Newbie Questions - opinions sought, various issues

[tg73]

Hello to everyone on the forum!

I have searched through the threads and I have found answers to some of my "newbie questions" so I guess it's more of opinions I am looking for....

I will preface this with a short overview of (How I got here)

I have always been pretty healthy both physically and mentally. I am 41 years old, 180lbs, 5'11" tall. I was diagnosed ADHD as an adult at about age 39. I have just recently (past two weeks) been diagnosed with "Obstructive Sleep Apnea".
For ~ the past year I have been dealing with constant "unexplained" shoulder pain, excessive daytime sleepiness, loss of focus, mild to moderate cognitive decline, etc....

I cannot really nail down when this started because the Adderall for my ADHD may have hidden the symptoms as they crept into play but at some point nearly 1 year ago these symptoms overtook the medicine.

I have been to two sleep studies:
1.) Overnight and the Daytime sleep latency test.
2.) Overnight with CPAP machine to determine optimal treatment pressure.

The doctor sent me to the first expecting to see negative results for apnea and narcolepsy based on my weight, lack of snoring and time it takes me to drift off to sleep. However, after the first sleep study BOTH came back positive.
The doctor informed me that the multiple sleep latency test (narcolepsy) could have been a false positive based on the fact that I did not sleep well the night before. He suggested we treat the apnea and see if the symptoms (aside from shoulder pain) subside since they could all be explained by lack of restful sleep.

I got my ResMed AirSense 10 Autoset and ResMed F10 full face mask Wednesday and have used them both Wednesday night and last night @ the recommended pressure setting of 8.0 - 9.0

When I got the machine they gave me the printout from my two sleep studies.

I was reviewing my results from the two sleep studies along with the data from my first two nights on the APAP machine and here is where my questions or request for opinions comes in.....

The first sleep study sans machine showed the following results:
1 Obstructive Apnea Events
24 Central Apnea Events
38 Hypopnea Events
AHI 10.3/hour

The second sleep study with machine showed the following results (when looking at the Respiratory Table):
At ALL pressure settings there were 0 Obstructive Apnea events
There were Central Apnea events at pressures 5 and 9
There were Hypopnea Events at pressures 5, 7, 8 and 9

Night one on the APAP machine resulted in 20.6 events per hour
Night two on the APAP machine resulted in 17.4 events per hour

On the website I cannot see which events were obstructive vs central and have not yet loaded the data from my SD card into SleepyHead to see that level of detail.

I know this whole thing takes getting accustomed to but I just wanted to verify that:
1.) I am on the correct type of machine for my apnea
2.) The higher (events per hour) results that I am seeing on this machine are expected during the acclimation period.


I hope that is not too long for a first post but still provides enough detail to get some opinions from you (the users/sufferers/experts)

Thanks in advance!

[PaulaO2]

Well....

Based on the night without the machine, I'm surprised you're on a regular CPAP machine. Granted, the Autoset can adjust as needed so that's good. But it's not going to treat the central events.

If the AHI increased with the machine's use, it would be the central events that increased, not the hyponeas. That is common.

I suggest you express your concerns about the central events not being treated. It could be they are trying to see if the autoPAP will settle everything or not first then go with the bilevel or ASV. Most insurance wants the user to "fail" CPAP before they will pay for a bilevel.

[Crimson Nape]

First, Welcome to the forum.

For ~ the past year I have been dealing with constant "unexplained" shoulder pain, excessive daytime sleepiness, loss of focus, mild to moderate cognitive decline, etc....

You just described being married!

You definitely need to allow more time to become accustomed to your new sleep environment. After establishing a baseline is when the next steps should occur. Two questions you might want to ponder are; 1. Do I feel better? and 2. Is there anything with my current equipment that is causing me a major annoyance?

Hang in there and I'm sure others will give you some good advice.

[tg73]

I suggest you express your concerns about the central events not being treated.

Thanks PaulaO2.....I have emailed these same two questions to the doctor.
Another thing that drives my concern about "The correct machine for central apnea" is on the back of the page for sleep study 1 the diagnosis said "Obstructive Sleep Apnea" when the front clearly said 24 central events and 1 obstructive event. I thought maybe I was unclear about how they decided which treatment to use. I hope to hear back from the doctor soon....I knew it wouldn't be a quick as you guys have replied

You just described being married!

