Central SA / disordered breathing / hypopneas / POTS / air hunger

[Madhi]

Hello

Relevant health stuff (or key words for anyone else searching for these things): Central Sleep Apnea, hypopneas, POTS/dysautonomia, cerebral hypoperfusion, air hunger, breathing pattern disorder

After using CPAP for about a year and a half for central sleep apnea (where hypopneas are my main problem), I have just discovered OSCAR, and it's amazing.  The graphs pick up my disordered breathing so well!

Specialist had me trial CPAP just in case it helped with the CSA, knowing that in most people it doesn't.  Turns out it did actually reduce my hypopneas a bit, so I've been using it for over a year now.  I see a CPAP clinic nurse a few times a year, but she just looks at an automatic summary report that gives her a summary of average numbers.  No one has been looking at my actual daily info!
I'm fascinated by what I'm seeing, and wanted to post my graphs, because it would be interesting to see if anyone has seen other graphs that look like mine.  Or if people with a similar health profile to mine might see something similar in their own data.


Quick explainer for those interested:
When I'm awake I have hyperpnea (excessive deep breaths), as a result of cerebral hypoperfusion (reduced blood flow to brain) and air hunger.
This is the body's natural response to reduced blood flow to the brain.  Chemoreceptors in the neck mistake it for hypocapnia (reduced c02), so the body responds with hyperventilation or hyperpnea, and constricting cerebral blood vessels, which just makes it worse of course.  Air hunger means every waking minute I feel like I'm suffocating and can't get enough air even though technically I am.

To the graphs:
I have included 4 graphs as example.  3 of them are pretty normal and average for me (AHI of 8.27, 9.59, and 10.69).  One of them was a bad night (AHI 18.69) just for comparison.
The AHI 9.59 night I'll attach to another post below accompanied by a zoomed in section.

I find it interesting that it picks up hypopneas when I'm awake around the same rate as when I'm asleep.  I'm not surprised by this, as I often find myself holding my breath and have to remember to keep breathing.  It's validating to actually see it.

Because of my hyperpnea (excessive deep breathing), it's really obvious when I fall asleep lol.  Just look at the Tidal Volume, Resp Rate, Minute Vent, Inspiration Time and Expiration Time.  They all have sudden and drastic changes all at once.  Once asleep, my body starts breathing really shallow in comparison to when I'm awake!


Question:  Does this look like possible 'positional' hypopneas?  I've been reading a bunch of posts and sometimes see comments about that.

[Madhi]

On this example night (AHI 9.59) from a few nights ago, I have also selected and screenshotted the 30 minute window where I fell asleep, where the sudden change in breathing occurs right in the middle.
Here are some of the changes just in that 30 minute period from the graph.

MY TIDAL VOLUME
(Calculated ideal tidal volume from apneaboard wiki gave me a range of 359-480 ml/kg)


My awake range is super high, which I'm not surprised by, given I have hyperpnea.  Sleeping range seems a bit low though.

Awake: 450-1018
Asleep: 250-320  


MY INSPIRATION TIME

Awake: 1.7-6.6 sec  (excessive, but again not surprised)
Asleep: 1-2.1 sec

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This has all motivated me to get another referral to see the sleep/respiratory specialist again, because I think there's more to talk about...

[Jay51]

Your tidal volume appears to be the most concerning thing IMO.  I have used several ventilators during sleep.  A machine that can "assure" a certain "x" tidal volume with every breath has helped even out my breathing at night (tidal volume, respiratory rate, minute ventilation, etc.).  

Machines with "back up" rates can trigger a person to breathe when their respiratory rate gets too low.  You rate overall, judged by my OSCAR median seem to be ok.  This is just a thought for the future.  

Discuss these above issues + take some OSCAR charts to your next appointment.  

Here is the reading on positional apnea that might help you some with all the H's:   

• 5.3Positional Apnea                                                                                                                                                                                              Things like lowering pillow height, side sleeping vs. back sleeping (with something under chin to keep it from tucking), and even using a soft cervical collar could help this.  
  

[SarcasticDave94]

Any chance you know what any sleep study tables of event type and count were telling the doctor? Asking because of the Central Apnea you referred to. Not much of the CA in these OSCAR charts.

[Sleeprider]

I'd like to see several zoomed images of the flow rate at a resolution of 3-4 minutes so the flow wave is clearly visible. I can assure you that for an individual with hypopnea and CA events, the Philips CPAPs seem to produce much higher event rates than Resmed which has more tools to work with like EPR, and with the Vauto, Ti min, Ti max and trigger and cycle controls. The purpose of seeing the zooms is to get an idea of the inspiratory flow morphology, particularly flow limitation. FWIW, if you move to ASV, the slow deep breathing while awake is going to be disruptive to the targeting of respiration rate and volume. If you can consciously attempt to moderate that with a higher, shallower respiration rate, that might be helpful. Your explanation of the variable breathing is interesting, but unless you have some assessment of blood profusion, I think it may be more likely some form of loop gain. https://www.apneaboard.com/wiki/index.ph...entilation