Treatment-Emergent Central Sleep Apnea
About 10 months ago, I took an at-home sleep test after finally choosing to see someone about my snoring problem. I thought perhaps I just needed my abnormally long uvula trimmed down, but my ENT doc didn't want to do anything about it until I took a sleep test. I met with sleep doctor at a sleep clinic and got the at-home test. The at-home sleep test revealed that I had obstructive sleep apnea with an AHI of 19.0. AI was 5.0 and HI was 14.0.
My sleep doctor told me that I didn't have any mixed apneas, but now I'm looking at the test results right now and it says I had a few central apneas, but they took place separately from the obstructives. Central apnea was never discussed or diagnosed.
I started treatment with an APAP in December of 2018. At first it didn't help and my AHI was higher than 19.0. I eventually did a titration study in an overnight lab after a month of PAP therapy, where the pressures were settled at a better setting. After that things improved slightly, but it was noticed on follow up appointments that I had barely any obstructive apneas—around .8-2.0 per hour, but my central apneas had increased to between 10-15 per hour every night. It seemed I had traded obstructive apneas for central apneas. My doctor told me that some patients develop central sleep apnea after starting PAP treatment. Damn, this sucks. He didn't really have any solutions other than to continue and hope things improved or resolved. They didn't.
After some sleuthing online, I found these forums and the reddit sub on sleep apnea. I read that adjusting EPR down could help, so I did so. Wow! My centrals dropped down to below 5 almost every night with AHI around 1 or 2 per hour. My doctor never told me about this setting. When I followed up with him, he seemed to not know about this phenomenon. I dropped centrals from 15 to below 5 with this and he didn't know about the EPR settings having anything to do with helping someone in my situation. I now know that I have "Treatment-Emergent Central Sleep Apnea." I spent most of this summer with AHI totaling anywhere between 3.0 and 8.0
After this appointment, my sleep doc wanted to set up another titration study with a BPAP in an attempt to see if this could help. The study was a success! I had zero (0) central apneas and only 3 obstructives at a non-ideal pressure setting. I used a full face mask for the study, while I normally use just a nasal cushion at home. I was so happy. A follow up appt with my sleep doc had him ordering the Resmed AirCurve 10 VAuto. I was sure this was my cure.
I got the new BPAP machine (the AirCurve) one week ago. They did not approve the full face mask, so I'm still using my nasal cushion, which I like. They set up the pressure at 12 IPAP and 8 EPAP and recommended PS at 4, which were the recommendations from the sleep study. The results were garbage. My AHI was through the roof anywhere from 20 to 16. Centrals were taking up the bulk of these apneas. I then read about the "PS" settings on the BPAP machine and it seemed like they are similar to EPR, but I still don't quite know what PS does. Again, my doctors told me nothing about PS settings and had the machine set to PS level 3 when I got it despite the sleep study recommendation calling for PS level 4. I moved it down to 3 after a few nights and saw no improvement. Last night I moved it to 2 and saw modest improvement with AHI at 11.8, centrals at 10.9 and AI at 10.4.
So, here I am basically after 10 months of therapy and really no real, sustainable solution to my Sleep Apnea problem. I have adjusted the PS level down to 1 and hope tonight will be better. Maybe I need to give the BPAP time to adjust to my patterns. Maybe I need to push for a full face mask like I did in the successful sleep study. What about an ASV machine? Would this help? If none of this works, I may just give up on PAP therapy.
I am overweight, but have lost over 10 pounds in the last three weeks and am dieting and exercising again. I may just pursue this route and try to get skinny again like I used to be. Maybe work on developing my throat muscles with a didgeridoo. What about a jaw device? I guess there's that surgery option too. Might be time to get rid of the long uvula after all.
Any suggestions are open for me. This is my first post and this seems like a great community. Thanks in advance for all your help.
~GiantCat
My sleep doctor told me that I didn't have any mixed apneas, but now I'm looking at the test results right now and it says I had a few central apneas, but they took place separately from the obstructives. Central apnea was never discussed or diagnosed.
I started treatment with an APAP in December of 2018. At first it didn't help and my AHI was higher than 19.0. I eventually did a titration study in an overnight lab after a month of PAP therapy, where the pressures were settled at a better setting. After that things improved slightly, but it was noticed on follow up appointments that I had barely any obstructive apneas—around .8-2.0 per hour, but my central apneas had increased to between 10-15 per hour every night. It seemed I had traded obstructive apneas for central apneas. My doctor told me that some patients develop central sleep apnea after starting PAP treatment. Damn, this sucks. He didn't really have any solutions other than to continue and hope things improved or resolved. They didn't.
After some sleuthing online, I found these forums and the reddit sub on sleep apnea. I read that adjusting EPR down could help, so I did so. Wow! My centrals dropped down to below 5 almost every night with AHI around 1 or 2 per hour. My doctor never told me about this setting. When I followed up with him, he seemed to not know about this phenomenon. I dropped centrals from 15 to below 5 with this and he didn't know about the EPR settings having anything to do with helping someone in my situation. I now know that I have "Treatment-Emergent Central Sleep Apnea." I spent most of this summer with AHI totaling anywhere between 3.0 and 8.0
After this appointment, my sleep doc wanted to set up another titration study with a BPAP in an attempt to see if this could help. The study was a success! I had zero (0) central apneas and only 3 obstructives at a non-ideal pressure setting. I used a full face mask for the study, while I normally use just a nasal cushion at home. I was so happy. A follow up appt with my sleep doc had him ordering the Resmed AirCurve 10 VAuto. I was sure this was my cure.
I got the new BPAP machine (the AirCurve) one week ago. They did not approve the full face mask, so I'm still using my nasal cushion, which I like. They set up the pressure at 12 IPAP and 8 EPAP and recommended PS at 4, which were the recommendations from the sleep study. The results were garbage. My AHI was through the roof anywhere from 20 to 16. Centrals were taking up the bulk of these apneas. I then read about the "PS" settings on the BPAP machine and it seemed like they are similar to EPR, but I still don't quite know what PS does. Again, my doctors told me nothing about PS settings and had the machine set to PS level 3 when I got it despite the sleep study recommendation calling for PS level 4. I moved it down to 3 after a few nights and saw no improvement. Last night I moved it to 2 and saw modest improvement with AHI at 11.8, centrals at 10.9 and AI at 10.4.
So, here I am basically after 10 months of therapy and really no real, sustainable solution to my Sleep Apnea problem. I have adjusted the PS level down to 1 and hope tonight will be better. Maybe I need to give the BPAP time to adjust to my patterns. Maybe I need to push for a full face mask like I did in the successful sleep study. What about an ASV machine? Would this help? If none of this works, I may just give up on PAP therapy.
I am overweight, but have lost over 10 pounds in the last three weeks and am dieting and exercising again. I may just pursue this route and try to get skinny again like I used to be. Maybe work on developing my throat muscles with a didgeridoo. What about a jaw device? I guess there's that surgery option too. Might be time to get rid of the long uvula after all.
Any suggestions are open for me. This is my first post and this seems like a great community. Thanks in advance for all your help.
~GiantCat
