Transition to sleep question.

[estgad]

       

Using resmed AirCurve 10 auto.  1 screen shot shows mode S the other mode vAuto.

In both the graphs begin when I first put the mask on and try to go to sleep. There is a series of apneas obstructed/hypotonia & clear airway/unobstructed (central).

There is that final event and then it is like a switch is thrown and I enter a sleep stage and everything evens out. 

Can someone describe and explain why there are all these apneas as I try to transition into a sleep stage, and is there anything that can be done to make this better? 

Thank you.

[Jay51]

I can relate and will give it my best shot of explaining.  During my PSG, the RT said that just before I fell asleep, my mouth would drop wide open and I would stop breathing.  

CA's during the transition from awake to sleep and then from sleeping to awake can occur because the brain does not perfectly transition from voluntary to involuntary (and vice versa).  It is referred to here as, "sleep wake junk".  It is relatively common (more common than you would think).  

As far as the obstructions and hypopneas, this can occur as the muscles of the tongue and throat, etc. relax and the soft tissues fall back into the airway; either partially blocking or completely blocking it.  

Only CA's can occur; only obstructive event and hypopneas can occur; or both can occur almost simultaneously as your chart shows.  

A machine with a back up rate has stopped the CA's for me during this transitional time (it forces a breath for me).  Also, I wear a soft cervical collar to prevent any obstructions or hypopneas as I am falling asleep.  This seems to work for me and be my best solution to this "dual" problem that is showing up on your charts.  

Also, raising your EPAP pressure a bit more might help stop the OA's and H's if you can tolerate it.   The higher the pressure support and the higher the trigger setting (high, or better yet very high) can help combat CA's also.

[estgad]

Thank you very much for that detailed and informative reply. 

"machine with a back up rate"
Just to clarify you are talking about a timed back up rate where the machine initiates the ipap on its own? 

"soft cervical collar"
Do you have any recommendations for a side sleeper? I am guessing I would want something that would be very thin on the sides with the support under the chin to hold my head upright? 

"raising your EPAP pressure a bit more might help stop the OA's and H's if you can tolerate it"
My next phase will be to start fine tuning the settings, the issue is tolerating pressure, and that is a very big problem that I have with the machines.

Once again thank you for that answer and the description of how the tongue and mouth can be causing those apneas when I try to fall asleep.

[CPAPfriend]

I don't have a confident answer, but instead second what Jay said. The period of transitioning to sleep is often times volatile, irregular, and punctuated with 'events'. PSG techs do not score this period and neither should we. I have seen it be problematic for some patients, where the events wake them, but even so it's usually only once in a while / not a nightly phenomenon. I think Jay's solution is likely the most effective, available solution.

[estgad]

"PSG techs do not score this period and neither should we."

I agree, and I am not concerted with the score, just the issue of not transitioning to sleep.

"I have seen it be problematic for some patients, where the events wake them, but even so it's usually only once in a while / not a nightly phenomenon."

Regretfully I am one of those people where it is problematic, and because I get up overnight it is not just a nightly phenomenon but multiple times during the night. 

I will be starting to drift away and then one of those apneas will hit and it will bring me back to awareness and then I have to start the process all over again. 
On rare occasions it will be dramatic enough to where it brings me fully awake to where I have to just get up do something for a little bit and then go back to bed when my mind has settled down. 

This is the main reason why I started this thread addressing just the transition to sleep. And after reading Jay's response I think this will also address some of the issues I have while I'm asleep.  

[Jay51]

Thank you for the comments CPAPfriend.  Yes, a machine with a back up rate uses Pressure support to initiate a breath.  (most you can set to a specific rate like 12 or 15 breaths per minute, etc.  ASV has a more dynamic back up rate algorithm that can change based on the breathing rate that it detects initially when you mask up and start breathing.  Also, if you don't want to use a soft cervical collar when side sleeping, you could use a rolled up towel and place it between your chin and chest to provide the same function as a soft cervical collar.  Some people even use a "C - shaped travel pillow" turned around backwards.

[estgad]

Thanks Jay.

ASV, another long story in my struggles to sleep. Short version, ejection fraction too low.
So I am trying to get an AirCurve 10 vAuto to do what it can for me.
I turned Easy Breath off, and set the Rise Time to 150ms, and turned the seeing to start the ipap to very high so it doesn't take much at all for it to initiate the breath. This past week has been quite a difference, as I am using it for 6-8 hours a night.

Ok, still turned into long story....

As to the collar, I took some time this afternoon and started reading up on them. I have a follow-up with my sleep doctor Friday morning and after that appointment I am pretty sure I will pick one up at a local pharmacy.