Requesting Sleep Report Analysis & Second Opinions

[Sleeprider]

I agree, turning off ramp, especially with these lower settings will help.

[omariumprime]

Thanks guys gonna try ramp off tonight, not sure what the sleep tech changed things to after I told him what I wrote in my last post, but if no improvement I’ll fiddle with the settings tomorrow. Will update again then, thanks again!

[omariumprime]

Hey all, back again after 5+ months since my original post. I reached out to another university clinic in my city that have “better capabilities” both with the overall combined expertise of their doctors and specialists in regards to sleep medicine and better tools and equipment. I just finished an in-lab CPAP titration study and was given a preliminary fixed pressure setting of 9-11cmH2O that apparently was the optimal choice for best sleep.

Looking back at my journey since my most recent sleep report, the only logic behind why some of you + another sleep doctor recommended ASV was because of the “high central” presence of 57 but this current doctor that I spoke to who reviewed my case in detail, clarified that this is actually not that high considering it’s divided by the total amount of sleep I got during that sleep study so it comes down to around around 8 centrals/hour, although they are present, he said that the hypopneas being as high as they are makes sense to diagnose OSA and not CSA.

Beyond all this theory and data analysis, I’ve been pushing with ASV for the past 3 months, with about 2 weeks cumulative break since it’s definitely not consistent with bettering my symptoms. For example, just a few days ago I woke up feeling magical (in comparison to my usual hit-by-a-truck feeling upon waking and throughout the day), and I thought wtheck is going on, is the ASV actually working? Then most days before and beyond that has been as worse as usual despite the AHI readings being near zero with leakage. The only logic I can think of is it has to do with a mix of sleep hygiene + positioning that night. In general, ASV has been a major issue because of 2 reasons: 1) Bloating when I wake up from built-up air collecting in my abdomen, that I then take at least a few hours after waking to pass as gas and 2) The constant increase of inhaled air throughout the night as a response to my shallowing/ceased breathing actually wakes me up sometimes and I end up taking the mask off.

Looking back even further to when (as per my other thread) I was working on the APAP and eventually found a good setting at the 8-9 fixed pressure mark, and looking at the current new CPAP titration study prescription as 9-11, maybe it is OSA that’s my issue and not CSA. I’m still waiting for the sleep doc to call me in about a month to discuss my results in detail and follow-up on treatment, but for now I’m gonna go back to CPAP and try the new 9-11 (will set it to fixed 10 for now) setting and will post charts in a new thread.

For now, especially for those who were adamant that my issue is CSA, I would appreciate a second look at the report and maybe some feedback in regards to the most recent sleep doctor’s diagnosis and his reasoning as to why he believes it is OSA and not CSA. It seems to me that there’s a drastic gap between an OSA and CSA diagnosis despite using the same report.

Finally, I’m still waiting on an ENT specialist referral to rule out anatomical deficiencies and an MRI; if it turns out I’m a candidate for surgical intervention, and the MRI doesn’t show anything of concern, I will pursue surgery if the research and consultations point me in that direction. Thanks y’all!

[Sleeprider]

I don't agree that the presence of hypopnea changes a diagnosis of central apnea to obstructive. Hypopnea can be central or obstructive, and without knowing if there is increasing respiratory effort with less flow (obstructive hypopnea), vs a diminished respiratory effort resulting in lower flow (central), we cannot know. That information would be available if the data was analyzed, rather than simply counting the hypopnea and making assumptions.

You have been able to try both CPAP and ASV therapy, so what works best for you and your sense of well-being is probably what you should focus on. Your ASV therapy was impeded by intolerance to pressure, and I don't recall if you tolerate the proposed 9-11 CPAP pressure, but I suspect you will be back at comfortable pressures sooner than later. There is simply no way to titrate CPAP in the presence of centrals because, as we have discussed, central apnea is consistently inconsistent. So a lull in central during a titration study ends up being viewed as effective, when it is just a pause in in events that is unrelated to pressure.

If your path moves you towards surgery, please consider it will likely make your intolerance to pressure and aerophagia worse, and is certainly not appropriate to a central apnea problem. Hopefully you will receive competent guidance.

[SarcasticDave94]

Quick initial on the new duck analysis. Not buying it. Make him hold his breath 8x hour. Sleeping well quack? No not really. You must be in contact with my latest fired quack's brother. He's full of duck poo. Fire this incompetent fool. The answer is still ASV, and dummies reassessment didn't help you or change the need. Quack quack. An MRI for...? You're not the one with brain issues or whatever crazy nonsense quack says. And surgery well not fix but make it worse in all likelihood. No offense to you but you need to demand some dummy listen to your complaints. You are telling them what you suffer from diligently right? Things are going from bad to worse it seems.

[omariumprime]

Thanks for the input to both of you I really appreciate it!

You’d think after 2 years of self-research I would at least be very close to “figuring it out”, but it’s quite irritating seeing such a gap in the sleep report analysis, the logic of that analysis and more concerning is which “science” is being used to justify one way of analysis and diagnosis vs another. I don’t see what more I could do besides letting an in-lab sleep study and over 4 “certified sleep medicine doctors” review that “hard raw data” help guide me. No wonder the majority of apnea patients fall into a pit of eternal doom and hopelessness. 2+ years of consistent effort and what I thought was sufficient willpower yet it truly is getting exhausting.

I guess the uphill battle continues. There is not much else for me to do at this point other than continue my research and see where this CPAP path leads.

*Note: one major thing that none of these “specialists” have cared to question and give me their “expert opinion” on is the fact that precisely being on medication (Seroquel nightly) for over 5y was what resulted in my first sleep study showing an AHI of 5-7 with very few centrals, so overall the medication as far as the hard raw sleep study data was doing something worthy. Then the 2nd sleep study about a year later and discontinuing that medication resulted in the 50+ AHI that made me go “wth”? There is also research that suggests that the very medication that made me think I was getting quality restful sleep, but actually wasn’t, ironically has been shown to trigger general health problems both long-term and permanent including central sleep apnea. Again, in my opinion any “specialist” who doesn’t have a holistic and individualized approach to health and instead tunnel visions on a singular cause and effect, tells me they don’t really know what they’re talking about other than to fill a quota and get paid.

[SarcasticDave94]

I edit mine a bit, if ASV felt better to you, it's the better choice, and if PAP was the better go with that. Either way the quack deserves firing.

BTW I think it's pretty well known my ASV therapy fell apart in 2019. I have been using the ASV off and on, had 2 titrations from two different doctor's orders to get it to work, producing 0 AHI on the OSCAR, but feel and breath sync go askew 1-3 hrs into it. Current time delay is 1.5 ish years of the imploded ASV therapy of mine. And I'm in fight like mad mode continually. So you'll have to adopt the fight like a lunatic mode or you're stuck for a while.

Saying that bit to mention again, or to hammer home the bottom line, comfort, feel and such are more important than mere numbers. That's why the symptom/complaint list is so very valuable.

PS I don't know anything on the med you mention, but the up or down CA can possibly be chalked to the variable consistent inconsistent CA just being CA. Even so your dummy doctors aren't convincing me of their medical expertise.