[Treatment] Complex Sleep Apnea Questions

[bh1332]

Hi folks,

First time posting, but I have read many posts on this thread since being diagnosed with OSA a few months ago. It is a wonderful resource, so i appreciate the info that is provided. I thought I’d see if some of the experts can point me in the right direction for my next step in therapy. A bit about me:
Healthy 41 year old male. Active lifestyle at 6’-4” and 200 lbs. (took over 2 years for my neurologist to diagnose me with OSA because of that). From what I’ve been told by multiple doctors, I just don’t fit the bill for sleep apnea. Did an at-home sleep study first that confirmed it was the problem (and why I have felt bad for a half dozen years or so). Baseline AHI was in the mid 20’s, so moderate OSA. They put me on APAP first from 5-15 cm pressure, and it didn’t work. Resmed’s algorithms aren’t there yet in my opinion. Did an in-lab sleep study for cpap titration, and they said I needed a pressure of 12 cm. Went to CPAP at 12 cm, and it was horrible. It caused central sleep apnea for me, and it was so difficult to even function throughout the day (or run/exercise for sure). Did a third sleep study, this time an in-lab bipap titration. Doc moved me to bipap at 8 cm and 12 cm pressure. It has worked better fo me, as I do feel better than I did on CPAP. Been on bipap for almost a month now. AHI is still 17 for the last 30 days. Thanks to info on this site, I do use OSCAR and have found that my obstructive AHI is typically at 1.0 or less, but the clear airway obstructions are what makes up the remainder of it. I have not scheduled a follow-up yet, but I am wondering what my next steps should be. Respiratory therapist told me I did not have central sleep apnea during my bipap titration, so i did not need ASV. I am just wondering if I should request an ASV machine to try it out or if the centrals will improve over time. Thoughts?

[SarcasticDave94]

Welcome to Apnea Board,

Well let's start at the beginning. Did you request your detailed sleep study results of any of these tests? If not, you need to put that request in ASAP.

Two things, you need them for your personal health file. And you can post the redacted of your personal info version here. The most important info is the event table naming event type and count, then the doctor's recommendation and other notes.

You need to pin down if those Central Apnea were actually not an issue. I myself started off just taking the doctor's say and not getting the report. Mine was very wrong, telling me I only had Obstructive Apnea at 24 events per about 8 hours. Doc blatantly dismissed 124 Central Apnea.

Your case might be like this, with CA in the mix. It might not be either, and you're just dealing with treatment emergent Central Apnea. However we don't know this right now.

OSCAR charts show what?

[bh1332]

[attachment=70969][attachment=70970][attachment=70970][attachment=70970][attachment=70970]
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Thanks for the quick reply SarcasticDave94. I have gathered the info you mentioned (I already had it), and you may be correct. The "Snap" study (first at-home sleep study) showed central/mixed apneas of 15. I am limited in how many attachments I can do to one post, so forgive me for the multiple replies showing all the info you mentioned. Thanks! Thoughts are greatly appreciated.
[attachment=70970][attachment=70968][attachment=70969]

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Trying to figure out the attachments...... .
           

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More attachments.            

[bh1332]

OSCAR data    

[SarcasticDave94]

OK thanks. No need to redo this tonight, however you can attach OSCAR charts as attachments. Best is daily details within OSCAR. I'll link a wiki to assist on this.

I'm not saying you have a big Central Apnea issue, however they were on the test results you posted. 24 Obstructive to 15 Central Apnea. Not quite ASV necessity, with it not being a 50/50 split. But it's not that there's no CA either. The diagnosis more likely should be mixed Apnea not straight OSA.

Take a look at the link on OSCAR chart attachments.

https://www.apneaboard.com/wiki/index.ph...pnea_Board

[bh1332]

           
Thanks for the reply and link. I attached a daily snapshot for October 19th from the OSCAR daily view. Thanks for all your help and thoughts! I need it with my AHI still around 20 every night and finding doctors that know what they're doing being so difficult.

[SarcasticDave94]

In any of your tests, was there a Titration test to determine pressures they think may work? By the way, typically their guess will still be off.

Regardless if one was done, you'll need to do a few things. One, thinking of your doctors, which would order a Titration including ASV? Second, you'll want to research which doctor knows how to treat Central Apnea, and become their patient. Next, you probably are in need of ASV. Also, consider the fire and replace of the RT that's not treating your CA.

Despite what I said about the 15 CA, there's a nasty habit Central Apnea possess. They are always consistently inconsistent. This means the Central Apnea will be up, down, absent for no reason, then reappear suddenly. This also means your test with 15 CA on night X might be 35 CA the next night.

[bh1332]

Yes, I have had two titration tests done in the last few months (one CPAP and one bipap titration). On the second titration study, which was the bipap one, I mentioned ASV to the RT before it began. She said they go through a process through the night and if I do good on bipap, then ASV is not done because it's done after bipap and at the end of the sleep cycle. After the sleep study that night, she said I did good on bipap and do not need ASV. But, she didn't know of my original sleep study showing I had central sleep apnea too 23% of the time. Heck, I missed that too and just caught it this past weekend as I have been researching it myself. It's been so frustrating dealing with all this and trying to get the right treatment. 

The obstruction is being treated, as it's consistently below 1 every night. I just messaged my doc to point out that the original at home sleep study showed I had central sleep apnea events 23% of the time and asked him to prescribe an ASV machine. I also made an appointment with another doc (pulmonologist), but can't get in until over a month. We will see how it goes getting an ASV from the first and I'll fire and replace if not and move on to the second one. Rural healthcare through, so it's tough finding good treatment.

I sincerely want to thank you for the valuable insight and information. Sleep apnea has been debilitating for me for a few years now that has affected my entire life and family. I just began treatment a few months ago due to the diagnosis and I am feeling better than I was, but just not where I need to be yet in what appears to be centrals left to treat. So, a heartfelt thank you!

[SarcasticDave94]

You're welcome.

As I used ASV myself for 2 years, I'm well aware of the uphill battle to get it. If you make progress on getting ASV, they'll likely require you to get an echocardiogram to clear you from a flawed study that indicated people with heart failure and ASV don't mix.

This may still be in place as a requirement. The echocardiogram is fairly simple. Once ordered, typically you'll go to a local hospital's imaging department. They'll perform the test and hand it off to a cardiologist for review and sign off.

If you have the money, you may decide to buy an ASV by yourself from places like DotMed. You'll have to search that.

[bh1332]

SarcasticDave,

You mentioned you used ASV for two years. Do you no longer use it? Just curious if there is another option for me available. I have looked into INSPIRE, but that will not do anything for central sleep apnea and will only treat my obstruction.