[Treatment] Questioning my Doctor's Attitude

[Lukie]

I found that when I wear a full face mask like the quattro fx I get a lot more centrals. When I wear my nasal mask either the nano or the eson I often get very low AHIs with very few apneas. I wore the epson a few nights ago with a ruby red chin strap and had an AHI of 0.0.

[nunanie]

Hello and welcome. Many others will also show up in the next few hours. I will first say that not all sleep docs are created equal. As in many issues, some are better than others. Many will see you without a new sleep study if you will get them the records from the first one. That said, most of us believe that no one will care about your health as much as you, yourself.

My OSA was very bad (well, still is, but controlled) - and an AHI of 10 or less is a win in my book. I have also added a recording Oximeter, so I can see how badly I am desating at night. I am pleased when I can keep it to 10 minutes or less under 88% (most all people bounce around 90-94% at night, it's the time under 88% that can be bad. I do not get headaches in the morning any longer, which is a plus.

Your nights will vary. So the key is to look at 'averages', weekly, or monthly - never just one night to the next. Stress, when you last ate, any booze, your meds, all these things will change your AHI. It will bounce.

The key is to see what is 'normal' for you (over many weeks/months), and then see what, if anything you can do to improve it at all - sometimes it is what it is, and that's as good as it'll get - but you won't know if you don't try.

The key areas to watch are leak rate!!! And AHI. A high (or higher) leak rate will skew the numbers all over the place. Yes, raising pressure *can* cause centrals - but in that case they will usually go down with time - as your body gets used to the pressure.

Welcome~! There is a lot of great info all over the place here, try the new cherry kool-aid, very tasty

thanks for your suggestions about monitoring over a few weeks instead of daily. I had one overnight study with an oximeter and it showed 92.5% at 90% and 7.5% at 89% - the doctor seems satisfied with the results and again told me it was all in "how I felt". Fine Science at work !!

[nunanie]

Centrals seem to rule the night - but I was told that by raising my pressure to 11. that *I* have created them.

HI nunanie
If raising the pressure is the cause of central apnea than why not lowering it or even raising it in the first place
Sometimes there is trade off, pressure high enough to deal with obstructive apnea and low enough not causing central apnea, its a bit tricky to accomplish with fixed pressure machine. For this reason, I like my autoset, the autoset raise pressure in response to flow limitation (which proceed obstructive apnea, not central apnea) and obstructive apnea but does not raise pressure if central apnea detected ... best of both world providing the set pressures are optimal

I brought up the topic of Central Apnea's a few weeks ago with the sleep dr and apparently they showed up on my original sleep study. The CA's didn't seem to increase with raising the pressure from 9 to 11. In August I asked for a prescription (for travel purposes) and instead I was told to do a vpap study for 10 days. (still don't have an up to date prescription) That's where it showed that my average pressure should have been at 12.3 (not the 9 at the time). Because I was not hearing anything more from the clinic, I raised it part way - to 11.0 - at which time I was sleeping better and generally felt rested in the morning.

I didn't mention this on my original post (it was already getting long) I was sent for a Sleep Study because after surgery for a Spinal Fusion (May 2013) I spent 6 hours in the recovery room - I would just forget to breath. The staff would come over and bump the stretcher so I'd start to breath again and my O2Sats were in the mid 80's most of the time I was told, so the CA and Cheyenne Stokes Breathing was already apparent before the sleep study - that was why I was sent in the first place.

As for lowering the pressure - I have tried that twice since September for about a week the first time and the second time for 5 days. Both times I felt like I had been driven over by a transport in the morning and I was not functioning well during the day. Raising it back to 11 seemed to take that awful feeling away. Dr. seemed alright with leaving it at 11.0 - "it all depends on how you feel". Like I said in a previous post - fine science at work !!

Thanks for your help - any bits of information is helpful in getting this all figured out.

[drgrimes]

Nunanie, first of all you are not alone. My sleep doctor has offered little advice or help along the way. My DME guys have been much more help. From the data you have mentioned, it does sound like you are doing pretty well.

