Possible Cheyne Stokes?

[mu50256]

I am having severe sleep issues.  My sleep patterns are incredibly messed up.  I am up all night and sleeping all day.  Some days I barely get any actual sleep no matter how hard I try.  I have tried things like melatonin, magnesium, etc.  My doctor prescribed trazadone and I am still barely getting any actual sleep.  I am in a constant state of exhaustion.  I get confused easily.  I have light headed spells.  I've always had sleep issues, but this is the worst I've ever been. 

I have severe GERD so I am supposed to sleep with my head elevated.  I have an adjustable bed.  I was doing that, but till having issues with potential positional apnea so I have lowered it to where I am only slightly elevated.  It's a catch 22.  I do get more reflux symptoms at night, but my AHI and O2 improved a bit.  I did try a cervical collar, but I found it to be incredibly uncomfortable and I had a harder time falling asleep so I am not using it.

This week has been especially bad.  I have not slept much at all.  I went to bed at 3:00 a.m. last night, but did not fall asleep until nearly 1:00 this afternoon.  When I plugged my card in, I see this breathing pattern throughout my sleep that has me concerned.  Please see attachments. 

I use the Wellvue O2 Insight Pro watch, but I have found inconsistencies with it so I don't fully trust the numbers.  Sometimes it will say my 02 has dropped drastically while I am awake and watching TV.  

Last night I had lowest O2 of 82 and a high O2 of 105.  I had 1 minute and 36 seconds under 90%.   For a while my O2 wasn't dropping below 90 and my AHI was staying below 5.  I don't know why this week has been so bad.  My AHI has been between 5 and 10.  My O2 is dropping into the 80's every night.  My sleep is very fractured.  I wake up a lot throughout my sleep.  

Does this sleep pattern look like Cheyne Stokes?  It was mentioned on my last sleep study that I do have severe sleep apnea with fractured sleep and decreased slow wave sleep and I never reached Stage 4 or REM sleep.  It was pretty bad.  I am on Auto settings, but my prescribed settings are 17 ipap/10 epap. 

Thanks. 

   
   
   

[Jay51]

IMO it isn't Cheyne Stokes.  Why?  Several clues.  1.  Doesn't look like classic CSR with crescendo- decrescendo symmetrical pattern - like some tennis balls or footballs connected by a string.  2.  No CA's involved.  CA's have to be involved in the chain for it to be real CSR.  3.  You have a H right before this, and a cluster of H's right after this.  4.  Your flow limitations rise in almost perfect unison with your breathing pattern.  

Looks like you had a hypopnea.  Cleared your airway a little bit, but not completely.  Then, the airway begins to get more compromised as the H cluster starts.  You only have 4 CA's in the chart.  And all happen way after this particular event (and in the "Sleep-Wake Junk" portion of a chart - beginning and ending). 

I hope this helps.

[Dormeo]

I agree that that isn't CS breathing. It was a period of unstable breathing with repeated arousals followed by a dwindling flow rate. Not restful, but not CS.

Have you looked into cognitive behavioral therapy for insomnia (CBTi)? There's more information here:

https://www.sleepfoundation.org/insomnia...y-insomnia

Yes, you're in a Catch-22 with the GERD and the apnea. I wonder whether your collar was the right size and fit. There's some information that might help you here:

https://www.apneaboard.com/wiki/index.ph...cal_Collar

The next time you post a chart, would you include one that covers the whole night, for context? And would you close the calendar and the pie chart and provide the following graphs in one screenshot:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

[mu50256]

Thank you so much.  I appreciate it.

[mu50256]

Thank you for this information.  I will look into the cognitive behavioral therapy.  I am desperate for help with my sleep. 

I ordered 3 different cervical collars based on the recommended ones from this forum and returned 2 that did not seem like they fit well.  The 3rd one did fit well, but when I laid down, it was bothersome to me.  

I will see if my husband can help with screenshot how you requested it.  I have small monitors so I can only see a few graphs, then have to scroll 3 more times to see all of them so I am not sure how to try to get them all into one screenshot.  I will see if he can help with with that and we can post a couple of different days so maybe you can see my sleep patterns and give me some advice on what I can do differently.  I am having an issue with leaks right now and am waking up often with a lot of mask noise.  I am using a new cushion so I am not sure why this is an issue.  Its been an issue in the past as well, but I thought this new mask would help with that. 

Thanks.
Melanie

[mu50256]

Is this what you are looking for?  Does this help?

Thank you.
Melanie


  jhiklklhkjlhjlkmkjln.pdf (Size: 1,003.67 KB / Downloads: 8)

[Dormeo]

Yes, that does help, thanks. You might try squishing the key graphs a little bit to fit them into one screen shot. You can do that by grabbing the horizontal gray bars that separate them and pushing up on them.

It looks like you have some positional apnea going on, which isn't surprising given your need to have the head of the bed somewhat elevated. If you can find a comfortable collar, that could help keep your airway open. More here:

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[mu50256]

Thank you.  I will play with the graphs.  I didn't realize you could do so many things in there until I started playing around the other night. 

Could mask leaks be a big cause of my issues?  I had a period of time using the same equipment at the same elevation (about 4 inches vs. nearly 12 inches from before), and my O2 was staying above 90 and my AHI was down to 2 and under.  I have a new cushion on my mask, but I am getting so many leaks and I don't understand because nothing has changed.  The other thing that may or may not be significant is that I am having some esophageal swelling right now due to a period of pretty bad reflux that caused a lot of irritation.  It will ease up eventually, but takes some time. Not sure if that could cause more issues as well. 

Thanks. 
Melanie

[Dormeo]

I doubt whether the leaks are directly responsible for your problems, but it's good to avoid large leaks (because your machine can't compensate for them). And even smaller leaks can be a problem if they wake you up.

I also doubt whether the esophageal swelling is directly in play, since it isn't part of your airway. But it sounds tough to deal with, and the discomfort may be messing with your sleep.

You might try re-fitting your mask, in case the new cushion is in some crucial way sitting on your face a little differently. You should be able to find some fitting videos on line.

I really hope you can find a comfortable collar that helps to keep your airway fully open. It'd be worth experimenting with different types and size.