Sleep doctor says CPAP data on CA's not accurate

[Benzi]

Hi

I finally got to consult with a sleep doctor who acknowledged that such a thing as CA actually exists.
She sent me for another sleep test, which I did at home. The test showed AHI 6, of of it OAs. She said the test showed no other apneas. When I told her that my S9 showed lots of CAs, she said that although the machine does a good job dealing with apneas, the data in its reports is not reliable, and repeated that their test showed no CAs.

I kept complaining about my sleep and telling her that my S9 shows I have lots of CAs. Eventually she sent me for a test with CPAP in the hospital to see whether there were any CAs. They hooked me up to a million sensors and I put on the CPAP mask. The combination of CPAP and sensors was not a great success as far as quality of sleep is concerned. Took me a couple of hours to fall asleep, slept for 3 hours, woke up and couldn't fall asleep for another 2 hours, then after another hour and a quarter of sleep they woke me up to end the test. Good thing I had arranged for someone to drive me home.

Result of the sleep test with CPAP: almost zero apneas, including CAs. (The S9 showed lots of them.)

Does this sound logical to you guys? The doctor told me before the test that if it showed CAs she would probably recommend changing equipment (I assume BIPAP or ASV). She's been in this field for decades so I tend to think that she knows something and that it's not a matter of insurance trying to reduce their costs.

I was actually hoping that the test would show CAs so I could do something about treating them. 

Does it seem possible that the S9 data on CAs could be so wrong?

I'm attaching last night's Oscar report.

Thanks for any advice.

[Gideon]

To discuss the CA events please post a 10 minute view that includes them.

That and post a copy of that sleep study. Not just the summary, the full version including the charts and tables.

Note the sleep test would include only fixed pressure and since your CA seemed to appear at higher pressure.

Note that CPAPs evaluate the airflow to determine if the airway is open or restricted. They do not measure respiratory effort either abdominal or thoracic, a key factor in determining Centrals.

[SarcasticDave94]

There's a few things about testing that needs considered. Central Apnea are consistently inconsistent. This one night snapshot didn't have any, but that just proves they weren't there for that night.

Second, I mention this because it happened to me recently. A doctor in Hanover, PA was one of my pulmonary doctors of recent. He works sits in a chair at UPMC. He's stated that I had no Centrals, and viola no Centrals appeared in the diagnostic and Titration. This was last year, 2020. After he wanted me on CPAP, and that no symptoms or complaints were listened to, I fired him.

This year, I was referred to a new sleep and pulmonary team at Penn State Hershey, PA. I actually go to a satellite office a bit closer to home. I told them I have symptoms and complaints identical to my past untreated high pre-existing Central Apnea state. A new diagnostic says high levels of CA and patient needs ASV.

Hmm, SarcasticDave94 says if the pulmonary team is actually wanting to treat you and are really looking for CA and don't mind finding them, they might be on your test results. If the doc doesn't want to deal with the CA events, then CA don't show up at any level at all.

Lastly, look at the trend on your own test results. Were CA present at any level consistently? I mean if you had x number of tests and all those tests showed some CA activity but the one done by Dr. Dolittle had zero CA, then maybe just maybe Dr. Dolittle demanded CA were not to show.

Yes ok Dave's a crazy conspiracy theorist. Doc blocked input from the effort belt or something to prevent CA from reporting. OK regardless of my weird conspiracy ideas, again look at the trend on all your prior tests. Were there CA of any level present except this one? The statistics that this can be accurate seem to be difficult to accept.

[Geer1]

It is potentially logical and that is the reason Gideon asked for zoomed in view of some of the CA events. The potential logic is that these machines don't know when you are awake or sleeping and an apnea is only an apnea if you are sleeping. Your AHI is high enough and based off the overall view I have a feeling these a sleep transition central apneas. If sleep transition central apneas I don't know how they would get scored during a sleep study (if normally counted or not).

Along with some zoomed in examples I would be curious to know if you ever have tried using EPR and if so if you noticed it had any effect on your AHI?

[SarcasticDave94]

Given the history on other threads, I think you might fall into idiopathic Central Apnea. And it seems like none of the doctors you've encountered are really willing or able to help much. No matter how it's sliced, you're in an uphill battle. That doesn't mean not winnable though.

If you've not done so, write your timeline of things involving treatment, machines tried, and ongoing symptoms and complaints regarding your Apnea treatment. Try to get this doctor to listen. If not, it's probably a lost cause with this doctor. Sometimes, you need to keep searching for a different doc.

From June 2021:

http://www.apneaboard.com/forums/Thread-...-LONG-CA-s

[Sleeprider]

I am yet to see anyone that has posted results like yours, that did not achieve a near-zero event rate with ASV. Just saying.

[Benzi]

Thanks guys.

In response to your questions:

• EPR - I have it on 2.
  

• Sleep lab results - I didn't get any graphs or tables, just a summary letter which I'll have to translate into English before I post it.
  

• I'm attaching 2 screen captures - I zoomed in on two periods where CAs are indicated. Is this what I was asked for?
  

   
   
Any insights appreciated!

Thanks,

Benzi

[Gideon]

The first chart shows CO2 induced breathing.
The second a lot of awake breathing with likely breath holding centrals.

[Benzi]

The first chart shows CO2 induced breathing.
The second a lot of awake breathing with likely breath holding centrals.

Thanks Gideon, but what does it mean? (Forgive my ignorance)

[Sleeprider]

This article explains respiratory drive and the relationship of CO2 In your case is also discusses the feedback loop that can occur as the respiratory drive waxes and wanes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193835/ If this is not in your wheelhouse, you need to know that respiratory drive, the urge to breathe, is strongly related to the amount of CO2 in your bloodstream. As CO2 rises, so does the urge to breathe, and similarly, as CO2 is purged from the bloodstream by higher ventilation rates, the urge to breathe is diminished or absent. A feedback loop can develop where you experience a low respiration rate or apnea that triggers the urge to breathe deeper and faster, then as CO2 drops as a result, respiration becomes shallower and slower. This gives a wave-like appearance to the flow rate that we sometimes call periodic breathing or an apneic breathing pattern. This is distinguished from obstructive sleep apnea by the lack of flow limitation and the oscillating flow rate that arises out of response to CO2. In more severe forms this can be punctuated by a central apnea, or clusters of central apnea. There is s considerable difference in sensitivity to this fluctuating CO2 between individuals, with some of us able to tolerate high ventilation rates and pressure support without significant respiratory drive suppression, and others like you having therapy onset centrals with relatively low pressure and pressure support. The fact your doctor does not understand this fundamental respiratory drive and attributes it to a false data signal shows he is unqualified to treat your central or complex apnea. You will not change him or educate him. You need to find a doctor that understands this condition.