[Health] Trying to understand my therapy better.

[Ghandi]

Hi everyone,

I have been using cpap therapy sucefully for over 3 months now.My nigths are usually seperated by 2 consecutive sessions. And i'm averaging 8 hours of sleep per nights. At the sleep study my AHi was 9. My average AHI is 2.5. C-flex plus is at 3.

In the past week i have noticed that when i'm sleeping on the rigth side my AHI was lower (1.5). Because my lesft nostril is always breath better. Even when i dont have any congestion at all. that way the obstructives apneas have decreased.

Hypopnea 0.98
Obstructive Apnea 0.28
Clear Airway Apnea 0.28
Vibratory Snore 0.14

I noticed that my OA were very long. IT's ranging between 30 seconds and 45 seconds. I though the cpap machine was supposed to restart my breath as quickly as possible to avoid oxygen decrease or micro arousal, disrupting my sleep cycles. I mean if i stopped breathing for more than 40 seconds it must disrupt my sleep? Is there any way to improve that? Is the machine doing the job properly?

My hypopneas are usually a big long breath followed by shallower breathing which at some point becomes a flat line for about 5 seconds. then the flow restarts.

My CA are shorter than my OA. somtimes the flow doest stop and if it does it's like for 5 or 9 seconds. I think it's combines with the breath becoming shallower.

Yesterday out of the blue my ahi went to 3. And some nigths it can go near 4. I did't feel any congestion (well yesterday i was really tired, completly out of energy when i went to bed)


Hypopnea 0.71
Obstructive Apnea 1.07
Clear Airway Apnea 1.19
Respiratory Effort Related Arousal 0.12
Vibratory Snore 0.36
Periodic Breathing 0.35

What preoccupies me is I've had a periodic breathing event. It was the first time. What does it mean ?

Sometimes i feel well rested. But sometimes i'm feeling sleepy. I do more R.E.M for sure because i make lots of dreams. So my sleep cycles seems to be be better but i'd like to optimize it to avoid sleep disruption as much as possible.

The technician isn't really heplfull and does't even like me to play with the confort settings and i'nt really happy about the fact that i'm monitoring my data via sleepyhead,so i though i'd post my story here. Any comment, feedback, tips or trick or insights would be apreciated.

Thank you.

[Terry]

I have been using cpap therapy sucefully for over 3 months now.My nigths are usually seperated by 2 consecutive sessions. And i'm averaging 8 hours of sleep per nights. At the sleep study my AHi was 9. My average AHI is 2.5. C-flex plus is at 3.

. . .

I noticed that my OA were very long. IT's ranging between 30 seconds and 45 seconds. I though the cpap machine was supposed to restart my breath as quickly as possible to avoid oxygen decrease or micro arousal, disrupting my sleep cycles. I mean if i stopped breathing for more than 40 seconds it must disrupt my sleep? Is there any way to improve that? Is the machine doing the job properly?

If you're waking up when you don't want to, chances are you're not breathing or not breathing well. While your numbers are low, it's still entirely possible that you're not doing well, since the AHI is an average. One or two apneas don't sound like much, but if you stop breathing for an entire minute, it's going to suck.

The machine should fix your OAs. If it isn't doing this, the lower pressure limit probably isn't sufficient.

Even auto machines don't actually fully do what the name implies, since the pressure increase seems to be limited by what the designers thought they could get away with, without waking you up. They're also reactive instead of pro-active, which means that it needs to detect an event before it even tries to fix it.

Also, they have no memory of previous nights, so if 7 wasn't enough, and it worked it's way up to 14, the next night, it would start off at 7 again and do the same thing. Also, if the machine is set for 7 - 20, for example, and you need 16, it's probably never going to get there before it detects a lot of apneas (this is just my personal experience with a PR System One), so even if it does eventually fix them, it will have taken a while, and you're still going to feel not-so-great in the morning.

Adjusting the machine so that it starts out at the pressure required to prevent apneas has made a huge difference in how I feel. It's the difference between being punched by Mike Tyson and saying "Hey stop that!" or not being punched in the first place. 8-)

I have no professional qualifications in this area, but have had a lot of success monitoring my data with SleepyHead and adjusting my starting pressure accordingly.

Here's a link for periodic breathing: http://www.apneaboard.com/wiki/index.php..._breathing

"Clear Airway Apnea" is also called "Central Apnea", and is where nothing is blocking your breathing, you just "forget" to breathe. If these become a problem, your doctor may need to switch you to a different machine that knows how to handle the problem, since pressure increases won't fix this.

Terry

[Ghandi]

Thank you Terry!

I forgot to mention i'm on fixed pressure.
I called the technician talk about how long my OA are. And that they should be treated. She said it's normal as long as my AHI is under 5. She told me that the machine still fixes most of the apneas.

