After reviewing where I am with my insurance deductible and max out of pocket amounts, there isn’t much difference between buying an APAP and getting another sleep study completed. Basically, an APAP will put me into my max out of pocket range (scary, as it’s around 6k), though I can’t really return the machine without paying a substantial fee. I’ve opted to just get the titration study done and be through with it. Hopefully the centrals are mostly about sleep transition and not something more sinister. The doctor didn’t seem too worried about the central aspect as I’m an otherwise healthy and active person.
So I finally had my appointment with the sleep doc. It was a bit rushed an not as informative as I’d have liked.
Anyway, he basically wanted me to get another sleep study/titration. Didn’t have a firm opinion on positional therapy other than just leaving that up to me. This seemed odd to me as my ahi supine is 13, left side 4.1 and right side 3.4. That’s a pretty significant difference to me. He did suggest that the centrals might not all be centrals as they could be obstructive that the respiratory effort just wasn’t significant enough to be caught. And of course, some centrals could be sleep transition related.
At this point I think I’m going to try a positional belt for a few weeks and see how I feel. If it’s not an improvement I’ll get the titration. If it is, I might get an O2 monitor with recording capabilities and do some data logging.
Edit: doc called to apologize for hurried appointment this morning and also offered trying an APAP out, thinking the centrals on the study might not be an issue and it would save me another night in a sleep clinic as well as some money.
Good point. Not too excited about getting into more medications if not needed, now that I think about it.
Looking at a few things other than AHI in my report and I see a few things that didn’t originally jump out.
14 arousals associated with respiratory events for rai of 2.4.
109 spontaneous arousals for index of 18.9. That seems terrible!
47 awakenings, 194 sleep stage shifts and 1 rem period.
Sleep efficiently at 72.9
It also says in comment section that the psg was notable for abnormal sleep architecture and sleep fragmentation as well as hypoxemia due to osa syndrome. But I didn’t have any obstructive events! Are the Hypopneas obstructive and resulting in central apnea’s?
So it seems like my spontaneous arousals and multitude of sleep stage shifts might be as damaging to my energy levels as the ahi number itself. Or am I off base?
Edited to say, I guess I did mention some of these things though they didn’t really hit me until I took another peek this afternoon.
Thanks for all of the advice. I’ll need to have a legal pad with me to remember all of my questions when I have my md appointment.
Has anyone heard of this before? Rather old I suppose but interesting nonetheless.
Might I have messed up the sleep study with the Benadryl tab? It was only half a dose and the tech approved. I do sometimes take a Benadryl or a half dose of NyQuil on nights where I’ve woken up around midnight and been unable to sleep.
The bed was quite uncomfortable as were the pillows. But that’s all obvious I guess. I often sleep prone at least part of the night and was unable to do that. Oddly enough though, I felt slightly better than usual the day after. Of course I slept from 9:30pm to 5:30am and then went home and slept another 2-3 hours, so I got an extra 2 hours of sleep compared to my usual routine.
The fanny pack and tennis ball don’t always work as I sometimes find myself at least partially supine. Maybe I should get a more functional device that is meant for this purpose.
Your question about how to monitor going forward is a great one. I suppose it could be partially based upon how I feel. Or maybe an o2 sat meter that records?
It’s not entirely logical to me either. I’ve had some abdominal and rib soreness off and on the past few weeks and I thought for sure it was related to OSA. You know, struggling to breath against the resistance of a restricted airway. But if it’s all CSA as this sleep study says then I don’t know. Also a bit odd to go from 4 obstructive and 3 central apnea’s on home study and now having all central apnea’s. To me anyway. I’m sure I’ll spend some time googling this over the weekend and maybe come up with some plausible explanations for some of this.
I appreciate the feedback. With respect to machines, I wonder why they suggested CPAP or BiPap? Seems strange. The machine you suggested is about 3500 here. Wouldn’t want to be replacing that too often!
Looking at it a different way, it seems if I could totally eliminate the supine position from my sleep I’d have a very normal ahi. Maybe that’s the first step to take?
I think I’ll talk to my gp this next week and see if he might send me to a cardiologist. Honestly, not knowing where this is coming from is what scares me the most. Well, that and allowing this apnea to terminate my existence while I’m waiting on a diagnosis and treatment from my medical team. And having to wait weeks to discuss with your sleep doc isn’t good for impatient people like myself!
Also, the report suggested I do another study, titration for CPAP or BiPap. Naturally they would suggest this, at $6500 per study. I think I’ll have met my out of pocket max so the money isn’t a big issue now I suppose. Truthfully it’s not a great experience anyway. Very clinical, uncomfortable to sleep connected to all of the wires, etc. Can I push for an auto BiPap? Would that be out of the realm of reasonable, assuming I’m going to be using a machine?
No attempt at auto CPAP yet.
So I wound up having an in lab Test. Slept pretty poorly as I rarely sleep on my back at home now with a fanny pack and tennis balls to hel/remind me, and also took a Benadryl to make sure I would sleep (sleep tech approved this).
18 central, 28 hypops for an ahi of 8.
No RERA. Longest Apneic event 17.2, mean 13.1.
Longest hypopneic 76 seconds mean 30.
Minimum O2 of 91%.
Intermittent sinus bradycardia and sinus tachycardia. I’ve had some palpitations recently and switched to a new bp drug. Valsartan from hctz.
Sleep efficiency at 73 percent. 47 awakening, 194 stage shifts and 1 rem sleep period.
Most centrals on back. 14. 1 on left and 3 on right.
Most hypopneas on back. 20 back, 7 left and 1 right.
Any thoughts? I’m troubled by the centrals. Wondering where this came from all of the sudden...seemingly.