One thing you don't mention is leak rates. When you up your pressure, you are much more likely to increase leakage. You indicate a full face mask, so I can't help but suspect that some of your Centrals are being caused by leakage. They go hand in hand, at least mine did. You might talk to your DME about trying nasal pillows. That solved almost all of my problems. Be patient, give it some more time, and include some of your leak data on this forum.

[nunanie]

I found that when I wear a full face mask like the quattro fx I get a lot more centrals. When I wear my nasal mask either the nano or the eson I often get very low AHIs with very few apneas. I wore the epson a few nights ago with a ruby red chin strap and had an AHI of 0.0.

At my second sleep study, I was given a nasal mask but my nose gets too stuffed up to be able to use them. After an hour of struggling with it the lab tech put a full face Quatrro FX on instead and I was finally able to go to sleep.

Ruby red - nice!! In style ,even when you're sleeping.

[nunanie]

Nunanie, first of all you are not alone. My sleep doctor has offered little advice or help along the way. My DME guys have been much more help. From the data you have mentioned, it does sound like you are doing pretty well.

One thing you don't mention is leak rates. When you up your pressure, you are much more likely to increase leakage. You indicate a full face mask, so I can't help but suspect that some of your Centrals are being caused by leakage. They go hand in hand, at least mine did. You might talk to your DME about trying nasal pillows. That solved almost all of my problems. Be patient, give it some more time, and include some of your leak data on this forum.

I'm still new on using this "board". When I figure out how to get a snapshot of my data, I'll post it. I did have high leaks a couple of weeks ago but a new mask has settled those down.

[me50]

thanks for your suggestions about monitoring over a few weeks instead of daily. I had one overnight study with an oximeter and it showed 92.5% at 90% and 7.5% at 89% - the doctor seems satisfied with the results and again told me it was all in "how I felt". Fine Science at work !!

FYI: you want to download your info at least every 3 days so you don't loose detailed data (or download 2 times per week).

Yea, not good to make changes daily as that isn't enough time to see a trend or what might be happening.

[WakeUpTime]

I was sent for a Sleep Study because after surgery for a Spinal Fusion (May 2013) I spent 6 hours in the recovery room - I would just forget to breath. The staff would come over and bump the stretcher so I'd start to breath again and my O2Sats were in the mid 80's most of the time I was told, so the CA and Cheyenne Stokes Breathing was already apparent before the sleep study - that was why I was sent in the first place.

I just read your story and it felt so familiar. I was in the emergency department a few weeks before going on CPAP due to heart problems (now I know that it was because of severe sleep apnea). My hospital breathing monitor kept alarming every 10 minutes. The nurse would come in and click something on the monitor and leave. After doing this several times, she finally said to me: "Would you remember to breathe!" This was just before getting the results of my sleep study.

Fast forward a bunch of months and my centrals are still persistent, but relatively low (5 per hour) and of short durations. Everybody says it's probably just temporary and may just go away as I get to the right pressures.

You also mentioned CA events and Cheyenne Stokes. Why didn't you go on a BiPAP-SV machine instead of a fixed pressure (with relief EPR) machine? I too have those periods, even during the day, where I just, well, stop breathing for a bit. Ironically, my 1st and 2nd sleep study (2nd with machine) didn't show large central event issues, mainly OA. So, that doc doesn't feel an SV machine is needed. But I still can't help but wonder, "it seemed to be a big issue for an emergency room nurse".

I'm also really curious how you're making out these days.

[Peter_C]

I just read your story and it felt so familiar. I was in the emergency department a few weeks before going on CPAP due to heart problems (now I know that it was because of severe sleep apnea). My hospital breathing monitor kept alarming every 10 minutes. The nurse would come in and click something on the monitor and leave. After doing this several times, she finally said to me: "Would you remember to breathe!" This was just before getting the results of my sleep study.

This was happening to me after my last surgery (hip replacement), in the recovery room. They had me on O2 (nose tube), and of course I am still out of it, and I told the nurse she needed to turn it up higher - she wouldn't So finally I woke up enough to take it out of my nose, and then stuck it in my mouth - she complained til I pointed out the alarm stopped going off

What can I say? Once a mouth breather...