New to the board: Pre Therapy, suspected Central Apnea

[MVoltaire]

Hello everyone,

I am new to the board, therefore please forgive me in case my posting behaviour is not yet fully in line with the forum rules.
Since several years I am having the suspicion of Sleep Apnea but was never able to objectively verify it.

Almost 15 years ago at the age of 26, I slept one night with a Polysomnograph from my local doctor, but the results were in normal range.
About 2 months ago I finally made the decision to by myself a SleepU (Viatome) Pulse Oxymeter and used it continuously throughout the last month.

While my overall O2 levels are not that bad, I am continuously observing one recurring pattern, which is a low number of significant Apnoic Events during each night, which seem to be of central origin (I never wake up choking or gasping for air).

Even if these events are of small number, my O2 levels go down significantly for an extended period into the low 80s, sometimes even 70s.

Since this is a recurring pattern which coincides with periods of increased heat-rate, I would exclude measurement-errors at this point.

The question for me is, how to proceed in my case. Another Polysomnograph session is already scheduled. However, I am not sure if I would be the typical CPAP candidate.

[PeaceLoveAndPizza]

It is best to get the sleep test done, then decide if or how to proceed further.

[Sleeprider]

The desaturation of SpO2 and increased pulse appears to me like a cluster of obstructive events. The only way to know is to either wear a CPAP with monitoring capability, or undergo a sleep study using a home sleep test with respiratory effort channel or full clinical PSG. If you're concerned about insurance costs, it may be more economical to pick up a Resmed Airsense 10 Autoset CPAP, which can provide breath by breath monitoring that can be correlated to your SpO2 results. A new on can be obtained for about $459 plus about $100 for a mask, or much less if you buy used. If you have good insurance coverage then that is probably the way to go. If these desaturation events are not very frequent, try reading our positional apnea wiki and see if you can makes changes to your pillows or sleeping position to avoid conditions that lead to clusters of obstruction. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[grubsztyl]

You can't differentiate between central and obstructive apneas without proper sleep study. The difference is that during obstructive apnea there is persistent chest and abdomen movement, indicating respiratory effort. This movement isn't there during a central event. It has to be measured properly. Your subjective feeling isn't a good indicator. I've never woken up gasping for air and I mainly have OAs.

Make sure you're doing a proper polysomnography test and not simple polygraphy.

[MVoltaire]

The desaturation of SpO2 and increased pulse appears to me like a cluster of obstructive events.  The only way to know is to either wear a CPAP with monitoring capability, or undergo a sleep study using a home sleep test with respiratory effort channel or full clinical PSG.  If you're concerned about insurance costs, it may be more economical to pick up a Resmed Airsense 10 Autoset CPAP, which can provide breath by breath monitoring that can be correlated to your SpO2 results.  A new on can be obtained for about $459 plus about $100 for a mask, or much less if you buy used.  If you have good insurance coverage then that is probably the way to go.  If these desaturation events are not very frequent, try reading our positional apnea wiki and see if you can makes changes to your pillows or sleeping position to avoid conditions that lead to clusters of obstruction. 

Thank you all for your helpful responses!
Another thing I would like to add is my observation that these single desaturation events seem to appear both during deep sleep as well as REM phases.
I remember two nights ago having a vivid dream when my Oximeter started vibrating again as I was crossing the 90% alarm threshold due to a prolonged Apnoic Event (similar to the screenshots).

Regarding the Airsense 10 recommendation:
What is your opinion on the Dreamstation 1 Auto CPAP?
I know there have been previous issues due to the degrading foam material. But here in Germany there are currently good offers for 2023 production models and I was already eyeballing them.

[TechieHippie]

This seems like an odd pattern, because your oxygenation is so good for the rest of the night. You have pretty much a perfect score otherwise. I agree that that sounds positional. You might try a cervical collar first before a new machine. However I agree that a machine might be better than another sleep test, and cheaper. Chances are the next test may not show anything either, since these are so infrequent.

