Crazy Breathing Event (Waveform included)

[ScrewtapeJenkins]

So, I finally got a data capable machine. Everything's been going great, but last night I had one of those events where I woke up feeling like I haven't been breathing for minutes. And the waveform chart seems to confirm my feelings. The software exported too big a PDF to be attached, so I uploaded the image here:

Waveform Report

This is what has always driven me crazy about my sleep apnea. My average numbers are always pretty good. my AHIs have been under 2 since I got the machine, and they've been under 4 for the entire year I've been on CPAP. But once or twice every couple of weeks, I have one of these events where it feels like I STOP breathing rather than just struggle to breathe. What the heck is that event and should I be worried? It looks like I stopped breathing for almost a minute, maybe more. Could I have Central or Combo Apnea, or is something else crazy going on?

This is why I always feel like I have severe apnea, but when I'm tested, I'm told I have moderate to mild apnea. I do fine most of the time, then have these crazy events.

[vsheline]

This is what has always driven me crazy about my sleep apnea. My average numbers are always pretty good. my AHIs have been under 2 since I got the machine, and they've been under 4 for the entire year I've been on CPAP. But once or twice every couple of weeks, I have one of these events where it feels like I STOP breathing rather than just struggle to breathe. What the heck is that event and should I be worried? It looks like I stopped breathing for almost a minute, maybe more. Could I have Central or Combo Apnea, or is something else crazy going on?

This is why I always feel like I have severe apnea, but when I'm tested, I'm told I have moderate to mild apnea. I do fine most of the time, then have these crazy events.

Hi ScrewtapeJenkins,

Your events are obstructive. I think you would benefit from trying to eliminate those occasional long obstructive apneas.

Perhaps you only have a problem when you are in REM stage sleep when sleeping on your back, which is usually the very worst case combination for Obstructive Sleep Apnea. Try taking precautions to stay off your back while asleep.

For example, I wear a snug teeshirt with a tennis ball in a pocket sewn right between the shoulder blades or a little higher on my back, so that if I roll onto my back while asleep I will wake up enough to keep enrolling until I am on my other side.

In any case, I suggest you gradually increase your minimum to pressure from the present 4 to perhaps 6 or 8 or higher, and if you are seeing that your pressure is rising to 13, consider raising the max pressure a little.

Keep an eye out for problems caused by high pressure, such as excessive (painful) air swallowing, or an increase in Central Apneas or Periodic Breathing.

Raising the Min Pressure to maybe 1 or 2 cm H2O below your median pressure might help eliminate the RERAs, but bi-level therapy sometimes helps best to eliminate RERAs. Or, some find they do best when their Min Pressure is very close to (or even the same as) their 90 percentile or 95 percentile pressure.

By the way, there is a "My Profile" link at the top of each forum page which we can use to update our profile and update the machine we are using.

Take care and good luck,
-- Vaughn

[ScrewtapeJenkins]

Thanks, vhsine. But are those long apneas particularly dangerous? I've looked at a few waveforms here and I've never seen one that long. It looks like I stopped breathing for a full minute, which is kind of terrifying.

I've already increased my minimum from 4 to 10. I was working with a 10 minimum on that waveform. The weird thing is, my 90% is 11.5. So, I start off with a pressure that's pretty close to what I need. And my max is at 20, which is the highest pressure my machine can give.

Sorry, if it's not already obvious, I'm new to trying to read these graphs.

[justMongo]

You are using reporting software from Respironics; but your profile says you have a ResMed Machine.
And it looks like, from the pressure pulses indicated during those long flow rate stops, that you may be on a timed machine such as an ASV.
Please update your profile in the User Control Panel so one can tell what type machine you are using.

ASVs are used to treat people with mixed or central apnea. I'd report it to the doctor -- your treatment appears less than optimal.

[ScrewtapeJenkins]

Updated, thanks Justmongo. As you hopefully can now see in my profile, I'm using a PR System One Remstar Auto Machine.

What is an ASV machine, and what exactly is a pressure pulse?

[justMongo]

Updated, thanks Justmongo. As you hopefully can now see in my profile, I'm using a PR System One Remstar Auto Machine.

What is an ASV machine, and what exactly is a pressure pulse?

ASV is Auto Servo Ventilation. It attempts to compel inspiration at a minimum timed rate using a pressure pulse to inflate the lungs. It's one or two steps down from an invasive ventilator.

Maybe I'm mistaking those tick marks during your zero flow periods. It may be scoring obstructive apnea or a pressure pulse. Usually an OA is only flagged once in a event. Resp SW is marking approx every 10 seconds during your zero flow events.
(perhaps just the way Resp SW reports OA.)

I tried to download your file; but it required me to sign in with facebook -- and I do not use facebook. I'd like to see a pressure graph along with a flow graph to see what the machine is doing in response.

I think Sleepyhead can read your data --(not 100% sure) have you tried SH?

It's a long flow stoppage. The one that begins near 02:34:30 appears to exceed 60 seconds. Not to scare you; but, I would be concerned. It would be good to know what your blood oxygen levels are doing during those stoppages.

We need some opinions from some folks on the forum who are smarter than I.

[ScrewtapeJenkins]

I looked at my data for the whole night. Looks like I had 3 of those events where I stopped breathing for about a minute, but other than that I had almost no events. My AHI for the night was 1.9, despite the fact that I stopped breathing for about a minute 3 times. And today I feel fairly tired.

This only happens to me about once a month. I thought finally getting an autocpap would stop this from happening. Is it possible I need a machine that can deliver a pressure over 20? My titration at my sleep study was only 14 and my 90% on the machine is about 11.

[retired_guy]

I looked at my data for the whole night. Looks like I had 3 of those events where I stopped breathing for about a minute, but other than that I had almost no events. My AHI for the night was 1.9, despite the fact that I stopped breathing for about a minute 3 times. And today I feel fairly tired.

Yes, I can understand feeling a little pooped alright.

This only happens to me about once a month. I thought finally getting an autocpap would stop this from happening. Is it possible I need a machine that can deliver a pressure over 20? My titration at my sleep study was only 14 and my 90% on the machine is about 11.

If your 90% is sitting on 11 a machine that could deliver a pressure over 20 won't make any difference.

You could slowly bring the minimum up however to drive the 90% above 11. For instance right now you're at 10, so go to minimum of 11 for a few days and see what happens. Then 11.5 for a few days. That sort of thing.

Remember that whenever you make any change your body needs a little while to figure out what to do with it. So don't change more than one thing at a time, and let a few days run by before you do something else.

...and do avoid sleeping on your back for awhile. Raising the head of your bed is also a good thing to do.

[ScrewtapeJenkins]

I thought the whole point of an auto cpap was that it could determine the best pressure for me? If it's setting me at 11 most of the time, wouldn't that indicate that I should be on 11 most of the time?

I guess I don't know how to interpret that 90% number?

[bwexler]

You had a brief break in your graph, followed by a large leak, coinsiding with your flat line.
You may have temporarily removed or dislodged your mask, causing a major leak. The large leak prevents the machine from properly recognizing what is or is not happening, other than the lesk.