[Health] Interpreting sleep study results, EERS enhanced expiratory rebreathing space

[JoeyWallaby]

I have

• Nocturnal mouth breathing (I tape my mouth before sleep)
  
• Mild to moderate GERD
  
• Moderate to severe nocturnal bruxism
  
• Family history of sleep apnea (mother was diagnosed with obstructive sleep apnea in her forties and is successfully managing it with CPAP)
  
• Anatomical risk factors for sleep-disordered breathing (mildly narrow palate, mildly high dental arch)
  

I don’t have

• Daytime bruxism
  
• Daytime nasal/breathing issues
  
• Insomnia (fall asleep within 10-20 minutes usually)
  
• Nocturnal awakenings (only very occasionally, not a common occurrence)
  

I had a sleep study done because of my nocturnal bruxism and persistent day-time tiredness/fatigue. I’m normal weight, young, exercise almost every day and eat relatively healthy, there’s no obvious reason for me to be tired/fatigued during the day.

The sleep doctor wasn’t concerned with any of the sleep test results, said CPAP wasn't clinically indicated and told me to go on my way; my issues persisted. Based off my interpretation of everything, it seemed that I had some form of sleep-disordered breathing worth treating.

I tried a CPAP and an APAP, my tiredness and grinding improved. I suffered aerophagia initially which mostly subsided upon further use. However, I would often wake up and subconsciously take off the mask during the night; I believe due to issues with exhaling against such a high pressure when using APAP or just having an event when using CPAP.

I don’t have any OSCAR/sleepyhead data as I haven’t used CPAP in a while (lost the data) but when I did; the vast majority of the events I suffered were hypopneas followed by clear airways and lastly obstructive. AHI improved using APAP, however, incidence of mask removal during the night increased. I tried using EPR and not using EPR, it did help to use EPR.

Conclusion: I’ve attached the sleep study, is there anything particularly interesting to note in it? Based off the sleep study and provided data, what do you think I have, and do you think I would do better with an auto bilevel instead of an APAP?

Note esophageal manometry was not used, as such RERAs were not scored.
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[Sleeprider]

Joey, you say that you tape your mouth due to nocturnal mouth breathing. Did you do this during the test as well? There are a number of things that willl affect your sleep and sense of well-being. The bruxism might be treated with a dental device, and may avoid the need for taping.

Your test suggests an AHI of 5.4, but you have 14.1 arousals per hour, and half of these are respiratory related. A complicating factor is that all apnea are central, so the diagnostic of mild obstructive sleep apnea, while typical, may not describe what is going on in your case. Your sleep study included about 6 hours of sleep, and that 's not bad for a sleep clinic. Many of us have much longer sleep onset latency and shorter sleep witht he disruptions of a test. You sleep on your back nearly all the time. I don't think that is a problem, but very little positional change through the night. Nothing to worry about in terms of oxygen desaturation, so that looks pretty good.

You're not feeling sleep is refreshing, so it's a tough call. Your doctor called it by the book and said no treatment. I guess if you want to try CPAP, you're on your own. It may or may not help. To be honest there is no compelling argument from the data either way.

[JoeyWallaby]

Joey, you say that you tape your mouth due to nocturnal mouth breathing. Did you do this during the test as well?  There are a number of things that willl affect your sleep and sense of well-being.  The bruxism might be treated with a dental device, and may avoid the need for taping.

Your test suggests an AHI of 5.4, but you have 14.1 arousals per hour, and half of these are respiratory related.  A complicating factor is that all apnea are central, so the diagnostic of mild obstructive sleep apnea, while typical, may not describe what is going on in your case. Your sleep study included about 6 hours of sleep, and that 's not bad for a sleep clinic.  Many of us have much longer sleep onset latency and shorter sleep witht he disruptions of a test.  You sleep on  your back nearly all the time.  I don't think that is a problem, but very little positional change through the night.  Nothing to worry about in terms of oxygen desaturation, so that looks pretty good.  

You're not feeling sleep is refreshing, so it's a tough call. Your doctor called it by the book and said no treatment. I guess if you want to try CPAP, you're on your own.  It may or may not help.  To be honest there is no compelling argument from the data either way.

Thanks for the advice Sleeprider.

I did not tape my mouth during the sleep study. I do wear a bruxism splint to protect my teeth, however my grinding is pretty severe so my teeth are being prematurely worn irregardless. I mouth breath irregardless of wearing the splint. I know there's other dental appliances which purport to stop bruxism rather than just protecting your teeth but the cost of making, fitting and adjusting is in the multiple thousands I'm sure.

