Should I see a neurologist? slightly freaking out

[Mistralwind]

Hey there,
I got diagnosed with OSA in my early twenties but I found out that I now have severe central sleep apnea.  

I did a sleep study to find out what pressure my bipap needs to be set at- things seem to be ok.  Finally getting under 10 an hour.  However, the doc said the results were very abnormal. I got no Rem sleep, 70+ spontaneous arousals, and stayed an abnormally high amount of time in stage 3 sleep. 

I’m really worried that this is an early sign of some neurological disease like Parkinson’s. Sleep problems seem to common in everything from Parkinson’s to brain tumors.

The CSA is hereditary- have a parent with it but this was a very unusual sleep study results. 

When I was having 30+ episodes an hour, I would get vertigo and aching legs in the morning and evening. Doesn’t seem to be as bad now.

Thoughts?? Does this sound bad?

[Crimson Nape]

Hi and welcome to the forum.  Without data, it is very difficult to provide any answers.  Depending on you Resmed model (S9 or newer and above the basic model), it is likely you can provide your sleep data for our members to review.  Please download OSCAR (the link is in the name), a free software for data analysis.  In addition to OSCAR, you will need an SD card that is 2Gb to 32Gb in size.  If you don't have one, the SD card can be purchased at most big box stores, pharmacies, and online.

[Sleeprider]

We have many members with central sleep apnea and complex apnea. It's fortunate you are learning about it now. Most of the time you will be evaluated for what might be causing the central events, and there are a number of possibilities, including opiate use and neurological problems; however the vast majority of people simply have "idiopathic" central apnea. To help you understand this, we need to know more information. Do you currently CPAP or bilevel? What settings? Central apnea can result from a chemical imbalance where the bicarbonate (PCO3) in blood is low, known as alkalosis. This reduces respiratory drove. This can be caused by use of CPAP or bilevel with pressure support that reduces the amount of CO2 in your respiration (hypocapnia). So there are many reasons central evens might be happening, and you should not push the panic button about a neuro disorder at this point.lo

Treatment of CA is with an adaptive servo ventilator (ASV) a common form of bilevel machine many on this forum use. It simply maintains your breathing rate and volume by using as much pressure support as needed to normalize your breathing volume on a breath by breath basis. When you spontaneously breathe, it stands aside and acts like a low-pressure CPAP, but when you need it, the machine increase pressure during inspiration, and lowers pressure during expiration. This is a non-invasive ventilation therapy.

[Mistralwind]

We have many members with central sleep apnea and complex apnea. It's fortunate you are learning about it now. Most of the time you will be evaluated for what might be causing the central events, and there are a number of possibilities, including opiate use and neurological problems; however the vast majority of people simply have "idiopathic" central apnea. To help you understand this, we need to know more information. Do you currently CPAP or bilevel? What settings? Central apnea can result from a chemical imbalance where the bicarbonate (PCO3) in blood is low, known as alkalosis. This reduces respiratory drove. This can be caused by use of CPAP or bilevel with pressure support that reduces the amount of CO2 in your respiration (hypocapnia). So there are many reasons central evens might be happening, and you should not push the panic button about a neuro disorder at this point.lo

Treatment of CA is with an adaptive servo ventilator (ASV) a common form of bilevel machine many on this forum use. It simply maintains your breathing rate and volume by using as much pressure support as needed to normalize your breathing volume on a breath by breath basis. When you spontaneously breathe, it stands aside and acts like a low-pressure CPAP, but when you need it, the machine increase pressure during inspiration, and lowers pressure during expiration. This is a non-invasive ventilation therapy.

Thank you for the response! Here is some additional info based on last 30 days looking at my sleep report:
On a resmed aircurve 10 bipap
100% compliance
Pressure: 14.0
Exp pressure:8.7
Leak: 1 L per min
Vt: 460 ml
Rr: 9
Mv: 4.6 L/min
Ti: 1.4 s
I: 1:3.1
Spont cyc: 93%
Ahi: 13.4
Total ai: 13.1
Central ai: 12.4

Note they just changed the pressure a week ago. My doc said that the past week my ahi has been like 7

I’m waiting for the doc to send my sleep support to me soon.

[Sleeprider]

If I could talk you into downloading and using the free OSCAR software, you will get much more detailed reports. We would prefer that you post some Daily Details charts. My signature shows how to Organize your OSCAR charts and how to Attach an Image. It appears you are using an Aircurve 10 VPAP S or Vauto bilevel, with EPAP 8.7, IPAP 14.0 which is not possible since settings are in 0.2 increments. I suspect you are reporting median actual IPAP and EPAP as reported in MyAir or Resscan. If you post some charts from OSCAR, I suspect we could mitigate your central problems pretty quickly. CAI is nearly always made worse on the Vauto with higher pressure and/or higher pressure support. Put simply, you are using the wrong tool for the job, and it may actually be making your central apnea worse. In other words, it's not your health or neurological issues, it is the machine causing CA by providing pressure support (separate inhale and exhale pressure) without a backup that can trigger an inspiration. You may have started on CPAP, and your doctor issued this bielvel, and now your central apnea is out of control. This is a predictable progression, not your fault, and is easily solved.