They are not willing to help %$/"?%"?%**

So i'll have to talk to my pneumologist about it. He is the one changing the rx. I have an appointment in november.....
He is open minded.

Also i'm in Canada and the technician threatened that my pneumologist could stop treating me if i ever played with the pressure settings. They said he stopped seeing patients for that

[robysue]

I noticed that my OA were very long. IT's ranging between 30 seconds and 45 seconds. I though the cpap machine was supposed to restart my breath as quickly as possible to avoid oxygen decrease or micro arousal, disrupting my sleep cycles. I mean if i stopped breathing for more than 40 seconds it must disrupt my sleep? Is there any way to improve that? Is the machine doing the job properly?

CPAP and APAP machines are NOT ventilators. In other words, when you are not breathing, these machines will NOT try to trigger an inhalation to make you breathe.

And even if they did, the pressure they generate is NOT enough to "blow" a collapsed airway open.

The way CPAP works is that the small amount of additional air pressure makes it harder (but NOT impossible) for the airway to collapse in the first place. And by making it harder for the airway to collapse, the CPAP prevents the vast majority of the events from happening in the first place. There is no expectation that a CPAP will prevent all the events from happening. (Even people without OSA can have a few obstructive apneas every now and then.)

Now, I'm not a doctor and I don't know how common it is for OAs to last as long as you say many of yours do. And those really long OAs may indeed be a problem. That's something you should bring up with your sleep doc (NOT the tech) in my opinion. The doc may recommend a pressure increase in an effort to make it even harder for your upper airway to collapse if the length of the OAs is a concern.

My hypopneas are usually a big long breath followed by shallower breathing which at some point becomes a flat line for about 5 seconds. then the flow restarts.

We need to see this.

But a couple of things to keep in mind: These may or may not be real Hs that would be scored on a sleep test: The big long breath itself may indicate a (spontaneous) arousal and the shallower breathing pattern that follows may be a normal "sleep transition pattern." And in that case the EEG data on an in-lab sleep test might indicate the event started in WAKE and is not part of sleep disordered breathing at all. In other words, it's possible that some of the things your machine is recording are not real sleep disordered breathing hypopneas at all.

And given your low HI (0.98) this pattern is not repeating dozens and dozens of times each night, and that too indicates this may just be a normal response to falling back asleep after a spontaneous arousal/wake that is too short for you to remember in the morning.

My CA are shorter than my OA. somtimes the flow doest stop and if it does it's like for 5 or 9 seconds. I think it's combines with the breath becoming shallower.

A few CAs scored here and there are nothing to worry about. Many of them may not even be "real" in the sense of being something that would be scored on an in-lab sleep test. This is particularly true if the CAs are being scored at times during the night when you are likely transitioning to/from sleep.

Yesterday out of the blue my ahi went to 3. And some nigths it can go near 4. I did't feel any congestion (well yesterday i was really tired, completly out of energy when i went to bed)

Our sleep is not the same night after night after night. And sometimes it's just plain worse than usual.

Sometimes we can find a reason for a random bad night or two. And sometimes we can't. A long term poster on another forum jokingly refers to these random bad nights as "visits from the aliens"

In my own data I've noticed that my usually good AHI often increases dramatically a couple days before I come down with a nasty head cold or the flu. It's reliable enough for me to regard a sudden increase in AHI as being an early heads up that I'm probably coming down with something.

Periodic Breathing 0.35

What preoccupies me is I've had a periodic breathing event. It was the first time. What does it mean ?

This is NOTHING to worry about. Again, even normal people have a bit of periodic breathing every now and then. And 0.35% of one random night spent in PB is "a very small bit" of PB.

Technically PB is nothing more than a pronounced waxing/waning breathing pattern where the cycle repeats every 1-2 minutes for a long enough period to actually be detected. PB becomes an issue if (and only if) the amount of time in PB is really excessive, is occurring on the vast majority of nights, and is frequently accompanied by CAs or Hs (or occasionally OAs) being scored at the nadir of almost all the breathing cycles. In this case, central sleep apnea may be the problem. Significant amounts of PB can also be an issue if the patient has moderate or severe congestive heart failure. In this case, the cause of the problem is the heart disease (not sleep disordered breathing) and the effective treatment of the heart disease usually fixes the PB problem.

The technician isn't really heplfull and does't even like me to play with the confort settings and i'nt really happy about the fact that i'm monitoring my data via sleepyhead,so i though i'd post my story here. Any comment, feedback, tips or trick or insights would be apreciated.

Learn to endure the wet noodle whippings and/or request that a different tech be assigned to work with you.

[robysue]

So i'll have to talk to my pneumologist about it. He is the one changing the rx. I have an appointment in november.....
He is open minded.