While I slept on my back during the test, I actually usually side/stomach sleep. I find it difficult to fall asleep on my back, I think the reason I slept on my back during the test was all the wiring making it difficult to side/stomach sleep. I don't know how accurate their scoring is regarding spontaneous vs respiratory arousal. 

My main reason for thinking about CPAP is that I don't know of any good treatment options for my issues (bruxism, poor sleep quality) aside from some form of CPAP.

I pulled out the old S9 Elite last night, pressure 10, EPR 3.
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[JoeyWallaby]

This is the full data for that night https://www.mediafire.com/file/idfrjvaf8...P.zip/file (password is apneaboard, go to January 4 2008. date is messed up, don't know why).

[mper6794]

Hi, Joey,
pretty much all your information, including your charts, suggest/matches with an UARS/FL-bearing person. Usually people may take care of UARS/FL by trying, and in this order: (1) change sleep position to stomach or side, (2) nose dilation strips, (3) dental device, and the golden standard (4) BPAP.
I would suggest you start up your journey by reading (if not already) everything you can on Dr. Steven Park's free articles in the internet.

Good luck

[Sleeprider]

The event types and frequency using the S9 Elite at 10/7 pressure using EPR 3 are consistent in type and frequency with your sleep test.  The close-up of the flow wave show flow limitation as suggested by MPER, even with the 3-cm pressure support from EPR.  My concern with higher bilevel pressure support would be the frequency of CA would likely increase, and it is already twice the level of your hypopnea.  From this chart compared to your sleep test, we see a reversal of the CA and H indices and hypopnea is very low.  It's possible that we could control hypopnea to lower levels by using CPAP, and reduce CA by either reducing EPR or using some enhanced expiratory rebreathing space (EERS)  http://www.apneaboard.com/wiki/index.php...ace_(EERS) .  Read the linked wiki and let me know what you think.  These are not a difficult DIY solution if you are handy.

[JoeyWallaby]

Hi, Joey,
pretty much all your information, including your charts, suggest/matches with an UARS/FL-bearing person. Usually people may take care of UARS/FL by trying, and in this order: (1) change sleep position to stomach or side, (2) nose dilation strips, (3) dental device, and the golden standard (4) BPAP.
I would suggest you start up your journey by reading (if not already) everything you can on Dr. Steven Park's free articles in the internet.

Good luck

The event types and frequency using the S9 Elite at 10/7 pressure using EPR 3 are consistent in type and frequency with your sleep test.  The close-up of the flow wave show flow limitation as suggested by MPER, even with the 3-cm pressure support from EPR.  My concern with higher bilevel pressure support would be the frequency of CA would likely increase, and it is already twice the level of your hypopnea.  From this chart compared to your sleep test, we see a reversal of the CA and H indices and hypopnea is very low.  It's possible that we could control hypopnea to lower levels by using CPAP, and reduce CA by either reducing EPR or using some enhanced expiratory rebreathing space (EERS)  http://www.apneaboard.com/wiki/index.php...ace_(EERS) .  Read the linked wiki and let me know what you think.  These are not a difficult DIY solution if you are handy.

I used a borrowed APAP last night (Min pressure 10, EPR 3) which reduced hypopneas to 0, but as you've mentioned, increased clear airway/central apneas. I'll try EPR 2 tonight. I'd definitely like to try EERS, I'll see what I can put together with the mask I'm using  (AirFit N20 Classic). Would the whisper swivel valve used in the wiki examples fit with standard 15mm ClimateLine tubing?

Here's the charts and data (password apneaboard, day 13 October 2019). https://www.mediafire.com/file/36vc5wpza...t.zip/file
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[Sleeprider]

Everything is standardized with 22 mm fittings and will fit with standard tubing. Just keep the tubing to a reasonable lenght (6-12"). If you create too much rebreathing space, you won't get enough air exchange. So as long as you're not talking about a full length of tubing, then yes, standard tubing works. Corr-a-Flex is commonly used with ventilation in hospitals, it's cheap, and seems to fit on 22 mm fittings.

[JoeyWallaby]

Great, thanks sleeprider.

I tried EPR 2 last night. Here's the charts and data (password apneaboard, day October 14th 2019) https://www.mediafire.com/file/a7lz9pm3w...2.zip/file
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[Sleeprider]

Let's take the minimum pressure all the way back to 7.0 and keep EPR 2 and see how it goes. Your numbers are giving me information, but I'm just as interested in how you qualitatively feel.