Hey, I gotta keep laughing to keep the panic at bay.  

I followed your link to the post on CSBD and it was a little over my head. I'm on my way to read your cliff notes version in the help section. Gotta put on my thinking cap for this stuff.  

I'm concerned for the folks out there who are trying or considering experimenting with a home remedy on the assumption that they have CSBD. Seems like something best treated by an expert after a positive diagnosis.

SnoozeHunter

Sorry. Was going to post new sleep study results, but the formatting is wonky. Will try later.

Split-Night Study: Nov 19, 2005

Without Bipap:

Total Recording Time: 111.9
Total Sleep Period: 84.9
Total Sleep Time 55.0
Sleep Latency: 27.0
REM Latency: NA
Sleep Efficiency: 49.2
#REM Periods: 0
#Stage shifts: 40
Awakenings 19

Sleep Stage as % TST:

Stage 1: 24.5%
Stage 2: 30.9%
Stage 3: 44.5%
Stage 4: 0.0%
REM: 0.0%
MVT: 0.0%

Body Positions Slept:

Supine: 0.0%
Right: 100.0%
Left: 0.0%
Prone: 0.0%

Respiratory Analysis:

Central apneas.....NREM: 10.....REM: 0.....Total: 10.....Index: 10.9
Obstr. apneas................. 2.............0................2.................2.2
Mixed apneas...................0.............0................0....................0
Hypopneas.....................19.............0..............19................20.7
Apneas + Hyp.................31............0...............31................33.8

Supine events: 0
Non-Supine events: 31     Index: 33.8

Oxygen analysis:

Mean SaO2(%).....Awake: 95.7.....Non-REM: 93.9.....REM: NA.....TRT: 94.8
Min SaO2(%)...................85.0....................84.0..............NA............84.0
Max SaO2(%).................100.0...................99.0..............NA...........100.0

SaO2 (%TRT):

100-90: 25.4%
90-80: 1.4%
All other ranges: 0.0%

PLMs: 0

Arousal Analysis:

Total Arousals......Non-REM: 35.....Index: 38.2.....REM: 0.....Index: 0.0.....Total: 35.....Index: 38.2
PLM Arousals........................0.................0.0..............0...............0.0................0.................0.0
Resp. Arousals....................31................33.8.............0..........NoREM...............31..............33.8
Spon. Arousals.....................4..................4.4.............0................0.0................4................4.4

Split Night Study: Nov 19, 2005

With Bipap:

Total Recording Time: 295.5
Total Sleep Period: 293.9
Total Sleep Time: 233.0
Sleep Latency: 1.6
REM Latency: 276.0
Sleep Efficiency: 78.9
#REM Periods: 1
#Stage shifts: 65
Awakenings: 25

Sleep Stage as % TST:

Stage 1: 3.2%
Stage 2: 75.1%
Stage 3: 14.6%
Stage 4: 0.0%
REM: 7.1%
MVT: 0.0%

Body Posititions Slept:

Supine: 10.3%
Right: 89.7%
Left: 0.0%
Prone: 0.0%

Respiratory Analysis:

Central apneas............NREM: 110.....REM: 0.....Total: 110.....Index: 28.3
Obstr. apneas.........................11.............0................11.................2.8
Mixed apneas............................0.............0.................0..................0.0
Hypopneas..............................19.............0................19.................4.9
Apneas + Hypop....................140.............0...............140...............36.1

Supine Events: 0
Non-Supine Events: 141     Index: 40.5

Oxygen Analysis:

Mean SaO2(%)...........Awake: 97.6........Non-REM: 94.4......REM: 97.0......TRT: 95.2
Min. SaO2(%)........................84.0.......................81.0..............95.0..............81.0
Max SaO2(%)......................100.0......................100.0..............98.0............100.0

SaO2 (%TRT):

100-90: 65.3%
90-80: 5.5%
All other ranges: 0%

PLMs: 0

Arousal Analysis:

Total Arousals..................Non-REM: 211.....Index: 58.5.....REM: 1.....Index: 3.6.....Total: 212.....Index: 54.6
PLM Arousals......................................0..................0.0.............0...............0.0..................0.................0.0
Resp. Arousals................................141.................39.1.............0...............0.0...............141...............36.3
Spon. Arousals.................................70.................19.4..............1...............3.6................71...............18.3

Pressure Level Analysis:

Pressure.....TRT.....REM.....Non-REM.....Obs.....Cen.....Mix.....Hypop.....TotalEvents........RDI.....MaxSaO2%.....Min.....Mean
10/6...........9.8.......0.0.............2.8.........0........3........0............0................3............64.6.........99.0.........84.0.....96.4
11/7..........10.0......0.0.............9.0.........0.......12........0...........0...............12............80.3.........99.0.........82.0.....92.3
12/8............4.8......0.0.............4.8.........0........5........0............0................5.............62.5..........99.0........85.0.....95.3
13/9............3.9......0.0.............3.9.........0........4........0............0................4.............61.7..........99.0........84.0.....92.3
14/10........24.3......0.0............21.8........4........11.......0............2...............17............46.7..........99.0........87.0.....94.7
15/11........27.3......0.0............25.8.........1........5........0............2................8............18.6...........98.0........89.0.....95.2
16/12..........3.2......0.0..............2.2........0........3.........0...........0.................3.............81.3..........99.0........90.0.....96.7
17/13........11.6......0.0............11.1.........1.......11.......0...........2................14.............75.3..........99.0.......84.0.....94.3
18/14........76.0......0.0............38.0........0........47.......0............2...............49.............77.4.........100.0.......81.0.....96.3
19/15.......123.9.....16.5..........97.0.........5........9........0...........11...............26.............13.7..........99.0........82.0.....95.0

The study didn't go as planned. Didn't have much time without the bipap and it looks like I didn't get much time to settle in at any of the pressure settings. Don't know if re-doing the study was helpful or not but at least the findings were consistent with those of the earlier sleep study. The report recommendation was the same as before: Bipap settings of 19/15, and an additional note that "an empirical increase in pressure may be needed..." How high do these things go?

