[split] 0.00 AHI with a lot of arousals. What's next?

[Boudou123]

Thank you Jay

I really appreciate your feedback and I would say that this is what I was going to try tonight. 

Historically, my AHI have been higher at lower pressure but at 20, the pressure may be too high, causing aerophagia and disrupting my sleep.

I will try at 19 this evening and post my results.

May I ask what benefit will the cervical collar bring? I thought it was to prevent the mouth from opening and causing mask leaks which is not an issue in my case.

Thanks again, lets see what's next !

[Jay51]

You are welcome Boudou123.  The soft cervical collar can keep the airway straight at night during sleep.  When the airway "kinks" like a garden hose, flow can be compromised.  The worst position is called "chin tucking."  Not everyone suffers from chin tucking, but some do.  Your charts show the higher pressure responding to most likely obstructive apneas.  By wearing the soft cervical collar at night, it could help stop obstructive apneas and enable you to bring your pressure down significantly.  Using a lower pillow height and possibly changing sleep position (from back to side for example) could also help.  But the collar seems to be the most effective device for most people.  

I wear a collar every night.  It took some experimenting at first to get the pressures just right.

[Boudou123]

You are welcome Boudou123.  The soft cervical collar can keep the airway straight at night during sleep.  When the airway "kinks" like a garden hose, flow can be compromised.  The worst position is called "chin tucking."  Not everyone suffers from chin tucking, but some do.  Your charts show the higher pressure responding to most likely obstructive apneas.  By wearing the soft cervical collar at night, it could help stop obstructive apneas and enable you to bring your pressure down significantly.  Using a lower pillow height and possibly changing sleep position (from back to side for example) could also help.  But the collar seems to be the most effective device for most people.  

I wear a collar every night.  It took some experimenting at first to get the pressures just right.

Thank you Jay

I purchased a collar and will try this as well. It would be great to be able to reduce the pressure.

I will experiment for a couple of nights and post an update later this week.

[Boudou123]

I am curious how do you get data on your pulse rate?

[Narcil]

I am curious how do you get data on your pulse rate?

you need to buy a pulse oximeter. most ppl seem to use the wellue o2 ring, it's about 150€ here..

the list of devices compatible with oscar is at the bottom of the wiki

[Boudou123]

Thank you Narcil

[Boudou123]

Good day !

I have now used a soft cervical collar and reduced the pressure down to 17 and the results look interesting. I will continue to reduce the pressure by 1cm every night until I see the AHI starts increasing again.

Here is my data from last night. I would like your opinion on the Tidal Volume variations that we can see during some of the sleep stages. On the second plot, are such variations normal and if not , what "normal" variations should look like? Should it be more like what I put on the 3rd plot?

   

Showing more erratic Tidal volume. Is this normal?
   

More erratic (potentially REM sleep) but is this what should be expected vs previous graph?
   

Can you also direct me to a previous resource showing what would a "ideal" data should look like? This will help me understand better what I am trying to chase and compare to.

Thank you again for your help.

[Jay51]

Thank you for posting those Boudou123.  From your experiment, using a collar and lowering pressure produced about the same results as higher pressure and no collar.  

The varying tidal volume at times:  I am not sure what is causing this.  It could be partial obstructions and then recovery breaths that causes your tidal volume to vary so much at certain times or simply REM sleep variations.  That is probably the most likely occurrence.  

Could you describe your medical history please?  Anything in your medical history that could be related to this?  (Heart, lungs, neurological, etc.)?  

I great plan would also be to show this to your Dr.'s.  Show them the variations in tidal volume during the night and see what they think.   

It will be interesting to see what happens when you lower pressure even further.  There is a possibility that your tidal volume becomes more steady at lower pressure.  We shall see.

As far as what would be ideal:  probably a more consistent tidal volume chart with less fluctuation.  But, during REM, like Pete stated before, there can be significant changes in tidal volume, etc.  I hope that the 2 articles do not scare or concern you too much, they state 2 possible reasons for such variation in tidal volume during sleep:  respiratory or neurological abnormalities.  Heart abnormalities can play a part also.  Just for your information.  

Tidal Volume During Sleep

Sleep alters respiratory physiology in various ways. REM sleep, in particular, is the sleep phase with the highest degree of breathing irregularity, both in frequency and respiratory rate. During REM, almost all body muscles, including respiratory muscles, become hypotonic, except for the diaphragm. Therefore, a person relies on the diaphragm to maintain an adequate tidal volume during REM. Additionally, respiratory response to hypoxic and hypercapnic stimuli decreases, not to mention the decreased central respiratory drive, which, along with accessory muscle paralysis, leads to a slight decrease in tidal volume and minute ventilation. The change is usually not prominent in healthy individuals but becomes prominent in patients with preexisting respiratory disease.[7]

Physiology, Tidal Volume

Sasha Hallett; Fadi Toro; John V. Ashurst.

Author Information and Affiliations


Last Update: May 1, 2023.

Sleep-disordered breathing in neuromuscular diseases is due to an exaggerated reduction in lung volumes during supine sleep, a compromised physiologic adaptation to sleep, and specific features of the diseases that may promote upper airway collapse or heart failure.

Sleep-disordered Breathing in Neuromuscular Disease





Loutfi S. Aboussouan
-Author Affiliations

• Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
  Corresponding Author: Loutfi S. Aboussouan
  

17,059112
Metrics
Total Downloads17,059
Total Citations112

https://doi.org/10.1164/rccm.201412-2224CI [b]      PubMed: 25723731[/b]

Received: December 14, 2014
Accepted: February 24, 2015

[Boudou123]

Thank you again Jay for taking the time to share this information.

Regarding your question regarding any pre-existing condition, I have none. I have also just had an extensive health check (Heart Echo, Stress Test, Blood Work) and I am considered in perfect health.

Interestingly last night at 16cm gave a nice 0.2 AHI and no Aerophagia. Bugger that the SD card was in my computer and not on the machine ...

So I will lower the pressure to 15cm this evening and see what happens.

Once I reach a lower threshold where the AHI start to increase, I will stop and see what is the status of the variations in the REM part of the sleep.

More to come soon and thank you again for your support.

[Old Steve]

I run my machine in CPAP mode too and it works for me.  Although, I would suggest that you put your CPAP into APAP mode and use it as a diagnostic tool.  Try a minimum pressure of 12cm with an EPR of 3 and a maximum pressure of 18cm.   I think you might get a better idea of what pressures are stopping apneas and what pressures are allowing them by using the APAP mode.