, sadly the CA just are, they were present in the test and are now as well, and my belief is they'll be a frequent hindrance unless treated head on and not avoidance or doc pretending they aren't an issue, if my chart looked like that, I'll be very tired and very irrate at avoidance treatment

Bottom line, far too much purple marks on OSCAR for you to gain rest. You decide how long you want to continue. But when you've had enough call the doctor's office, DEMAND they address Central Apnea from the test and besides the AutoSet increases them, makes them intolerable.

Now do note, Central Apnea will be consistently inconsistent, they will increase then decrease, maybe disappearing then returning, no intervention needed for Central Apnea to be variable.

[CLCCW]

I got better rest last night. I seem to wake up around 4am typically, with or w/o machine... I have been wakeful like this for a long time. I am just often awake for an hour in there, reading.

Mask is comfortable. That is a plus.

What does it mean when you say about the CA's: "my belief is they'll be a frequent hindrance unless treated head on and not avoidance or doc pretending they aren't an issue" and "when you've had enough call the doctor's office, DEMAND they address Central Apnea from the test and besides the AutoSet increases them, makes them intolerable."

What do they do different with my settings, then? What is "treated head on" and what do I ask for, exactly? Are you talking about something like an AirCurve?

Thanks!