Re Post: What's the criteria in diagnosing Complex Sleep Apnea

I have posted this before but I have not had a reply back answering.   No doubt, many people in this forum would be interested in knowing more and what to look for.

My original post is here: http://www.medhelp.org/posts/show/408921

I would hope one of the generous doctors in this forum could further elaborate and provide some specific numbers.

[scarlet37]

Generally you must have 5 -15 apneas per hour to be defined as mild. However there is another breathing disorder newly being recognized it is called UARS ( upper airway resistance syndrome). Although many doctors will not treat this - they usually just say it's due to "depression" or "stress". Perhaps your doctor can prescribe a trial of bi-pap just to see if it helps.

An informational site i enjoy reading at is called sleep apnea dot org and also  talk about sleep dot com.

Sleep disorders are commonly treated as psychiatric disorders- do your research and find another doctor.

Please keep us posted as to your progress-
Best Wishes

[Sam888]

Thanks scarlet37. What you describe is  the measurement for obstructive sleep apnea:
mild:  AHI of 5-15
moderate: 15-30
severe: >30

Complex sleep-disordered breathing is a distinct form of sleep apnea. It has recognizable characteristics that are present without, and often worsened during, positive airway pressure treatment. Both sleep state stability and the behavior of the respiratory control system contribute to this complexity. It is only with a clear understanding of the factors contributing to complex sleep-disordered breathing that implementation of truly effective clinical therapy can be achieved for this disorder, which to date is poorly controlled. (see Recognition and Management of Complex Sleep-Disordered Breathing).

Anyone who has ever gone without a good night's sleep is aware that doing so can make a person emotionally irrational. While past studies have revealed that sleep loss can impair the immune system and brain processes such as learning and memory, there has been surprisingly little research into why sleep deprivation affects emotions.  

When we're sleep deprived, it's really as if the brain is reverting to more primitive behavior, regressing in terms of the control humans normally have over their emotions.

Too frequently though, in my experience some physicans tend to ignore common sense. Without sleep, the emotional centers of our brains dramatically overreact to bad experience,  Fortunately, we now, we have some research that shows otherwise. Acceptance by the physician is another obstacle the patient has overcome. (see amyglada in the Oct. 23, 2007 issue of the journal Current Biology).

The  amyglada in the temporal lobe affects emotion and controls anxiety. When a person is sleep deprived, the amyglada is working in overtime.  When physicians see someone with anxiety or even depression (who wouldn't be depressed from not getting decent sleep) and has problems with sleep, or even worse, suffers from sleep apnea, they prescribe meds without focussing on the cause or source of the anxiety or depression. This is a  a band-aid solution, at best. At worst,  anti-depressants have nasty side effects and many of them don't work better than a placebo, while at other times, they just "zone you out".

It's very frustrating that I am not able to find any information on the parameters (numbers) in diagnosing Complex Sleep Apnea (CompSAS), like with OSA and the mild, moderate, severe values posted above.   It seems that diagnosing this is very subjective.  If the patient is not responding to xPAP, physicians typically blame it on a psychiatric issue. It's no wonder that my research has shown that not many physicians world wide know very little about Complex Sleep-Disordered Breathing or Complex Sleep Apnea. Some say it's solely to do with constant positive pressure and others don't know.

[Sam888]

I just came across this: http://www.resmed.com/en-au/clinicians/about_sleep_and_breathing/documents/complex_sleep_apnea_education_factsheet_1011213.pdf

A diagnosis of central sleep apnea (CSA) requires all of the following:
• An apnea index > 5
• Central apneas/hypopneas > 50% of total apneas/hypopneas
• Central apneas or hypopneas occurring at least 5 times per hour
• Symptoms of either excessive sleepiness or disrupted sleep

[scarlet37]

Wouldn't  complex be treated the same as central or obstructive?

As far as the docs not knowing much The same could be said in regards to Narcolepsy. It has taken me 2 years and a thyroid surgery to have the true dx to go with my problems.
Although I am certain I do have breathing issues in addition to Narcolepsy I cannot get an MD to treat me properly. Having said that I DO wholeheartedly understand sleep deprivation and the emotional effects on the brain.

I am tired of being treated with medications that don't work effectively and when they don't I am thrown on yet another anti-depressant.

My new psychiatrist heard me clearly last week and agrees that this is NOT a mental disorder and has referred me to a neurologist he wokrs closely with. I just hope he is as good as the psych.

I wish I could give more specific info for you Sam- please check the above sites I mentioned- their forums are a wealth of info.

Best of luck.

