My Wife Keep Waking up at Night!

[Sleeprider]

We can only look at what the machine tells us, but in support of the idea these are CA events, there are small fluctuations in flow during the apnea and no recovery breathing, in spite of fairly long duration. Those characteristics are common with CA, while OA tends to show no flow and recovery breathing. What I would encourage you to bring to the doctor's attention, or one that will actually listen to your concerns, is that the respiration rate of 8.6 breaths per minute is uncommon if not incredibly low; and in combination with a low tidal volume of 380 mL results in a very low minute vent of only 3.4 L/minute.

I would like to see your wife tested with a recording oximeter to verify her oxygen saturation during sleep. If the tidal volume, minute vent or respiratory rate cannot be increased, then supplemental oxygen may be requires. Only a sleep test can confirm or refute the presence of CA events which predominate the results here. It would seem your wife suffers from hypoventilation and needs either a ventilation assist like ASV or ST VPAP which can provide higher breath volume and rate, or oxygen supplementation. The need for eiher could be very inexpensively determined by a recording oximeter.

[gumleafau]

Thanks you for your quick response!
Interesting you raised the issue of oxygen saturation during sleep. This question also was also in my mind, so she used the oximeter (Contec CSM50F) on 17 February 2019 and the results attached.
Obviously, by using the Resmed vauto bilevel machine help to improved her oxygen saturation level during sleep. But need further fine tuning! 
Wait and see what the sleep doctor have to say! 

[attachment=10854][attachment=10855][attachment=10857]
  Qximeter Rport 17Feb19.pdf (Size: 116.12 KB / Downloads: 31) [attachment=10859]

[gumleafau]

Last night I curiously set the Resmed Aircurve 10 vAuto of my wife to vpap and pressure setting to 12cmH2O and I was surprised to see there is NO Clear Airway event all night. (The attachment shown an incorrect setting of the machine)

Normally, the machine set to VPAPauto, PS 4.0 over 8.0-18.0 cmH2O, on 31Mar19 1.41 hrs of Clear Airway was detected!
Is that meant the CA event is pressure induced? Is there any setting needed to be adjusted to minimize the event to occur?

Also, I noticed there were clusters of OA shown up on after she woke up during her REM sleep. This happened in both modes of the machine. After that she is having difficulty going back into sleep. Maybe, the OA occurred due to miss alignment of the soft collar, but my wife reckon the collar hasn't moved!

[attachment=11089][attachment=11088]

[Sleeprider]

A lower PS will reduce the incidence of CA events in individuals sensitive to pressure support, however in this case the fixed pressure clearly resulted in a much higher obstructive AHI and more abundant flow limitation. A more fair test of your theory is to set the machine to Vauto mode with EPAP min 8.0, IPAP max 18.0 and PS 2.0. An alternative to reducing PS may be to employ "Enhanced Expiratory Rebreathing Space" (EERS) http://www.apneaboard.com/wiki/index.php...ace_(EERS) . EERS preserves the CO₂ and respiratory drive.

[gumleafau]

I am learning something new everyday in this forum! First time coming across EERS and need more time to understand it.
I read one of your reply posted by halokittie on Resmed Aircurve 10 vAuto or ST, and I have a similar question as well!

My wife has scoliosis and restricted her lung volume and she is getting some test done soon! Her sleep doctor on leave until early May, so she is seeing her GP and try to get a lung function test done somewhere else!

Meantime, I am pretty sure that she will need some assistance in her breathing, with your experience which Resmed Aircurve 10 machine with backup breathing rate support will suited her condition? I asked you this question, because I needed some extra time in shopping around for a new machine for her.

[gumleafau]

Is anybody have any clues why my wife always having clusters of OA near the last few hours of her sleep cycle?
Is the modified soft cervical collar being moved or something else?

