Severe Sleep Apnea

[Wheretofromhere]

Hello,
On the advice on the physician, I had a sleep study two days ago.  Although I hadn’t been experiencing fatigue, I did mention that I’ve been told I snore.  I am overweight, and have gained significant weight in the last year.  I have been experiencing some depression and was put on medication for being recently diagnosed with high blood pressure.  I’m a bit shocked. Results are as follows:  AHI 48.8 events/hour; RDI 50; O2 of 83%; hr 82-113 bpm; 

Diagnostic of 206.5 - sleep time 147.5 - 71.4 efficiency; 10 min to sleep after lights out; 14.9% N1; 42.4% N2; 31.2 N3; 11.5 REM; Arousal 2.4; 123 disturbances; 48 Apneas; 15 obstructive; 26 mixed; 7 Central; 72 hyponeas; 3 RERAS; REM AHI 70.6 per hour; 

With CPAP 7-10; 49.5 min to sleep; 4.2% N1; 33.6% N2; 33.1% N3; 29.1% REM; Arousal 1.1; 7.3 events per hour; RDI 9; Central 3 per hour; o2 90.

I have experienced shortness of breath periodically in the last year.  My Dr. said that is probably a separate issue from the OSA.  Another symptom that I recalled is driving far for work and mid drive finding that I suddenly can’t stay awake.  This occurred regularly after being fully rested and about 45 min into a commute.  In retrospect I should have stopped driving.  Instead I blared music and the AC.  I pinched myself and made phone calls.  I haven’t had that experience for awhile.  Are the above numbers indicative of CSA - that would be cause of suddenly feeling that I’m falling asleep?

I will be getting a machine.  I feel sad now at this diagnosis but will look to find strength in the forum posts and wisdom from your experiences.  

I’m open to replies and look forward on where to go from here.

Thank you for taking the time to read this.

[Melman]

Welcome to the form. You've come to the right place for help. If you have a copy of your sleep study please post it here (See link below for instructions). We would like to see the entire report and not just the summary.

You will be dealing with a durable medical equipment supplier (DME). Don't trust them to have your best interest at heart.  Read this to be prepared http://www.apneaboard.com/wiki/index.php...with_a_DME

Read this before selecting or accepting a machine. http://www.apneaboard.com/wiki/index.php...ne_choices

[DeepBreathing]

Welcome to Apnea Board.

I agree with Melman - it's very important we see the full report. I'm concerned that the number of central and mixed apneas you experienced will complicate your treatment and may prevent you from getting a satisfactory result with a conventional CPAP / APAP machine. It's common to see sleep techs and doctors being quite blind to central apnea and treating everything as obstructive. I believe you should question the number of central and mixed apneas and ask what their proposed course of treatment is. Do this before you get locked in to a machine which might not treat you properly.

[SarcasticDave94]

Welcome to the Apnea Board.

I agree with the above posts that you must be certain to question what the plan is to address the mixed and central apnea issue. Getting the wrong machine now will be a time and treatment waste. And a big headache too. Being issued the wrong machine can take at least a year to correct. Ask me how I know.

Get the full sleep study report and know for certain how all apnea variants on the report are to be addressed.

[Wheretofromhere]

Thank you for the recommendations.  I sent a note to my doctor about getting the right machine to address all of the issues.  When I saw him yesterday, he had ordered a CPAP.  Unfortunately that is the extent of what I know about it.  I certainly will not accept it unless I’m comfortable that it’s in the ballpark of what’s needed to addressed all issues.  

In retrospect I think the Apneas have contributed to regular headaches for the last 5 years.  It makes sense.  

So, I thought I was provided the full study - I’ll have to confirm.  I do have a 1 page line chart which I assumed was an extension of the numbers I posted.  

It’s funny I haven’t had tiredness during the day but after finding these results out yesterday, I felt exhausted at work today!  

I’ll keep researching the type of machine I might need, as I tend to believe my dr may require a bit of guidance.  Will update.

TY!

[Gideon]

OK, you understand that you have Central and mixed Apnea that need to be addressed, great.  The following is from ResMed and is about the modes and what they are designed to treat.  Note there is only one that is designed to treat ALL of your Apneas. (ASV Auto)

If they insist on a different machine ask what criteria are required to move to the next option and when and what can be done to expedite that path.
NOTE that it is possible that a AutoSet or VAuto will be sufficient, no way to know until you try.


CPAP choice to treat OSA, CA, obstructive or pulmonary restriction[edit]
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  

[SideSleeper]

I didn't know that my occasional sleepiness while driving were the result of having sleep apnea and found out the hard way when I rear ended a stopped car at a crosswalk. My sleep test put me at 30.8 AHI per hours--considered just in the severe range. Have you seen a cardiologist? Your low oxygen and high heart rate could indicate other problems as well as sleep apnea.