I m tired all the time. Clinic A says it s central sleep apnea & nothing can be done. Clinic B says it s obstructive. Whom should I believe?

Can I assume you had a formal sleep study done in a sleep lab? Because central and obstructive apnea look VERY different from each other and it's fairly easy to distinguish between the two on a polysomnogram. I can't imagine how one clinic could come to the conclusion of OSA while another reads that as central apnea.

It is possible to have a mixed disorder wherein you have both central and obstructive apnea, but again, that's pretty easy to distinguish on the test.

In central apnea, the neurological drive to breath stops intermittently during sleep. The airway remains open but there is no effort made to take a breath. In obstructive apnea, the neurological drive to breathe is still there and you make inspiratory efforts but the partial or total collapse of upper airway prevents that.

During a formal sleep study, we measure your EEG to tell what stage of sleep you are in, airflow at the nose to measure whether any air is moving during a breath, and inspiratory muscle effort to determine whether or not you are trying to breathe during periods of apnea; as well as oxygen saturation and heart rate. If you make muscular efforts at the chest but there is no airflow at the nose -- that's obstructive apnea. If you make no muscular efforts and there is no airflow -- that's central apnea. It is pretty hard to mistake the two for each other.

Based solely on the information provided, I am not impressed with clinic A. Yes, there absolutely is something that can -- and should -- be done for central apnea: BiPAP. Unlike CPAP, BiPAP uses two levels of pressure. In central apnea, the airway stays open but you don't take a breath. Because of the two levels of pressure, the BiPAP works like a pressure ventilator. It has a back-up rate set. If you breathe less than the rate set on the BiPAP, it delivers pressure anyway and you get a breath. When you breathe on your own, you get a pressure-assisted breath.

If you have a mixed disorder, the lower pressure on the BiPAP has to be enough to relieve the obstructive aspect of the apnea and the higher pressure has to be enough to deliver a breath during the central apnea events.

Obstructive apnea is dangerous enough but central and mixed disorders can be fatal. Because again, the reason for the apnea is literally that your brain stops telling you to breathe. Alcohol, medications, and other problems can precipitate a fatal apnea event in someone with central apnea. It MUST be treated and treated with something that delivers a breath during periods of central apnea. That really comes down to BiPAP.

Knowing nothing else about the clinics, I can only base my opinion on the info provided. I can't read your test so I can't provide an opinion as to an interpretation. But I can say that any clinic that says "there is nothing that can be done" for central apnea makes me question whether they can read a polysomnogram in the first place. Given that and that alone, I'd look into clinic B or finding another clinic altogether. Ideally, you're looking for a doc who is board-certified in sleep medicine -- preferably a board-certified pulmonologist (lung specialist) who is also board-certified in sleep disordered breathing. All other things being equal, pulmonologists who get certified in sleep medicine have a much better track record at managing apneas than other sleep medicine docs.

Best wishes

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see what clinic c says