Replies to This Discussion

Permalink Reply by 99 on December 9, 2009 at 3:00pm

No one can garuntee anything at any time anywhere all they can say is there is a strong likely hood of it working due to past experience

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Permalink Reply by Pam McReynolds on December 9, 2009 at 7:06pm

Thank you for your comments 99 and jnk.

We are still working on trying to figure out what is causing the central. There are some other things going on that might be the source and hopefully will have some answers in the near future. It may have to do with bulging disks in my neck that are pressing on the spinal cord, but I also have nodules on the thyroid, and with the GI stuff, it might be a combination.

I had researched and found what you are telling me about the ASV machine, but the insurance company has guidelines. Start with CPAP then go to BiPap, then CSV. How crazy. I am just frustrated by all this and a bit discouraged by all the side effects and not knowing yet why I am having so much central as opposed to obstructive.

Thanks for your support.

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Permalink Reply by Judy on December 9, 2009 at 9:46pm

And, suspicious soul that I am I would request and insist on receiving a copy of not just the doctor's dictated results (1-2 pages) but also the full scored data summary report w/condensed graphs (5+ pages), sometimes called the full disclosure report from my sleep EVALUATION sleep study. Yep, the PSG w/o xPAP! I wanna see FOR MYSELF how many central and mixed apneas I had BEFORE ever being put on CPAP.

They are part of your medical records and as such, assuming you are in the USA, you have a LEGAL RIGHT to them under HIPAA.

Actually, trusting soul that I am (NOT) I would request and insist on both report copies from EVERY sleep study I had done, whether sleep evaluation or titration AND a copy of EACH prescription and prescription change. I'm one who wants to see if my central and mixed apneas increase or decrease w/each xPAP and each pressure change titrated and ordered.

You have my DEEPEST SYMPATHY for that two solid months of nausea!!!! I fear nausea more than pain. When my Crohn's disease first struck I was nauseated 24 hours a day, seven days a week for 2 and 1/2 years. I swear I vividly remember every single second of that 30 months!!!!! Even just the "queasies" can put me in a panic yet today. And nausea can drive me to tears in no time. I just have no tolerance for nausea left in me. (((hugs))))

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Permalink Reply by Pam McReynolds on December 10, 2009 at 7:53am

It is difficult to remain patient, that's for sure. In the last year, I have accumulated 9 new doctors - sleep, heart, GI, thyroid, cervical spine. It's funny, but it's not.

It all started with thinking I had a kidney stone. Turned out my lipase and amalayse were eleveated and I was off and running. First it was GI doctors, started with one then wound up going to an even more specialized one. Then my new primary physician found a heart murmur. Yep, off to the heart specialist. Two slightly leaky valves, but heart so strong I have only a 2% risk of heart disease.

Did I mention I'm a runner? In the midst of all this I trained for the Knoxville Marathon, but I only trained to run the Half Marathon. So, then my husband mentioned to her that even though I'm a runner, I get winded when walking up the hill in our back yard or climbing a flight of stairs. Off to the lung doctor, which is where we were told we needed a sleep study and discovered I have apnea. Oh, by the way, the lungs are great.

My concern about the central apnea and soreness in my neck sent me in for an MRI of the brain and cervical spine. Found nothing in the brain (my husband said he could have told me that), but the cervical spine is a bit messed up. Two bulging disks touching the spinal cord and a couple other things. But hey, guess what?!?!?!? Yep, they found something else. The thyroid has suspicious nodules on it. The report said they need to be looked at. More tests. I am now being monitored and will have a fine needle aspiration done when they reach a certain size.

Along with all that, she was worried about my platelet levels, which I have had low platelets for most of my life. You guessed it, she sent me to another specialist.

I have had so many MRI's, Cat Scans, and X-rays I glow. The girls in the lab know me by name, even when they see me out in public because of all the blood they've taken from me. And my wallet is stuck in the open position from all the co-pays I've shelled out. But the interesting thing is, I'm still moving along and not freaked out about any of it, except this silly BiPap and not wanting to get sick from it.

My doctors are all wonderful and are working closely with me trying to figure things out. They all give me my reports and records for my personal files and have been great about letting me be a part of my own health care. I am fortunate to have a team of doctors who are working so closely with me. My primary physician hugs me every time I go in. She is the best doctor I've ever had. She's fresh out of medical school and is doing a fine job (almost too good) at finding all the things going on with this young almost 50 year old.

I'm really glad I got on this forum. It's helping just to put it all down and to hear from others. I am seeing from what I've read on some of the other members comments, that I am truly blessed with the group I am working with and need to not be such a big baby about it. :)

Thanks again 99, Jeff, and Judy for your support.

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Permalink Reply by 99 on December 10, 2009 at 9:09am

ps apart from the problems mentioned your fine

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Permalink Reply by Mary Z on December 11, 2009 at 8:18am

About Central Apneas- how are they treated any differently than OSAs? I realize because y'all keep saying that from the full result sleep studies one can tell central vs. obstructive events. Would someone mind explaining this a bit better for me, please? How do you tell the difference when reading the sleep study and how are centrals treated differently?
And Pam, good luck and thanks for posting.
I empathize with you. Sounds like you're doing all the right things. Hankg in there and please keep us posted.

Thanks,
Mary Zimlich

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Permalink Reply by Pam McReynolds on December 11, 2009 at 10:23am

Good questions Mary. Excellent, and easy to understand response Jeff.

