Can central sleep apnea cause daytime breathlessness?

Excellent, and I hope you are given the right equipment and settings/prescription to treat it properly. On another forum where we discuss only the various forms of sleep apnea and its various treatments, the consensus is that an ASV is what is needed to control central apneas. Sometimes the providers or the prescribers want us to try a BiPAP first, but so many people fail to improve with biPAP that we counsel them to press for an adaptive servo-ventilator (ASV). They cost almost double, unfortunately, but they work!

Another update: the referral for sleep medicine was finally processed and my appointment is in a month. Is there anything that can help treat central sleep apnea in the meantime? Do oral appliances work for central? Is there any legitimacy to Micro CPAPs? Could I ask my PCP for an oxygen concentrator to use at night or something? I hate to think that I am just slowly decompensating until I find something that works but that's kind of the reality. It all just feels like some cruel joke always waiting for another appointment. I am grateful that at least my appointment is in a month, I'm sure other people wait longer, but it also feels like an eternity. It felt long enough just waiting for the sleep study and stress test to begin with. But even after the sleep medicine appointment, it could be a matter of weeks or months if they want to schedule further sleep studies or other testing, then more time to actually try any treatment that may or may not work. It could be months before I actually find relief, if I am able to find relief.

Central apnea originates in the brain. It isn't something that you can take medicine for, or lose weight for, or have some weird appliance planted into your mouth or nose for. The only treatment that is worth paying for, and it costs a bundle, is a special PAP machine that is called an 'adaptive servo-ventilator', or an ASV They cost exactly twice what a typical Resmed AS11 Air Curve or equivalent costs at retail.

I'm in Canada where at least that kind of treatment is relatively fast and easy to acquire. However, reading at apneaboard.com sometimes suggests that PAP care in the USA needs some work. For one thing, the insurers who have to pay for your assessments and for whatever machine you end up with will make you go through several trials of machines widely known not to help with central apnea (CA). They'll insist you try a BiPAP for a month or two. This means several months before they agree you have not responded to the one or two machines they'll insist you try before they agree that you are not being treated properly and that, yeah, you really do need an ASV..........................I guess....

I wish what I have read from so many posters to apneaboard.com were better and that I could offer some encouragement, but...maybe you'll have a different experience, maybe not. I hope it goes faster for you. But, no matter who it is, when you need PAP therapy of a kind, you'll have to show what is known in the insurance industry as 'compliance'. It is often difficult to get comfortable with the machine, and to get it to reduce your events each night down to 4.9 or fewer. The machines take some getting used to just as something to wear all night, but they can be noisy, and the different prescribed settings might not work. If it's central apnea and you're forced to try an unsuitable therapy, it's just that much longer, and you wonder if you'll ever get the right treatment, or if the whole idea is just too much bother and you quit. The insurers would almost rather you quit than have to fork out at least $3500 for an ASV. But the usual protocol, based on their policy, is for you to use the machine a minimum of 4 hours for I think its 20 nights out of the month-long trial (you'll be told this, whatever the length is, and the many hours each night, so be sure to.....comply...if you go through the trial).

Good luck..

Update: I had a consultation with sleep medicine. They clarified that the overnight home pulse-oximeter I had done was not a sleep study and could not diagnose sleep apnea. He also said that the oxygen read 84% when I was taking off the device so it was probably a fluke but he got me in for a sleep study for my others symptoms. He also tested my ferritin and said that restless legs syndrome can be caused by low ferritin. Lo and behold my ferritin was low so he recommended iron supplements with ferrous sulfate which I am now taking regularly. Labs will be rechecked in 3 months.

I got the results of the sleep study today during my follow-up appointment. I have a lot of periodic limb movement at night with movements about 32 times an hour. He also mentioned I had a total of about 28 respiratory disturbances, meaning that I snore but without obstruction and my oxygen levels are good so he's not pushing a breathing device like a CPAP or anything similar at this point but says as I age it might be something I need to revisit if it becomes more of a problem. I wake up about 12 times an hour, largely spontaenous arousals, sometimes due to periodic limb movement, and occassionally (1.7/h) respiratory. I also grind my teeth which is fun (sarcasm). And I had ZERO REM SLEEP (0.0%)!!! Which explains the memory loss, cognitive issues, and fatigue. He said it was likely due to the excessive limb movement.

