Periodic Breathing

[Sleeprider]

Your results in the past were over 7-17 AHI.  This looks like an improvement from that point of view.  How is the comfort?

I'd like to try this a few more night and make sure we understand what's happening before making further changes, but this no longer resembles central or complex apnea.  Big improvement, and our next move may be to increase pressure to 8.5.

[jonathan richardson]

Thank you again for the reply and all of your assistance.

The 17 AHI is a misrepresentation due to the wake junk. In that screenshot (and with most of mine) I have highlighted the period where I knew I was not awake. During that period my AHI was zero. I agree to stay your recommended plan and will keep the setting at 8 with the aflex off. I really enjoy that Aflex but I'm sure I'll get used to it.  I may also be inappropriately cutting out areas that are legitimately causing events, I'll give you that, but not much. I wish there was a method in SleepyHead to cut out known wake states. I know I can roll over and hit ramp, etc. and restart, but it's not as easily done as it seems when one is trying to fall asleep.

[Sleeprider]

I think adding Aflex back is certainly something we should do once you establish a baseline for the lower pressure therapy. The whole idea of this is to get comfortable, with more and better quality sleep. I'm not a numbers person, but this was an improvement in continuous therapy. I personally always liked an AFlex setting of 1 better than 2 or 3 with my past Philips machines. and that might be a good way to go.

[jonathan richardson]

Hi Sleeprider,

I took it to 8.5 no aflex. I was able to get 2 hours of sleep on the machine.  Some periodic breathing came back right before I woke up. I was pretty stuffed up as I awoke, so tonight I am going to increase the humidity. However it was nice to get 2 hours in a row.  It looks like there were some leaks associated with my events, but I'm still new at deciphering this.

Do you think there is a chance that the pressure increase from 8 to 8.5 caused the periodic breathing or just coincidental?  

[Sleeprider]

PB is more common in disrupted sleep and near the end of a sleep session. I would not worry about this one.

What is keeping you from getting a full night of sleep? I think we have demonstrated that you tolerate CPAP pressure without EPR much better than variable pressure with EPR. This is actually another indicator that we are dealing with a complex/central apnea problem. Periodic breathing can often occur along with complex apnea, and while it's not serious in the form shown in your charts, is another indicator of the unstable respiratory regulation that goes with that. I'm always concerned that coaching borderline complex apnea cases may delay or prevent you from getting a better form of therapy. If you were suffering through 20 AHI every night, you would be on ASV much quicker than if we get you down to 2.5-3 AHI.