New - trying to figure this all out

[patrol]

Hi-- I've had my machine for 3 months now, and have got the AHI down to around 5 -- when I met with the Dr who prescribed this- after the study he just basically said "Here you need this"  See you next year.  Well- it's working great and I feel a million times better-- but I'm trying to get a better understanding of what is actually happening so I can think about how to fix it.....  If I break down into a seconds chart-- all the apneas look real similar.... after a pattern of breathing fine, I exhale , half inhale, and stop for between 10-20 seconds....  I think it's a Central Apnea but I'm just guessing based on what I have read.

Any comments appreciated! I'm trying to figure out this chart thing-- that is how to add it inline and it's not easy lol. I'm going to keep trying though.

[attachment=3253]

[patrol]

I would post a second - but I haven't figured out the post chart limit issue--

[Melman]

Your AHI isn't horrible but there's room for improvement. We will be able to help you better if you organize your charts as described here:

http://www.apneaboard.com/wiki/index.php...ganization

As for posting images use Imgur as described here:

http://www.apneaboard.com/wiki/index.php...pnea_Board

Your off to a good start with a good machine. With the right data the members of the forum will help you get your AHI down

[trish6hundred]

Hi patrol,
WELCOME! to the forum.!
Hang in there for more answers to your questions and good luck to you with your CPAP therapy.

[PoolQ]

so some questions and answers
What is the difference between central and obstructive? only the cause and not the breathing pattern. The CPAP machine can and does test to see which is happening, this is how it flags them in the report. Some may say they can tell by the waveform, I don't doubt that they can, but I cannot.

Trust the machine to flag them correctly. to get technical you have the CPAP machine looking into the hose-mask-nose/mouth, if it's obstructive then this is as far as it goes-because it is obstructive. If it's a central than you have the same thing BUT instead of ending as stated you have your lungs at the end of the path. This presents a big difference between the two for the machine to detect.

Also remember centrals can be "fake" caused by the machine itself. Have you ever been driving down a road, driving fast and stuck your head out the window? Suddenly getting the high pressure wind in your face causing you to catch your breath? A change in CPAP pressure can cause the same reaction, looking like a central-no effort to breath with an open airway when the machine tests for it.

Your numbers are good and you are sleeping well.

"what is actually happening so I can think about how to fix it" fix what? do you want AHI of 0? Do you want to sleep better?

[Sleeprider]

Patrol, it looks okay, but I think you will do better narrowing in your pressure range a bit from your current 5-15. I am going to suggest you increase the minimum pressure to 7.0. This should address some of the OA that we see in your example graph at the beginning of the night. If you are not seeing pressures above 12 that seem to serve any purpose, you might as well set the maximum pressure at 12. I'm not sure we will address the CA events, since these may be related to sleep disturbance from leaks, or could be mild complex apnea, but the general strategy is to keep fluctuations and maximum pressure to a minimum, You're not using EPR so that is not a contributor. I suspect if you used EPR you would have more CA events.

Overall, this is pretty good. You have a healthy tidal volume, minute vent and respiratory rate and seem to have dialed things in pretty good. I would like to see the graphs sized so we can see leaks, flow limitations and snores as they give us some valuable information. Mask pressure is not really needed at this point.

[patrol]

Thanks for the input everyone-  I guess I don't even know what I want-- really I think I already got it --in that I feel so much better.  I'm still a little in shock that I have felt like crap and been tired for 30 years - like my whole adult life-- and have been thru different drugs-- incl amphetamines, anti depressants, psychiatrists, etc..etc... and the whole thing ends up being something I knew I had the whole time-- and such a simple answer and treatment.

Part of the mystery to this was that anytime a doctor asked me how I slept- I would say I sleep all the time-- don't have any problem sleeping and I really didn't think I did !  I slept everywhere!  But then later I find out I was stopping breathing 80 times and hour and not actually sleeping at all!!  It wasn't until a student nurse was sitting in on a regular checkup and he picked up on it.  

So after all that, I do want to learn as much as I can, as in what is happening with my system exactly - I'm not sure I understand it correctly in that my brain is not telling my body to breath I guess-- and since the Dr. did not explain anything at all -- I'm interested in learning more.


This forum is great!

[Hydrangea]

Thanks for the input everyone-  I guess I don't even know what I want-- really I think I already got it --in that I feel so much better.  I'm still a little in shock that I have felt like crap and been tired for 30 years - like my whole adult life-- and have been thru different drugs-- incl amphetamines, anti depressants, psychiatrists, etc..etc... and the whole thing ends up being something I knew I had the whole time-- and such a simple answer and treatment.

Part of the mystery to this was that anytime a doctor asked me how I slept- I would say I sleep all the time-- don't have any problem sleeping and I really didn't think I did !  I slept everywhere!  But then later I find out I was stopping breathing 80 times and hour and not actually sleeping at all!!  It wasn't until a student nurse was sitting in on a regular checkup and he picked up on it.  