Had my first night on the new BiPap machine last night. Not thrilled, but will keep trying. It wasn't all bad, but had to take off about 3:30 a.m. because I was filling up with air and couldn't take it any more. I think I will try using a sleeping pill this evening to help me relax and let the machine do its work. I'm sure I will get used to it with time. Might need the pressure lowered a bit in a few weeks if the air thing keeps happening. Will see what GI doctor and sleep doctor have to say about it.

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Permalink Reply by Mary Z on December 11, 2009 at 10:53am

Thanks Jeff, very understandable.

Mary Z.

j n k said:

Central apneas are apneas that start in the brain, not the airway. They are listed in the results from the sleep study, since central

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Permalink Reply by RockRpsgt on December 11, 2009 at 11:14am

In a PSG 4 different parameters are used for measuring aiflow. Nasal pressure (canula) and airflow (the scary thing with prongs) are the 2 things that were stuck in your nose. These are used to measure airflow in and out of your nasal and oral cavities (mouth and nose). The belts that were put around your stomach and chest measure respiratory effort (lung effort) by measuring the expansion and contractions. This is then backed up by a fifth measuring device in the oximeter. The oximeter measures your blood oxygen level as well as your pulse. This is a very innvasive way to measure the respiratory system.

An obstructive apnea is a cessation of breathing caused by a blockage in the airway. On a PSG we would see this event through the flattening or attenuation of the air pressure and airflow signal.

A central apnea is a complete cessation of breathing effort. Big difference there. On a PSG this would be seen by a lack of effort or attenuation in all of the respiratory channels. Both oral/nasal and in the respiratory belts. This is cause by a lack of signal from the brain to breathe.

The biggest difference in the 2 is that there is still ling effort in an obstructive apnea.

OSA in a psg ^=respiratory effort, -=no effort
nasal pressure ^^^^^^^^^^^_________^^^^^^^^^
airflow ^^^^^^^^^^^^^^^^^^^_________^^^^^^^^^
thorax belt ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
abdo belt ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Central Apnea
airprassure ^^^^^^^^^^^^_________^^^^^^^^
airflow^^^^^^ ^^^^^^^^^^^_________^^^^^^^^
chest belt ^^^^^^^^^^^^^^__________^^^^^^^
abdo belt ^^^^^^^^^^^^^^^_________^^^^^^^^

I hope that helps Mary. For some reason my PC will not let me bring up any screenshots right now. I will try later.

Mary Z said:

About Central Apneas- how are they treated any differently than OSAs? I realize because y'all keep saying that from the full result sleep studies one can tell central vs. obstructive events. Would someone mind explaining this a bit better for me, please? How do you tell the difference when reading the sleep study and how are centrals treated differently?
And Pam, good luck and thanks for posting.
I empathize with you. Sounds like you're doing all the right things. Hankg in there and please keep us posted.

Thanks,
Mary Zimlich

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Permalink Reply by Mary Z on December 11, 2009 at 11:30am

Thanks, Rock, that helps a lot.
Mary Zimlich

Rock Hinkle said:

In a PSG 4 different parameters are used for measuring aiflow. Nasal pressure (canula) and airflow (the scary thing with prongs) are the 2 things that were stuck in your nose. These are used to measure airflow in and out of your nasal and oral cavities (mouth and nose). The belts that were put around your stomach and chest measure respiratory effort (lung effort) by measuring the expansion and contractions. This is then backed up by a fifth measuring device in the oximeter. The oximeter measures your blood oxygen level as well as your pulse. This is a very innvasive way to measure the respiratory system.

An obstructive apnea is a cessation of breathing caused by a blockage in the airway. On a PSG we would see this event through the flattening or attenuation of the air pressure and airflow signal.

A central apnea is a complete cessation of breathing effort. Big difference there. On a PSG this would be seen by a lack of effort or attenuation in all of the respiratory channels. Both oral/nasal and in the respiratory belts. This is cause by a lack of signal from the brain to breathe.

The biggest difference in the 2 is that there is still ling effort in an obstructive apnea.

OSA in a psg ^=respiratory effort, -=no effort
nasal pressure ^^^^^^^^^^^_________^^^^^^^^^
airflow ^^^^^^^^^^^^^^^^^^^_________^^^^^^^^^
thorax belt ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
abdo belt ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Central Apnea
airprassure ^^^^^^^^^^^^_________^^^^^^^^
airflow^^^^^^ ^^^^^^^^^^^_________^^^^^^^^
chest belt ^^^^^^^^^^^^^^__________^^^^^^^
abdo belt ^^^^^^^^^^^^^^^_________^^^^^^^^

I hope that helps Mary. For some reason my PC will not let me bring up any screenshots right now. I will try later.

Mary Z said:

About Central Apneas- how are they treated any differently than OSAs? I realize because y'all keep saying that from the full result sleep studies one can tell central vs. obstructive events. Would someone mind explaining this a bit better for me, please? How do you tell the difference when reading the sleep study and how are centrals treated differently?
And Pam, good luck and thanks for posting.
I empathize with you. Sounds like you're doing all the right things. Hankg in there and please keep us posted.

Thanks,
Mary Zimlich

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Permalink Reply by Pam McReynolds on December 14, 2009 at 7:45am

My heart felt gratitude to 99, jeff, judy, and mary z. I appreciate your support and comments on this discussion. It helped me to go into starting on this new machine with a good attitude. As a result, I have had four nights of much better sleep. The last three nights I've gotten 7+. It's still a bit of an adjustment, but I have to say, it's working better for me than the CPAP was. Thanks again. :)

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Permalink Reply by Judy on December 14, 2009 at 11:06am

Congratulations, Pam! 7 hours a night. Ahhh. THAT helps, a lot. We are glad you are seeing some improvement. And just think, there's more improvement to come!!!

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