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Correct Dx and correct machine - Bedlag - 10-03-2021
Hello! A newbie here and am hoping I can get some clarification.
I was prescribed CPAP in 2002 for mild apnea based on a sleep study. I never adjusted to the masks and would only haul the machine out during particularly stressful sleep periods, only to fail again, and struggle on. About 3 months ago my sleep pattern took a significant dive and I was more motivated to make the CPAP work. I had been experiencing sudden awakenings with headache, pulse rushing in my head, burning in my lower legs, preceded by a nightmare, which had previously been rare for me. My O2 sat monitor would register into the high 80s if checked immediately upon awakening. My heartrate trended into the 40s immediately before sleep. (I am 74 and NOT in-shape.) I was afraid to go to sleep!
The CPAP I am using is a RESMED S7, with no data card. With more motivation I was more successful in longer sleep intervals but again would experience these frightening episodes, although much less frequently. Random checks of O2 and HR remained unchanged. ( My PMD said no concern with HR if I was not dizzy. As I was lying down, not sure as to that assessment.)
I requested another sleep study which was completed 2 weeks ago. I was not given a copy of it and am requesting a copy. Prior to the test, my question and concern expressed to the CNP and acknowledged by the MD results letter was whether I had a central component as I've previously been diagnosed with some autonomic symptoms of unknown etiology. Last week I received a call from the RN in the sleep department who said I still had mild sleep apnea, she would refer me for a new machine with data capability but did not address the central aspect. Our phone connection was bad and the conversation poor. I said I would search for a machine online, to avoid their DME, and let her know where to send RX. With further research, I am not comfortable with knowing what my needs are. I don't want to buy a machine and then learn it doesn't work for me.
Here is the limited info I have from my study:
Total recording time 493, total sleep time 256.
Appropriate sleep latency but REM latency long at 418, 4% REM sleep, 8% slow wave sleep.
Average HR 56, max of 83. No ectopy.
Periodic leg movement index at 42
AHI 6.3 at 4%, AHI 9.1 at 3%. Low sat during night was 85%. Events much more common in REM sleep.
In addition, a fairly marked elevation in RDI of 17/hr.
My specific questions, is there anything here to suggest central sleep apnea? Does the RDI number have any relation to central apnea? If episodes occur in REM sleep, is there enough time to truly evaluate my sleep? Do I need raw data to get any information from this study? I will contact the CNP again with these questions but would appreciate any reactions from board members.
Thank you for any insight you may share.
RE: Correct Dx and correct machine - Geer1 - 10-03-2021
All you will qualify for prescription wise is a basic CPAP/APAP machine. You need to fail treatment with such a machine before a more capable machine will be considered. The recommended machine would be a Resmed Autoset APAP. If somehow you can get lucky and get a prescription for a Resmed Vauto that would be the next level of machine up and can do everything the autoset can do and more but as mentioned it is unlikely you will qualify for prescription or insurance for such a machine and most people end up buying them out of pocket privately because they can't get a prescription.
There is no evidence of central apnea being an issue and the machine used to treat central apnea lacks some functionality making it less ideal for obstructive apnea. You are better to start out with a more basic machine capable of data collection then you can view your data to see if machine seems to be treating breathing issues or if you need a machine for central apnea.
RE: Correct Dx and correct machine - clownbell - 10-03-2021
While not an expert, it is my understanding that there is a decision tree to be followed. First at-bat is a CPAP/APAP machine. If that machine fails to cure the patient's problem, then the second at-bat is a higher level machine -- and so on. You can't skip to second base without passing first base.
If you have a chance to rent rather than buy, renting could have the advantage of enabling you to return the machine for the upgrade if required. Owning would probably not give you that flexibility.
May I recommend that when you get your sleep study, redact your name and post it here. That will help the experts give you some guidance.