So after all that, I do want to learn as much as I can, as in what is happening with my system exactly - I'm not sure I understand it correctly in that my brain is not telling my body to breath I guess-- and since the Dr. did not explain anything at all -- I'm interested in learning more.


This forum is great!

I totally agree!!!!

My husband would ask me "How did you sleep?" and I would ALWAYS respond "Like a rock."  It was so annoying... I didn't WHY he was asking, until a LONG time later he told me that I gasp and choke when I sleep.  Of course, I have to wonder why he didn't tell me sooner.

But yeah, I can't recall ever feeling well-rested or refreshed-upon-waking in my life.  So why did it take almost 40 years to get a diagnosis?!  Very frustrating.  But I'm trying to concentrate on the positive, and just be grateful I got it figured out as young as I did!  We're the lucky ones here on this board - we've figured it out!

[DeepBreathing]

I'm not sure I understand it correctly in that my brain is not telling my body to breath I guess

That's a central apnea. There are two basic types - central and obstructive. Obstructive apneas occur when your upper airway collapses during your sleep. This can be one or all of your tongue falling back, soft palate slumping down or your throat constricting. In this condition you are trying desperately to breathe, but the airway is physically obstructed and you're unable to do so. Eventually you awake with a gasp, gulp in air and (most times) fall back to sleep.

A central apnea is quite different. Putting it very simply, your brain measures the amount of CO2 in your blood. When it reaches a certain threshold, it sends a "breathe now" message to the lungs. In central apneas this message is either not sent or not received, depending on your specific circumstances. So your lungs basically "forget" to breathe until the brain finally wakes up the the fact that something's gone wrong. As I said, this is putting it very simply (cos I'm an engineer, not a doctor).

Have you ever been driving down a road, driving fast and stuck your head out the window? Suddenly getting the high pressure wind in your face causing you to catch your breath? A change in CPAP pressure can cause the same reaction, looking like a central-no effort to breath with an open airway when the machine tests for it.

No - I've never been stupid enough to stick my head out the window when I'm driving fast.    It's not quite like that - a lot of people experience central apneas when they first start on CPAP because the levels of CO2 get disturbed and the brain can't initially accommodate to the changed circumstance. In most cases the centrals will go away after a week or two or three. If they persist and are frequent enough to be troublesome, then alternative therapy may be required. This may be by fine tuning your pressures and EPR or if that doesn't work then going onto an ASV machine.

Resmed machines detect the difference between an obstructive and central apnea (clear airway) by means of the forced oscillation technique (FOT). When it detects an apnea it sends a series of rapid low pressure pulses and measures the return echo. From this it can determine if your airway is open or closed (obstructed). You can see the FOT in action by zooming in on an apnea event and seeing a wriggle in the pressure trace.

[attachment=3257]

The machines are pretty darn good but not perfect and can sometimes return false positives. They can also record false clear airway apneas when you're in the wake / sleep transition phase.

[patrol]

I'm not sure I understand it correctly in that my brain is not telling my body to breath I guess

That's a central apnea. There are two basic types - central and obstructive. Obstructive apneas occur when your upper airway collapses during your sleep. This can be one or all of your tongue falling back, soft palate slumping down or your throat constricting. In this condition you are trying desperately to breathe, but the airway is physically obstructed and you're unable to do so. Eventually you awake with a gasp, gulp in air and (most times) fall back to sleep.

A central apnea is quite different. Putting it very simply, your brain measures the amount of CO2 in your blood. When it reaches a certain threshold, it sends a "breathe now" message to the lungs. In central apneas this message is either not sent or not received, depending on your specific circumstances. So your lungs basically "forget" to breathe until the brain finally wakes up the the fact that something's gone wrong. As I said, this is putting it very simply (cos I'm an engineer, not a doctor).

Have you ever been driving down a road, driving fast and stuck your head out the window? Suddenly getting the high pressure wind in your face causing you to catch your breath? A change in CPAP pressure can cause the same reaction, looking like a central-no effort to breath with an open airway when the machine tests for it.

No - I've never been stupid enough to stick my head out the window when I'm driving fast.    It's not quite like that - a lot of people experience central apneas when they first start on CPAP because the levels of CO2 get disturbed and the brain can't initially accommodate to the changed circumstance. In most cases the centrals will go away after a week or two or three. If they persist and are frequent enough to be troublesome, then alternative therapy may be required. This may be by fine tuning your pressures and EPR or if that doesn't work then going onto an ASV machine.

Resmed machines detect the difference between an obstructive and central apnea (clear airway) by means of the forced oscillation technique (FOT). When it detects an apnea it sends a series of rapid low pressure pulses and measures the return echo. From this it can determine if your airway is open or closed (obstructed). You can see the FOT in action by zooming in on an apnea event and seeing a wriggle in the pressure trace.



The machines are pretty darn good but not perfect and can sometimes return false positives. They can also record false clear airway apneas when you're in the wake / sleep transition phase.

Thank you deepbreathing.  That helps me understand it.   I can see this can get technical -   I'm going to research more and probably will be back with a question or 2.