Abnormal or just weird (with pictures!)

[mhjunk525]

           

In November of 22, I was diagnosed with Sleep Apnea with a score of 54 AHI after my sleep test.  I didn't think that I slept at all during the test as the air conditioner in the test room was broken and I was uncomfortable.  I stayed still and tried to sleep all night.  After getting the results, I figured I must have dozed off long enough to get a good result.  I was prescribed a Resmed 11 with a pressure set from 8 to 20.  

After a little while I noticed that I was waking up with the pressure blasting me out.  I thought after looking at the graphs that I would have some apneas, pressure would increase, I would wake up.  I am now most positive that it went like this:  I would wake a bit, have waking apneas (garbage to many), pressure would increase, I would wake up fully.  This is not a good set up for a solid night's sleep.  I changed the ramp time to 45 minutes and would then have to turn the machine off and on again once fully awakened when this occured.

As this is not ideal, I was able to get a titration test set up to find the right pressure.  The test used 11 to 14 as the psi to test range. I slept very well, and it went smashingly, I was able to handle all the pressures given and my AHI was down to 2.4.  Life is good, the therapy is working wonderfully.  So, after the test I was able to talk the pa into changing the range to 8-12 psi.  It seems that I can handle this amount awake or asleep,

Next thing to happen was that I noticed my apneas while awake (some say garbage) were not being scored during the ramp period.  I was coming out with very good AHIs but I saw that while awake I had what should have been scored as numerous Apneas (garbage).  Okay, time to get rid of the ramp time.  Oh my, the colors are a many.  Crazy amounts of apneas (garbage) and so consistent.  I must test this.

I took the machine down to my man cave and watched some tv while wearing the machine.  I then looked at the results and noticed something a bit odd.  I dozed off a couple of times and when I did my respiration rate jumped from ~7 to ~17.  I looked at this phenomenom going back historically and noticed the same held true quite consistently; when awake my respiration rate was around 7 and when asleep it was around 17.  So much so that you can point out when I was asleep vs awake.

Now the history of why I went to get a sleep study in the first place.  I mentioned to my doctor that I would often catch myself holding my breath and I knew it wasn't very normal.  I have been asked "What" a couple of times when I sigh while breathing as the speaker thought I was showing disaproval.  Sorry bud, just breathing the way I do here.  My doctor recommended a sleep study and here we are.

Now with Oscar I can see it on a chart; when awake I breathe in deep, hold for a second, and let it out slow.  If I let it out slower than 10 secs it's flagged as an apnea.  When asleep it is breathe in breathe out very consistently.  I know that holding your breath is not an abnormal thing, but I do it all the time while awake.  I have attached some images showing the difference between when I sleep and when I'm awake.  For these charts, I set the lower and upper pressure to 4 with no ramp time via the clinical menu.

I guess I officially have waking Bradynpea as it is a condition where you breathe slower than 12 breaths a minute but it is not a diagnosis.  I have always breathed this way I am not willing to doctor it up further looking for a word to put on it.  But, what I guess would be helpful is if anybody has any thoughts as to why I breathe this way:  Apneustic breathing during the day and breathing like a champ while sleeping.  Mostly just curious.

What I really want to know is if anybody thinks that my original sleep study was mis-scored.  I believe the original 54 was actually apneas marked while I was awake (eyes were shut and I was still while trying to fall sleep).  I cannot test myself at home except with the resmed set to lowest level.  Maybe the machine is helping while I sleep, but can't be positive.  I am going to use a locked pressure of 4 for a while when sleeping to see what my AHI is.  If the AHI is very low while sleeping, I might scratch using the CPAP it as I don't believe having 0 psi will be much different than 4 psi. 

Thanks for any help or thoughts on the subject.

Notes: 

I'm a 56 year old male in generally good health.
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My spo2 levels are fine both awake and asleep.

[cdplatt]

A good way to check if the machine is helping is to use a pulse oximeter with the machine and without.  There are numerous studies that suggest the Oxygen Desaturation Index (ODI) can be an alternative to AHI in screening for apnea.  It can't characterize the type of event (OSA vs Hypopnea vs CA), but it will let you know if you have a sleep disordered breathing problem that requires therapy.  If you have an apnea event, your O2 saturation will drop shortly afterward.  An oximeter will also tell you how many desaturations you have per hour and that number will likely be close to you AHI.  You can use it while you're awake to determine if there is any issue with your slow breathing while awake.  I suspect there isn't or you would notice symptoms - light headed, dizzy, tiredness.  I don't think using your Airsense as a diagnostic device is the best approach.  Even with a locked level of 4, it's still pumping air into you and altering the breathing pattern you would have without it.  Just wearing a mask will do that too.

[mhjunk525]

Thanks for your reply.  I have had issues with my SpO2 levels as well; it seems to be better now that I use the cpap machine.  It still drops, just not to the same level it was.  I see it drop badly when I nap without the cpap on.  I have been trying to figure out why it drops, and I think that it has to do with switching from my odd daily breathing pattern to regular sleep pattern.

I looked at my original sleep study and it appears that they did indeed mis-score when I was asleep.  I know I didn't sleep much at all due to the heat in the room (no AC).  The test was coded like I slept all night.  As a matter of fact it appears like I fell asleep for .5 hours two hours in and they have that coded as being awake, exactly opposite.  At the end of the night I agree with the coding as being asleep.  

When I actually was asleep, I had very few events.  Yet I was scored a 57.4 for the night.  The study showed me as sleeping for 390 minutes, but in reality it was much closer to 90 minutes of sleep.  I can't blame the scorer; who breathes slow and apnea-ish while awake?  Unfortunately I do, now I at least understand why I haven't felt better using the machine at the higher pressures.

I have since set pressure down to 4 and have been able to sleep longer and not get woken up.  I'll have to fine tune it now.  With the pressure set to the lowest, I am interestingly seeing quite a few RERAs, and a few Hypopneas.  I think that I have minor Apnea and need a low setting.  I'll figure out the best pressure for me personally and go with it.

Why do I breathe messed up during the day?  Perhaps I heard 'breath slowly' once too often as a wound-up kid, LOL

Thanks again for your help.