Call the pneumologist's office and request that your name be placed on a cancellation list.

Also i'm in Canada and the technician threatened that my pneumologist could stop treating me if i ever played with the pressure settings. They said he stopped seeing patients for that

Talk to the pneumologist about this issue. Call his office and ask for a "call back" from the pneumologist. And then tell him exactly what you were told and find out from him whether he has serious objections to your changing the settings on your machine.

Finally I'll also throw in my own two cents:

You've been PAPing for only 3 months. And your data indicates the machine is doing a good job of controlling the number of events you are experiencing. But you have concerns about the lengths of some of those events and you are not yet feeling better consistently.

I would urge some caution about changing the pressure settings on your machine without feedback from the pneumologist. (I'd also ignore the unhelpful tech as much as possible.) And I would counsel you to not change the pressure settings on your machine until you know you understood all the following:

• The data on your diagnostic sleep study: How bad is the untreated OSA? What kinds of events do you have when not using a PAP mahine? And how bad is the untreated sleep fragmentation?
  
• The data on your titration study if there was one: How was the prescribed pressure setting determined? What was the AHI at that pressure setting? How long was that pressure setting tried?
  
• The way the PAP is supposed to work when it comes to treating OSA. And you need to understand what kinds of problems a pressure increase might fix and what kinds of problems a pressure increase is NOT likely to fix.. And you need to understand and appreciate what kinds of problems can be triggered by increasing the pressure setting.
  

[Terry]

Also i'm in Canada and the technician threatened that my pneumologist could stop treating me if i ever played with the pressure settings. They said he stopped seeing patients for that

I'd call his bluff and tell the pneumologist that you don't appreciate the technician threatening you, and that he could probably find a provider that's better for his patients, but then I respond poorly to threats, so I might not be a good role model.

[Ghandi]

Wow a lot for all that information. You guys are very helpfull

I'll call and see what they can do to get a anpointment before. In public health care sometimes they have to prioritize. So even on the cancellation list the spots fill pretty fast for ppl having follow ups for hyperplasia per example. I'll kepp my fingers crossed

In the meantime i'll learn to understand the sleep report more efficiently.

robysue, like you are advising i will stay away from pressure settings untill i understand everything it can impact.

My sleep stydy had mostly OS. Mostly when i was on my back. And it could last has long as 50 seconds.
My titration was done at home with the machine. It was set on auto-pap ranging from 4 to 7. The machine got to 7 and my ahi was 2.5 and then it went back at 6 and my ahi went up to 3. When i told this to my doctor he decided to put the pressure tp 7 even if the titration was indicating 6. He turned the c-check off saying it's algorythm was sometime off.

Cant wait to see if tonight goes back to normal because it looks like the Aliens visited me last night

My hypopneas are usually a big long breath followed by shallower breathing which at some point becomes a flat line for about 5 seconds. then the flow restarts.

We need to see this.

When i get home i'll post some examples of my HI. So maybe you can help me distiguishe the real sleep disordered breathing hypopneas.

I,ll post some example of my CA and OA as well, if you dont mind. Maybe to help me pin point when i could be transitioning to/from sleep and dismiss those events.

robysue
If you dont mind i can even send my data. Or just screenshots. As you wish. I'm thrilled about this discussion.

I noticed you are using multiple softwares for the reports. Does it help you get more accurate? Will i be ok only using sleepyhead?

[trish6hundred]

Hi Ghandi,
WELCOME! to the forum.!
It's great to hear that you want to understand your therapy better.
Call the doc that you said was open-minded and ask him about changing your pressure and explain the problems you are having.
Hang in there for more responses to your post and best of luck to you with your CPAP therapy.

[Terry]

I called the technician talk about how long my OA are. And that they should be treated. She said it's normal as long as my AHI is under 5. She told me that the machine still fixes most of the apneas.

That's a very dismissive attitude and is unfortunately pretty widespread. Make sure you tell them you're still not happy.

5 might be OK for you, on the other hand there are a lot of other factors involved and it might just as easily be horrible. It's almost unfortunate that the AHI measurement became popular because it's not a really good rating for how well you're doing. It's mostly a number that seems to be used by insurance companies to determine who they'll pay for.

It's like someone telling you that you should be happy because your average bedroom temperature is 68F, when in it's actually 118°F all day and 18°F at night. The average is 68, but that's not useful information.

You're entitled to a good night's sleep and I wouldn't settle for less.

Terry

[Ghandi]

Hi Ghandi,
WELCOME! to the forum.!
It's great to hear that you want to understand your therapy better.
Call the doc that you said was open-minded and ask him about changing your pressure and explain the problems you are having.
Hang in there for more responses to your post and best of luck to you with your CPAP therapy.

Hi trish6hundred,
Nice to meet you!!!