Ha...I actually made that same comment to a coworker of mine when we were talking about my diagnosis!
Indeed I am married but I figure it would not have waited 17 years into my 18 year marriage to rear it's ugly head

You definitely need to allow more time to become accustomed to your new sleep environment. After establishing a baseline is when the next steps should occur. Two questions you might want to ponder are; 1. Do I feel better? and 2. Is there anything with my current equipment that is causing me a major annoyance?

Not to worry, I am certainly not ready to give up.
I did a little calculating (time mask used/apnea events) and it actually increased on night two!

Night 1 with machine = 2.692 events per hour
Night 2 with machine = 2.843 events per hour

I don't expect that I will feel the effects of treatment this early but I did want to make sure that the treatment wasn't making my apnea worse.

It's likely just noob anxiety

to you both!!!

[PaulaO2]

Hey, if your AHI is that low, you're doing good! Get SleepyHead though and let it do the math for you.

[tg73]

Hey, if your AHI is that low, you're doing good! Get SleepyHead though and let it do the math for you.

and....that's what I meant by foggy and cognitive decline.....
Okay, I took your advice and let SleepyHead do the math.....
Here is a screen shot of my first two nights.

[attachment=1211][attachment=1212]

As you can see, there was no need to divide my events per hour by hours AGAIN....stupid brain.

[trish6hundred]

Hi tg73,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with your CPAP therapy.

[quiescence at last]

given the data from only two nights is not much yet to go on, I might be inclined to do the following changes:

Set ramp start pressure to 6 vice 5 (for a short time like 5 minutes), set min pressure to 6.5 and max pressure at 8.5, and EPR to 2.

Run for 4 or 5 days, post numbers.

What I expect is - You will get more hypopneas and less central apneas. In your APAP studies show the CA occurring at 5 and 9, with H occurring at 5,7,8, and 9. We are going to keep you under 9 to excise some of the CAs but will probably not knock out the H that would be occurring at 9. Also the EPR of 2 should also combat the CA somewhat.

Looking for: CA less than 10 per hour, H between 2 and 6 per hour, and O between 1 and 3 per hour, for a consistent AHI of less than 15.

Does your doctor still think you should be taking Adderall? At the same level or reduced dosage?

What I scanned over the internet a few minutes ago suggests the Adderall side effects run counter to what you are trying to do with the CPAP. (i.e. insomnia, high corticosteroid levels)

aside from settings, consider:

1. taking several 2 hour sleep sessions followed by 1 hour breaks.
2. in the 1 hour prior to sleep - do some activity that it only mildly stimulating, like sorting CDs, or reading a science magazine.
3. consider lowering the light level somewhat in the few hours before sleep.
4. if you are sleepier during the day, then sleep during the day.

We have to find something that works. Then, you can modify as your body regains the restfulness and health.


* - of course, get the sleepyhead graphs and get used to what you are looking at.

[DeepBreathing]

G'day TG73, welcome to the forum.

The fact that you had primarily central apneas without the machine and you still continue to have centrals with the machine indicates that your diagnosis should be central apnea. I think "obstructive sleep apnea" is a default diagnosis they use for all types. Don't waste time adjusting settings - that machine will not do the job. You need a ResMed Aircurve ASV (or equivalent ASV machine from another manufacturer). http://www.resmed.com/us/en/consumer/pro...0-asv.html

I know this from experience - I had a very similar proportion of centrals (actually AHI > 60), was diagnosed with OSA and spent several months messing around with an Autoset before changing to an ASV which stopped my apneas cold. You might find that your insurance or Medicare or whatever require you to try the Autoset first, but it won't work. And make sure the doctor corrects the diagnosis.

[quiescence at last]

@tg73 - Obviously professional help is needed, and discussing the results with your doctor is definitely a good idea. The reasoning for picking this approach may have been well reasoned due to your other conditions.

What interested me was the presence of ADHD and medication.

@DeepBreathing - did you have an ADHD diagnosis as well?

My interest is stimulated by the OP charts provided - (1) that the respiration rate is so high 95th percentile 26 to 30. (2) the minute ventilation is so high 95th percentile of 14 to 15. The median numbers for respiration rate and minute ventilation seem to be good and normal.

Anyone else out there with ADHD that can tell us if they also experience high 95th percentile resp. and min vent?

@tg73 - your Tidal Volume numbers look fine. Let me ask you, do you regularly have vivid dreams, and do you remember having them many times a night?