Most Unusual Night

[wolson]

Lately, my apneas have been scattered through the night. But last night, I had an apnea cluster like I had never seen before. The hourly AHI jumped to over 36! Over the past 30 days, my AHI has averaged about 7.2. Last night overall, I was at 8.62 which I do not consider necessarily statistically deviant from what I have been experiencing. While I have had clusters in the past, I have nt had anything like this.

Has anyone else seen anything like this?

[vsheline]

Has anyone else seen anything like this?

Before getting my ASV machine, perhaps once a month I would see in my machine's data a Cheyne-Stokes Respiration like pattern for up to 25 minutes at a time, causing a CA Index greater than 5 for the whole night.

Then I got the ASV machine about 3 years ago, and I feel more rested when using it than when I use my backup machine, which is an S9 VPAP Auto.

I noticed that the higher the Pressure Support was set, the higher my CAI tended to be, so I kept PS low, less than 2, when I was using the S9 VPAP Auto.

I think my problem is slow circulation, causing the pattern. My pulse is usually in the 40's when asleep, but occasionally it gradually drops into the 30's. I see my cardiologist at least twice a year, with yearly echocardiograms. One day I'll probably need a pacemaker.

[GPSMapNut]

I've seen very similar flow pattern recorded by my DreamStation. In Encore, it showed as Cheyne-Stokes respiration without flagging any individual apneas within the period.

[BKeeper]

Vsheline, your comment above re slow circulation got my attention as I, too, have slow circulation. I see the Cheyne Stokes-like patterns especially as I am trying to adjust to a new mask or pressure. Could you expand as to why low circulation might cause the pattern and how an ASV machine helps?
Thanks,
Dick

[justMongo]

My guess is that slow circulation causes CO₂ to build up. Then a series of big breaths expels the CO₂. And the cycle repeats.

[PoolQ]

Perhaps the pizza you had before going to bed? JK of course, but you could have been dreaming (nightmare) during that hour or something that cause you to toss and turn. This is one night so far. No doubt that you are keeping watch.

This is important "Cheyne-Stokes Respiration like pattern " the "Like pattern" part of it. Cheyne-Stokes is something to pay attention to for sure and I think that it requires a much longer period than you are showing, therefore the "like" flag.

I had those also and the Doctor pointed them out and when I talked about the period length, he responded "well, yes". I had and still have quite a bit of periodic breathing that does not seem to be a problem so far. (I am watching it though)

[vsheline]

Vsheline, your comment above re slow circulation got my attention as I, too, have slow circulation. I see the Cheyne Stokes-like patterns especially as I am trying to adjust to a new mask or pressure. Could you expand as to why low circulation might cause the pattern and how an ASV machine helps?

During hypoventilation, slow circulation adds delay in the feedback loop, resulting in a time period which lasts too long during which the drive to breathe (which is caused by the build up of CO2 in the blood) becomes too strong, leading to hyperventilation, which in turn is followed by a time period which also lasts too long during which the drive to breathe is dialed back and becomes too weak (because too little CO2 remains in the blood after being washed out while we were hyperventilating) which leads to hypoventilation, in a repeating cycle.

The ASV machine stabilizes our breathing by helping us to remain adequately ventilated when our breathing effort slackens or goes away. It does this by increasing the Pressure Support (PS). PS is the amount the pressure is boosted during inhalation to do for us some or all of the work of breathing.

For example, the ASV machine might normally provide a pressure of 10 (an EPAP of 10) while we are exhaling, to keep our airway from collapsing, and might normally provide an additional pressure boost of 3 (meaning PS = 3, resulting in an IPAP of 13) to make breathing easier while we are inhaling.

But if we were to reduce or pause our breathing effort, the machine would notice the change and would increase PS as high as needed in order to maintain only slightly less than our normal amount of ventilation. If PS were increased to 10 or higher (in this example, resulting in an EPAP OF 10 and an IPAP of 20 or higher) this pressure boost during inhalation would usually be strong enough to provide for us all the work of breathing.

[richb]

It appears that you should be on an ASV machine. At least ASV will stabilize your breathing. It may also stabilize your CO2 and O2 which would also reduce CAs and Hypopneas (periodic breathing).

[PaytonA]

I have a question on the flow rate chart on wolson's 3rd chart. each of the two CAs in the middle of the time period has what looks like a small breath in the middle. Is that PRs pressure pulse to determine if the airway is clear or obstructed?

Best Regards,

PaytonA

[wolson]

Good question, PaytonA! Tomorrow, I will ne seeing a pulmonologist, hopefully to improve my treatment. Maybe he can tell me.

One thing I am noticing is that my breathing show more RB as the pressure increases.