[Treatment] Cental Apnea - Newly Diagnosed

[Direction4]

Hello.

I have recently taken a home sleep test and been diagnosed with Central Sleep Apnea. I am 54 y.o. and have no history of heart attack or stroke. The people at the sleep center prescribed a Madibular Advancement Device. According to research I did on the internet, a MAD will not help with my CSA. Should I get a second opinion?

Thank you very much.

[srlevine1]

You do not indicate what symptoms drove you to seek a sleep test or how severe they might be.

By all means, if your insurance will cover the expense, seek a second opinion, preferably from a qualified sleep doctor unaffiliated with the group that performed the first test.

CPAP is the gold standard for treating Apneas -- and you may have to trial a CPAP before moving on to an advanced machine such as a bi-Pap or ASV to deal with CAs. Some doctors believe that MADs are useful for improving symptoms but not for completely controlling sleep apnea.

One option is a three-month trial (rental) of a data-capable device, if your insurance approves, to see improvement in how you feel. Something to consider.

I am sure other forum members will weigh in with some solid advice.

Best of luck.

-- Steve

[Direction4]

I never wake up refreshed and I am drowsy most of the day. I don't think I snore (I live alone). 
Maybe I can take an in hospital sleep test.

Thank you.

[srlevine1]

You might also consider a full, complex, medical workup to rule out other factors like thyroid, blood-carrying oxygen capacity, night-time oxygen desaturation, etc. Also experimenting with sleeping positions. eenvironmental factors like ambient blue light, etc.

[Gideon]

Welcome to the forum.

I don't think a MAD device will do much for you other than empty your savings account.

the question now becomes do you have anything else going on? Any Cardio-pulmonary issues, COPD, Asthma, Neuro Muscular issues, Brain Injury, Stroke, seizures, Pain Meds especially opioids, anything else you can think of.

[Sleeprider]

A MAD device simply alleviates obstruction caused by upper airway tissues blocking your airway and has not effect on central apnea. You will likely need an Adaptive Servo Ventilator (ASV) which is intended to treat central apnea by maintaining your normal respiration rate and volume, even when you don't initiate the spontaneous effort to breathe. The ASV does this by adding pressure support when needed and as much as needed to maintain the normal respiration rate and volume. Your sleep tests suggests that your sleep disordered breathing is a "mild" case, and it may be something that is easier to live with than to pursue treatment.

Typically, patients in the US with CSA are dispensed CPAP. While CPAP is not really intended to treat central apnea, many users do get enough improvement to be considered "treated". With that, a less expensive device is deemed good enough, and it ends there. In some cases, CPAP does not resolve the underlying fatigue, brain fog and sleepiness, and the pursuit of better therapy depends on the determination of the patient to get good results. It's not easy to move up to ASV, so it really depends on how affected you are by all this. Your reply to srlevine1 tells us, you probably need treatment. I would suggest you push for CPAP (Resmed Airsense 10 or 11 Autoset) and that way you will get good therapy and be able to see the results in data, which you certainly can't do with a MAD which is actually more expensive, and not a comfortable solution as it can result in TMJ.

Not sure your best course to get CPAP, but mention it to your current provider and let them know you'll want a referral if they cannot provide it. I have never seen anyone go directly from a first diagnostic test to ASV without this jump, so give it a go.

[Direction4]

Thank you. I will follow up with a sleep doctor.

--Ben

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Thank you.