[Sam888]

lad to hear your psych is seeing the light and has referred you to a neurologist.  That's very encouraging.

Yes and no, there is really no way to treat central apnea effectively.

One interpretation (from Resmed ) is that Complex sleep apnea (CompSA) is a form of sleep apnea in which central apneas persist or emerge during attempts to treat obstructive events with a continuous positive airway pressure (CPAP) or bilevel device. Yet, other studies from Geoffrey S Gilmartin; Robert W Daly; Robert J Thomas indicate that that's just one way. Complex Sleep Apnea is still poorly understood and the reasons are not clear why it occurs.

It's very "challenging" as the scientists write in trying to o treat CompSA. Patients with CompSA cannot be adequately treated with CPAP or bilevel device. The clinical consequences are residual symptoms (fatigue, sleepiness, depressed mood) and intolerance to therapy.

The criteria used to measure I have found from the above link at Resmed is CompSA:

• The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared.

• CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour.

• With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA

Patients with CompSA may be seen as those who cannot tolerate conventional CPAP or bilevel therapy both during lab titration and at home. Neither CPAP nor bilevel therapy seems to alleviate their sleep disorders. For CompSA patients, treatment with CPAP or bilevel therapy will leave them with a somewhat elevated AHI, and their disorder will not be completely resolved. Bilevel therapy has been traditionally used to treat Central Apneas along with Oxygen therapy. Oxygen therapy is not without it's complications too.

There is a new (noisy) machine to help with CompSA, an SV machine but it's effectiveness is equivocal and very very costly.  It costs around $9,000.

It's further troubling for me now because I am having major intense  headaches that are further waking me up in the in the middle of the night.  These headaches linger all day.  I can't find a physician to acknowledge my sleep data from xPAP machine or how I feel and how it's affecting my quality of life.  They look at the results from my PSG and although they're not the best, they're not the worst and they're just looking at the numbers and not analyzing them or my symptoms....in fact, ignoring most of them.

[Holly008]

Ever heard of  VPAP-  it is variable pressure and it is suppose to be very sucsessful in treating complex sleep apnea

[Holly008]

I have recently been diagnosed with complex sleep apnea. About ten years ago I was diagnosed with obstructive sleep apnea and had a UPPP. It is not a pleasant surgery and is extremely painful for about 10 days afterward. I was much better for along time ...recently( the past  6 months) I have had a return of the day time sleepiness and increased depression. Do not knock the anti -depressants none that I tried ever zoned me out. The right one in the right dose helps tremendously. I am alert and much happier and much more pleasant to those around me. I have just had the sleep study that gave me the complex sleep apnea diagnosis and have not seen my doc yet. But if you do your research you will see that the VPAP with proper setting has tremendous success with complex sleep apnea.  

[Suri123]

Hi, hope you are feeling better and able to sleep well. Are you presently using any of aids to ease symptoms. keep updating. Take care.

[Sam888]

Thanks for sharing.

Vpap itself is actually not very effective in treating CompSA.  You may be thinking of either Resmed SV which is the first only recognized machine/treatment for CompSA. Respironics has it's own version of the SV.  Basically, the SV is a non invasive ventilator (it breathes for you).

Suri123, I am not using any aids to ease my symptoms.  I have tried many in the past including prescription sleeping pills and anti-depressants but they have not worked.

[Suri123]

Hi Sam888, how are you doing? Hope you feel better now? Thanks for your reply and an update on the Resmed SV, which is far better compare to a CPAP machine as it has many more advantages like delivering different sets of air pressure - increased when the patient inhales and decreased when exhales breath, making it easier for sleep apnea patients who have difficulty breathing spontaneously at their own rate and depth. Also can be useful in those with neuromuscular disorder as there is no requirement for an active process. More information regarding the product can be seen at this link http://www.2p-cpap.com/products.asp?category_id=4, consult your doctor for advise. Take care and post your progress.

[diepeacefully]

I have many medical conditions that I have to have treated. Now,I have recently been diagnosed with complex sleep apnea. and severe insomina.  During the sleep test, they said I sleep 2 hours a night and that is not all at one time. . I watch the clock beside my bed. I have seven people living in my hose, so there is no other room for me to go to . I don't want to wkae up the kids. The insurance will only pay for CPAP.  I will have to stop working because my health concerns and problems will bother others. So I will have no insurance, no money and not much time to live. Now I have heart problems. The doctors have advised me that I will only live for a few more years. Too much is wrong, and other things are showing up. So try and dind a way to treat your medical problem. Dn't dtop. Life is to short.
For those who have sleep problems, keep trying to find ways to help you live a better life. Or you won'y have a life.