Sleep apnea is not an immediate life threatening condition. Think about the oyster divers that go under water just by holding their breath for 5 minutes or longer at a time. An apnea event is more than 10 seconds, and typically in the 15 - 20 second range. The complications it can cause are long term, not immediate. That is just my non medical professional opinion.
When I started thinking about how much time I'm not breathing while I sleep it freaks me out. My AHI was 111 so for probably over 20 seconds out of an average minute of sleep I'm not breathing. My lowest oxygen saturation was 57 and it said the normal range was above 90. I dont now how low it can go but it seems well below where it should be. The results were sent to my Dr so I guess he will tell me if that is that bad. Thanks for the reply. My central apneas were 18 an hour. Googling those as I had only heard of obstructive sleep apnea.
Yes, that is a quite serious case of apnea. My wife was diagnosed at an AHI of over 80. And your oxygen desaturation is not so good either. Is there anything you can do to speed up the the prescription and approval by talking to your doctor? On line suppliers of equipment can ship it out overnight, but do require a prescription.
Not wanting to alarm you, but that central apnea frequency is high too. CPAP or APAP machines do a very good job of reducing obstructive apnea, but not so good with central apnea. In fact machine pressure may even make the central apnea worse. Are you scheduled for a titration study? That is where they do another sleep study but this time adjust the pressure to see what pressure works, and if central apnea is going to be a problem. Without any significant central apnea, it is common to go straight to an automatic CPAP or APAP. But with higher central rates the titration study is more necessary.
Just so you know your not alone, i was recently diagnosed as well with AHI of 104 and oxygen got down to 62% at the lowest. I understand the being scared to sleep! I did have a titration sleep done, and have been working with insurance to get my cpap and supplies for TWO weeks. Buying it out right would have been a lot faster, but i think it's just the company my insurance made me go through.
Hi everyone, my original AHI was 98, I was prescribed a CPAP and have used it every night for a year. My AHI dropped immediately but has varied between 5 and 20 for no reason I can discern. My doctor and provider both seem to feel that given where I started, this is an acceptable result. I was told not to worry so much about the numbers. When I suggest lowering the pressure I am basically ignored. I am concerned not only because of the inconsistent (and high) AHI but also because the clear airway apneas (according to DreamMapper) range from 14 to 98. Am I crazy to think that this is too high? Are clear airway apnea’s the same as central apneas? A month ago I talked them into trying an auto bipap machine but if anything the numbers are worse. I would appreciate any input or opinions.
The acceptable treatment standard for apnea is an AHI less than 5. I would suggest that is an average, and occasionally going over 5 is not a big concern. However if you are averaging over 5 that suggests a change in treatment should be considered. If the dominant part of your AHI is clear airway, that can be problematic. Clear airway is another name for central apnea. Central apnea is when you don't try to breath, whereas obstructive apnea is when you try but the airway is blocked.
Central apnea can be a sign of an underlying cardiovascular issue. I would talk to your doctor or heart specialist about the central apnea and if there is a need for treatment of a heart condition. Medications, like sedatives, especially opiods can also be a cause of central apnea.
I think there are kind of two ways to go with using CPAP for mixed or complex apnea (both CA and OA). The first approach is to minimize pressure used. That is best done with eliminating the use of Flex on a DreamStation, and also limiting the maximum pressure. The lowest possible pressure that controls the obstructive apnea part of the AHI is often the best solution. Once that pressure is found, then it can work well to just have the CPAP set at that pressure.
The second method is to try to assist the breathing by cycling the pressure up and down as you inhale and exhale. That is usually what a BiPap is used for. However, the problem is that it can result in a higher overall pressure and cause more central apnea, not less.
If central apnea cannot be addressed in any of those ways, then it may be necessary to consider an ASV (Adaptive Servo Ventilation) version of the CPAP. It acts somewhat like a BiPap to assist breathing, but changes pressure on a breath by breath basis to assist your breathing. The ResMed AirCurve 10 ASV is one example. They are quite expensive, and you need to have a special heart function test done before they will be prescribed. Those who use them report exceptionally low AHI numbers, often less than 1.
Hope that helps some,
Thank you for your input. I do have a faulty aortic valve, but none of my doctors seem to be concerned about it. I just feel powerless to get anyone in the medical field to investigate my situation past the basics. I don’t know whether they just don’t know what to suggest, or they seriously think my results are okay. I have had fibromyalgia for 35 years, so I am used to being told there is nothing they can do. When I first got the CPAP Machine, I felt about 50% better right away, which was great, but now I can’t help thinking I could be doing much better. Maybe I need to request a referral to a heart specialist or a neurologist. I have also read comments about titration which sounds like it might be helpful.
I think it is certainly worth discussing it with a heart specialist. When blood flow is lower than it should be, it can be a contributor to central apnea. Studies have found that "ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnoea." If your LVEF is > 45% you would still be a candidate for ASV.
I would also discuss with your sleep doctor the option of using the simple APAP mode with no Flex, and a reduced maximum pressure. The idea is to keep reducing the maximum pressure until the obstructive apnea starts to become a a bigger issue than the central apnea. There may be a happy spot for maximum pressure that keeps both obstructive apnea and central apnea at a low point. What is your current ratio of CA to OA events? The idea would be to reduce pressure until they are closer together.
I would like to talk about the AHI score for a moment. Ideally, you would like the treatment AHI to be below 5, which is considered "normal". But this is the real world. When a person is very severe(like an AHI of 98), our present equipment often struggles to cope with it. When your doctors seem not too concerned with a treatment AHI of 5-20, they are probably looking at a number of long-term studies that show that an AHI of 20 is low enough to take the really bad stuff(heart attack, stroke) off the table and low enough not to shorten a person's life span. Coming from an AHI of 98 that is a real improvement. Certainly you should not be terrorized by your situation. If you really want to get it down lower though, one thing you could consider is combination therapy using both an oral appliance and the CPAP. See: The Tap-Pap CS system. www.tapintosleep.com. Arthur B. Luisi, jr., D.M.D.
If the dominant component of the AHI is central apnea is a dental appliance really going to help?
You asked an easy question. However, the answer is not that simple. Recent studies of patients with very SEVERE mixed apnea(a combination of both obstructive and central apneas) show that the use of an OA to treat the obstructive component tends to lessen or even eliminate the central component. Don't ask me why. I don't know. Well, I could give you a very complex explanation based on fluid dynamics. but I can barely remember it myself. The point is, when you are using a combination device incorporating an OA and CPAP, the OA mainly holds the mask in place in lieu of the straps. The machine is going to do the heavy lifting with both the obstructive and the central components anyway. Remember, this patient is fairly close to getting down to the magic number of AHI 5. Certainly, the OA could help with the obstructive component and, marginally, with the central component. Probably, just enough to get her over the goal line. Worth it, I think, for this patient since the higher numbers concern her. Dr. Luisi
When I started thinking about how much time I'm not breathing while I sleep it freaks me out. My AHI was 111 so for probably over 20 seconds out of an average minute of sleep I'm not breathing. My lowest oxygen saturation was 57 and it said the normal range was above 90. I dont now how low it can go but it seems well below where it should be. The results were sent to my Dr so I guess he will tell me if that is that bad. Thanks for the reply. My central apneas were 18 an hour. Googling those as I had only heard of obstructive sleep apnea.