The good news is that your oxygen pattern was great overall, so whatever it is you are probably catching it early.

[Sleeprider]

Regarding the Airsense 10 recommendation:
What is your opinion on the Dreamstation 1 Auto CPAP?
I know there have been previous issues due to the degrading foam material. But here in Germany there are currently good offers for 2023 production models and I was already eyeballing them.

I would not recommend the Dreamstation or any Philips machine over the Resmed. I have had this bias long before Philips Respironics foam issues were found, and that just put the nail in the coffin.  The Dreamstation auto algorithm is terrible, and not proactive in preventing obstructive events. Unlike Resmed, the exhale pressure relief (A-Flex,  C-Flex, Bi-Flex) has no discovered therapy benefit, and is strictly a comfort feature.  The Resmed EPR algorithm is a true bilevel implementation, covertly posing as a comfort feature.  That means everyone with a Resmed CPAP has a bilevel at their disposal that can actually treat flow limitation, RERA, hypopnea and improve obstructive events.  It helps to know how to use it to best advantage, but we have seen objectively better results in nearly every category with Resmed devices compared to Philips.  I would suggest nearly every other manufacturer ahead of the Philips CPAPs, and I live in the town where Philips Respironics is headquartered and they are designed an manufactured.  I really wish this was not the case, but Royal Philips purchased the Respironics company in 2008 and ran it into the ground.  They have not significantly progressed the algorithm, and cheapened the build quality in the 15 years they have been in control. I have given away all of my past Philips CPAP and BiPAP devices, and would not use one if you paid me. In spite of that, I did use one about 5 years ago on a motorcycle trip when my device failed, so I guess it's better than nothing.

[MVoltaire]

Thank you for these quality recommendations!

I would never have found these facts regarding Resmed vs. Dreamstation based on my own research.
My initial thought was: Philips offers auto CPAP and an option for exhalatory pressure reduction - so it should be fine!
But if the Resmed goes more in the direction of a true BIPAP appliance, that should be a much better option.

Can you give me some pointer regarding cervical collars? I have not yet come across these products.

One more thing worth mentioning: I have also noticed that these isolated apnoic events seem to be significantly reduced when I eat little to nothing for dinner.
Therefore I had the suspicion that might somehow be related to metabolic or hormonal processes (insuline, acidity, circulation) and this fact also made me think about the option of Central Apnoic events.
However, I still have collect some more datapoints to verify this pattern...

[TechieHippie]

I too had/have drops that felt central and seen to be hormone related (thyroid /adrenal). According to my machine, they are not. I tried to use an oxygen monitor only (with supplements and other things) for about a year, but it wasn't enough. It did teach me some things and I would positional changes, but mainly it just woke me out of the sleep stages that caused the worst drops.

Because of those large drops, I think PAP is going to give you a lot more information. Normally I would suggest turning off the alarm to see the pattern without any interruption. ( You can do this from the dashboard in the phone software ). But that doesn't seem like a good idea in your case because you are going so low even with the alarm. I would have the same concern with a sleep test.

[MVoltaire]

I too had/have drops that felt central and seen to be hormone related (thyroid /adrenal). According to my machine, they are not.  I tried to use an oxygen monitor only (with supplements and other things) for about a year, but it wasn't enough. It did teach me some things and I would positional changes, but mainly it just woke me out of the sleep stages that caused the worst drops.

Because of those large drops, I think PAP is going to give you a lot more information. Normally I would suggest turning off the alarm to see the pattern without any interruption. ( You can do this from the dashboard in the phone software ).  But that doesn't seem like a good idea in your case because you are going so low even with the alarm. I would have the same concern with a sleep test.

Who knows for how many months or years this has already be going on?
I think I should not be too concerned about sleeping without the O2 alarm at some point in the future.

The Chinese Viatome Oxymeters are of great help. But what is really bothering me is the fact that these devices constantly emit Bluetooth radion throughout the whole night - even when not connected to a phone. You cannot turn the signal off.
Maybe I will get a more professional Oximeter at some point.