All in all I am thrilled to have so much comprehensive documentation and to have someone explain everything in detail. At this point the most pressing issue is addressing the periodic limb movement and he is prescribing low dose gabapentin. I have taken gabapentin for other reasons in the past and other than feeling a little weird I did not have severe side effects so I feel comfortable with this especially considering it will be a low dose. He says if I want to switch to something else in two or three weeks I can try Mirapex which I think is an interesting choice but apparently he has been successful with this in the past for patients with PLMD who do not respond well to gabapentin.

Thanks again for your ongoing support. I will check back in to drop a little progress note in a few weeks! I am so thankful for modern medicine!!!

This is progress! A polysomnography, over night in a sleep lab, would have detected the limb movement because leg sensor straps are part of the hookups, of which there must be 20 or so. Brain function, breathing, oxygen levels, pulse, and a machine you breathe into that detects stoppages or shallow breathing where you don't get enough oxygen (hypopnea).

I hope I don't ruffle any feathers......but.....an O2 level below 90% begins to bear scrutiny, especially if you spend a total of 15-30 minutes at that level each night. Below 85% means there's a distinct problem leading to a desaturation (desat). If it happens several times each hour, or even twice a minute, this is a distinct problem that ought to be rectified....ASAP. I sincerely hope your limb movement issue resolves, AND THAT it helps a lot with your sleep quality. But, I wouldn't be the least bit surprised to find that it's just one of the two or three sleep problems that you have. If you continue to get desats each night, and if your REM sleep doesn't climb above 12% as a minimum, there's still something else that needs to be fixed.

Good luck!

Hi gloaming. Yes I forgot to mention about that. The cardiologist was the one who mentioned the 84% oxygen level. I think he was probably just looking at the numbers, but during my consultation the sleep specialist pointed out that the one time it happened during the night was when I was taking the device off so it wasn't likely an accurate reflection of oxygen. My oxygen was thankfully otherwise fine on the home pulse ox test and during the overnight sleep study.

I downloaded Shuteye I think it’s about $60 a year a lot cheaper than a dr visit or sleep study. I recorded several nights and took into the doctor to give him a better pattern of my sleep habits instead of 1 night with wires all over you. I’ve had about 3 sleep studies and was told I was the worst patient he’s ever had . I could be asleep within 3 minutes.

Question for @gloaming

What physician/specialist do you recommend for low O2 sats which occur during sleep?

Thanks!

In order, they would be a sleep specialist or a registered respiratory therapist. It really sets things up nicely, though, if your family doctor refers you because he/she thinks you're in a bad way sleep-wise. In fact, your GP should....SHOULD...be able to prescribe a polysomnography at an accredited sleep lab...mine did. Those results, oddly, went to a psychiatrist (who is an MD first, and then a PhD in clinical psychology) who was also a sleep specialist, don't ask me how or why, and it was he with whom I had a video conference and we discussed his intended prescription for PAP therapy. Fortunately, mine was easy and straightforward. I just needed 8-10 cm H2O pressure, and he suggested 2 cm of EPR, expiration pressure relief where the machine paces your breathing and backs off the flow when you're attempting to exhale. This is strictly a comfort setting, but it is part of the overall, or holistic, therapy. Apart from those, it might be worth consulting a pulmonologist who can assess your lungs and tubes to see if you have another unseen problem. But that person won't be able to do much for irregular or broken sleep, poor habits, a damaged or diseased heart, or the three types of sleep apnea.

Update: it turns out I have PLMD, RLS, and upper airway resistance syndrome (not sleep apnea). The restless legs have resolved with iron supplements and I am no longer anemic. I am on Nasonex for the UARS though I can't really tell if it helps yet. If it continues to be an issue my sleep specialist will refer me for ENT. I had a bad reaction to the gabapentin, and a couple of other supplements used to treat the PLMD and am honestly sick to death of taking medications with horrid side effects in general, so my sleep specialist referred me to a micro-current neurofeedback clinic which he has had a lot of success with for patients who respond poorly to traditional treatments. I have had a few sessions so far so I cannot tell how effective it will be overall but so far it has given me more favorable effects with less side effects than anything else I have tried and plan to continue until my symptoms resolve.