Also, I have the graphs now from all of the tests, but I don't have a scanner to post them at the moment.

I'm not scheduled to see the doc again for follow up until January. He hasn't called to say he needs to see me sooner based on the new results. In the meantime I've started back on 50mg Trazodone which helps me fall asleep with the air blasting into my head (still set at 17/12 instead of the recommended 19/15). It's also kept me from hearing my alarm in the mornings (actually, I heard it a couple of times but couldn't figure out what it had to do with me). I was late to work every day this week, and washed my face one morning with hair conditioner. But, I'll get used to it.   Can't say that getting more sleep at night via drugs is helping me yet during the day. I feel like I'm in a fog most of the morning and come out of it just in time to feel sleepy in the afternoon.

SnoozeHunter

Yo Snooze:

Well, I really thought there was an area we had to concentrate on going in again:

Quote:

...a careful titration, allowing at least 15 minutes of continuous sleep (on each pressure) to properly assess response.  See if low level CPAP is all you need.

So let's see what they did.  I spiffed this up a little to get a better view:



They dove in at 10/7, BiPAP already, and moderate level at that.  This immediately started generating central apneas, so this was too high.  At that point, you had two choices, either stay where you are to see if the centrals subside, or turn it down.  They chose to crank it up.  More and more centrals were created, the durations on the pressure were again too short as they went up, this was doomed from the start.  Give me their e-mail so I can explain that low-level CPAP means 5!!!  The centrals are a sign it's too much!!  Even if it's that CSDB stuff, they could see that they were getting nowhere!!  Gad.

OK, those low O2 sats are still a problem, but we don't know if they are real or artifact.

I'd go for artifact cause they're only from hypopneas, and crying out loud there's 4 times more pressure than is necessary so they should be taken care of.

OK, what to do.  Let's get a look at the architecture.  If it looks like the O2 sats are junk, we can ignore them.

I'd really like to go back there and insist on some good analysis on LOW level CPAP and really give it a chance.  As a freebie, of course.

If the O2 sats are real and/or you do have CSDB, then it becomes even MORE important to the minimum amount of pressure necessary, because the more pressure you add, the worse it gets.  The only thing available for that now would be the non-vented mask with dead space ventilation, I can give them part numbers if they choose to go that route.

We could try an AutoCPAP with a low CPAP range, but only if we could do simultaneous oxygen saturation monitoring.  You can do that at home, just download the results of the machine in the morning.

How's the cardiac situation going?
Stay in touch.
sleepydave

Hi sleepydave!

Yep, the redo was a bust. Basically, a repeat of the other one. If I go up there again and ask for another titration, and free at that, they'll probably dismiss me as a patient. That would be awkward since I work in the same building.  

You said the centrals were generated by the bipap settings, but I also had them during the first part of the night when I wasn't on the machine. I had 10 centrals, only 2 obstructives, and 19 hypopneas. In looking at the results from the whole night, I was wondering why I'm being treated for obstructive sleep apnea, "severe obstructive sleep apnea" according to the new report. Doesn't look to me like I had many obstructive apneas with or without the machine.

Part of the problem that night was that I ended up in a different sleep lab, same org but different campus. The person who did my study was not the one of the people I had talked to about redoing it. I think something got lost in the translation that night.

Do places loan out equipment for trial? I'm wondering where I can get an AutoCPAP and something to monitor oxygen saturation. I'd rather try it myself than have the sleep lab do it again.

The cardiac situation is dead in the water. The sleep doc hasn't shown any interest in finding an underlying cause, and my family doctor reluctantly wrote the order for the echocardiogram but said no more follow up is necessary. I would push it if I knew what to ask for, but I know my family doctor doesn't know anything about sleep apnea so she's not going to think it's necessary based on the echocardiogram results. Not sure where to go with it from here.

Okay...I took the Trazodone about 45 minutes ago so my cognitive functions are starting to deteriorate. I'm feeling pretty frustrated with my doctors. I'm trying to walk this line of letting them know I'm concerned about the sleep study results without coming off as overly dramatic or a hypochondriac, but they don't seem concerned at all.

I'll call around this week about getting hold of some equipment. Would seeing the graphs still be helpful if I can get a scanner? Once scanned, do you just copy and past them in here?

Thanks again for your help, sleepydave!

SnoozeHunter

Snooze-
PM me when you get the graphs scanned, and we'll take care of that.

The AutoCPAP will be a good idea only if you can get overnight oximetry, preferably for several nights.  They may (should) just do that gratis.

The diagnostic centrals could be just from the poor architectiture, but with those sats, can't dismiss completely.  Same goes for the titration, they're from poor architecture or over titration.  But you just can't say for sure, them crummy sats again.

We'll try to work around that though.
sleepydave