You would immediately realize an AHI near zero with a Resmed Aircurve 10 ASV set to EPAP min 5.0, EPAP max 15.0, PS min 3.0, PS max 15.0, and we would fine-tune that setting. Your priority is not to worry about your central apnea, but to demand an ASV titration from your doctor. Even though the ASV is completely automatic, a titration is going to be required to get coverage. That will fully resolve this problem.

Your problem with central apnea is extremely common and has a simple solution. It has nothing to do with Parkinsons or a neurological issue. I am 100% certain you are in good health, have near normal weight and are really surprised you have apnea at all. You may live at high altitude which would also be a risk factor. Literally hundreds of members here have dealt with this. As soon as you start using ASV, your problem will be solved.

[kappa]

Do you have RLS and/or PLMS? Given the reported "aching legs" this might be a factor at play. Did you have a sleep study that monitored your leg movements? RLS is often hereditary too...

[Gideon]

What Sleeprider said above.  Like him I tend not to jump in when you are getting excellent advice.  
I was going to respond to one of your first posts here but when I got my rebuilt it had already been answered.
My response was going to be something like "Based in the info you have provided I strongly suspect that you have the wrong machine.  You likely will need an ASV.  Here on AB we tend to give better advice when we see OSCAR daily charts.  frequently we get a response like ' That was quick, you got all that from a screenshot?'"

There are many here that are very good at reading these charts. We frequently see issues that were not even discussed.  Please download OSCAR and post your charts.

[SarcasticDave94]

Not trying to be broken record like from that of others, but show us the OSCAR data and we'd tell if the ResMed AirCurve 10 ASV will be needed or not. It would not hurt a bit for you to get your detailed sleep study and/or titration results. These reports can be scanned into your PC and turned into attachment files for us to see this info too. Just remember to redact the personal stuff first. In the US, HIPAA states you the patient are allowed to request and receive these reports; no from the doc on this request isn't accepted. It appears thus far that an ASV is needed, but without data it's just a guess from some guy somewhere on the internet.

[34south]

Hey there,
I got diagnosed with OSA in my early twenties but I found out that I now have severe central sleep apnea.  

I did a sleep study to find out what pressure my bipap needs to be set at- things seem to be ok.  Finally getting under 10 an hour.  However, the doc said the results were very abnormal. I got no Rem sleep, 70+ spontaneous arousals, and stayed an abnormally high amount of time in stage 3 sleep. 

I’m really worried that this is an early sign of some neurological disease like Parkinson’s. Sleep problems seem to common in everything from Parkinson’s to brain tumors.

The CSA is hereditary- have a parent with it but this was a very unusual sleep study results. 

When I was having 30+ episodes an hour, I would get vertigo and aching legs in the morning and evening. Doesn’t seem to be as bad now.

Thoughts?? Does this sound bad?

I've only recently been diagnosed with OSA but, as a long-term (40 years) type 1 diabetic, also have peripheral and, it's been suggested, autonomic neuropathy.
My first two weeks on a CPAP have not yet mitigated my rapid onset, debilitating daytime fatigue which occurs daily - in fact, I have been plagued with the problem for fourteen years.

It was my rheumatologist who originally diagnosed me with ME/CFS (which I do not fully believe) and who recommended the sleep apnoea test which revealed 30.1 APIs/Hr. Whether this was caused by the discomfort I feel in my feet and legs is uncertain, but the CPAP has reduced my API count to an amazing 2 per hour and yet, as I have said, I continue to experience the daytime fatigue and discomfort. BTW, I am not obese and religiously go for a brisk hour long walk every evening. I do suffer from persistent myalgia and post-exertional malaise and the beginnings of arthritis and have had exhaustive tests done over many years, including for Hasimoto's thyroiditis, but the sleep apnoea is the only diagnosis that proved positive.

I do realise that this is hardly answering your question, but my CPAP has detected some central apnoea events and I was intrigued by your saying that you suffer from vertigo and aching legs. I have both, and the question is whether that was due to the apnoea or to diabetic neuropathy? The vertigo occurs very infrequently but always while I have been driving, which is of special concern although I have always pulled over. It also occurred if I had been reading in bed and then reclined fully.

I have found that when I am close to my next vitamin B12 shot - I am severely B12 deficient - the pain is especially acute, but is largely mitigated a day or two thereafter. B12 assists in nerve repair and it may be worthwhile checking your levels.

My deep sleep duration has improved slightly on the CPAP but, for years I have not had dreams, even now, suggesting lack of REM sleep. I was put briefly on low dose yelate to improve my sleep quality and I did recommence being able to dream, but had great difficulty waking in the mornings so discontinued taking it.

Of course, I'm not suggesting you are diabetic. However, the similarity in symptoms makes me wonder whether my neuropathy may be more related to my long-term undiagnosed and untreated sleep apnoea rather than my being diabetic.