[attachment=11274][attachment=11273][attachment=11272]

[Sleeprider]

The obstructive apnea near the end of therapy appears to be most like a positional apnea, i.e. chin-tucking. I suspect this is from a change in position, or how she is using her pillow, and the episode results from her airway becoming occluded due to her head/neck position. This is surprisingly common, and we have written a couple wiki articles dealing with it:
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...Limitation

We often suggest the use of a soft cervical collar to support the chin.

With regard to your question on a bilevel machine with backup rate that is appropriate to assisting your wife's respiratory effort, there are two approaches. Most doctors would probably recommend the bilevel ST (Aircurve 10 ST or BiPAP ST) which stands for "spontaneous/timed". This machine provides bilevel pressure support to a patient's spontaneous breathing efforts, and a timed trigger to IPAP when the breathing rate is not maintained. This is a simple bilevel that does not provide automatic pressure adjustments and produces the same pressure support for every breath. In short, this is not for central apnea.

Given the central apnea that also appears in your wife's charts, you might be advised to try an adaptive servo ventilator (Aircurve 10 ASV). The Aircurve 10 ASV can be set for a range of EPAP pressure of 4.0 to 15.0, and for pressure support from zero to 15 cm. In your wife's case, the minimum pressure support should be higher to assist her breathing, while the maximum pressure support is in reserve to address low volume breathing or central events. The pressure support is "adaptive" meaning it is delivers when needed, as needed. Your wife is currently using a PS of 4.0, and this is in part responsible for the centrals. With the ASV, that minimum could be raised (probably to 5 or 6 cm) and the even higher central event rate would be treated when they occur. As you can see on her charts, the OA clusters are not treated regardless of high pressure is applied, and that is where the soft cervical collar comes in.

[gumleafau]

Thanks Sleeprider for your response for both of my questions!

I have ordered a Dr Dakota Collar for snoring yesterday from Walmart using Shopmate from AustPost.
Hopefully my wife will get a more consistence result after wearing it without much neck pain!

As you recommended, the soft cervical collar definitely help reduced the flow limitation and AHI!

My wife have an appointment with the sleep doctor on 2 May 2019, and I will keep you posted on the outcome!

Meantime, thanks you again for the info on cpap machines on my second last post,  that will keep my mind occupy for a while!

I find the forum have wealth of information, and am learning something new everyday!

[gumleafau]

My wife had an appointment with a sleep doctor 2 weeks ago, and she received the report yesterday from him.

She also had a CO2 Blood test and booked for an appointment for lung function test in 2 weeks time!

In summary, the report said:
1. No hypercapnia;
2. The doctor suspect Resmed Aircurve 10 vAuto over treating her sleep apnea;
    He interpreted the data from the SleepHead in the 95th percentile instead of the Med column.
3. Her tidal volume and minute ventilation is normal for her body weight and size;
4. Agreed with using soft cervical collar to treat her sleep apnea;

I request a bilevel titration test for my wife, and the doctor said depending on the result of the CO2 blood test.
If the result showing no hyercapnia, then such tiration test is not necessary!

My wife still experiencing arousal and central apnea at night. I am still trying to find the right combination
of pillow/soft cervical collar without straining her neck muscle.  I bought her a Dr Dakoda collar, but it makes
her neck strain even worsed!

I attached report from the doctor, including blood test result and the Oscar report of last night for your perusal!

            [attachment=11987][attachment=11988]

[Sleeprider]

Sounds like you are in good hands with the doctor, and the report lends some clarity that there are no concerns for hypercapnea. The current Sleepyhead results show an AHI of 6.5 with nearly even distribution of central and obstructive events. Although the range of pressure is to 18, the Vauto is staying well below those limits, and a maximum pressure of 16 might make your doctor happier. The Dr Dakota wedge is a pretty firm support, and the report was the first awareness we had of the syringomyelia. I would stick with softer and more comfortable approaches to any positional apnea. The current results do not show a strong positional apnea cluster. Overall, it would be nice to see a lower AHI, but these results are okay, and centrals should diminish over time.

Have you tried a lower pressure support of 3?