help to understand sleepyhead results

[Apnea Infant]

So my therapy has been calmer with a change to P10. 

However am wanting to understand why I have so much CAs and why that might be. Have been reading and re-reading 'how to understand sleepyhead data and would be grateful for some help here. 

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[Gideon]

what did your sleep study say about ca and/or complex apnea.

[Apnea Infant]

Hi Bonjour

Not much really. I get copies of communication between the Sleep Clinic at Guys Hospital under whose care I have been under. Word for word, I have copied the letter of my overnight sleep study at the hospital to my doctor......

.....'Inpatient sleep study demonstrated mild degree of OSA with 7.2 apnoea events occurring per hour of sleep with the majority of those occurring during REM sleep. The patients sleep appeared relatively consolidated with minimal sleep fragmentation and no PLMS were observed. The APAP was initiated 3 hours after the sleep onset and lasted for 6 hours and was generally well tolerated. Despite the presumed mild OSA the therapy titrated up to a maximum pressure of 20cm H2O. Possible explanation would be that since REM sleep increases significantly as the night progresses, so would the severity of the REM OSA, pushing the APAP titration to the maximum pressures. For better CPAP titration we have elected to arrange for her a 2 weeks home APAP trial.'.........

I did receive a report on the home APAP trial from 30th March to 11th April but it must be so well filed as I cannot find it despite turning my room upside down and inside out looking for it, hence the delay in this reply. It did not say much more except that they were happy to set my CPAP at 16.8 cm H2O.

There were no charts, no graphs, no details even to my doctor so you can see that even my GP is treated like a lay person!!!! So it was that which drove me to scouring the internet and came upon this wonderful forum.

I shall ask for further in depth details of the overnight study as well as the 2 week home trial but please do not hold your breadth for its arrival any time soon.

Nobody I have been consulted with at Guys Hospital mentioned much about Centrals or Complex Apnea. I met them at the onset of my own journey and was not knowledgeable enough to question them in depth. I am now 2 months into the 3 months during which they have said I will be monitored but I do not know if I will get a consultation at the end of this period at mid July.

Some questions, do you think the CAs are brought on by CPAP? Do you think this might be reduced by lowering the max PAP of 14cm H2O?What might be the PLMS the hospital referred to?

Have to say, it is not comforting to think that my brain is not triggering 'breathe' despite my airway being open. However the chart seems to show the CA is flagged when the breadth is on 0??

Please help with the interpretation.........thanks.

[Gideon]

That is why the question about the sleep study, Be cause of the lack of mention assume pressure onset CA.

You are fixed but with EPR of 3. Need to try EPR of 0 if not 0 as low as you can tolerate. Effectively you have iPAP 14 ePAP 11. Since ePAP supports obstructives (OA, H, FL and Snores) I would target getting to 11 with no EPR.

Your numbers are good though, you have no reason to change anything if you are comfortable. How do you feel?

[Apnea Infant]

Hi Bonjour

What do you mean when you say.....'Since ePAP supports obstructives (OA, H, FL and Snores) I would target getting to 11 with no EPR'....

Do you mean to target max pressure to 11 and zero EPR?

When I tried IPAP of 12 cmH2O with EPR at 2 on 14th May, I had 64 OSA and 32 CA !! That was when I still was using the FFM. So I do not believe I could be lower than IPAP of 12 .

Yes it does seem that I am doing better currently but just wanted to understand why CAs have increased. CAs were almost non existence when IPAP was at 16.8 for about 4.5 weeks. But the FFM did not suit me at all and with large leaks the therapy was not effective. Dialling IPAP down to 14 with nasal pillows have brought better therapy for the last 3.5 weeks which has been busy with a holiday in 2 different cities and the sleep disturbance that that brought. Last week has also been difficult too with the troubles in London which brought tensions and illness as a result. I would like to stay with the status quo for few more days.

I certainly will try to reduce EPR to 2 say for the next change.

Any other views, anyone?

[Marillion]

Speaking for myself, EPR always brought about the undesirable effect of increased CA events. Once I turned off EPR entirely, my CA events were drastically reduced every time I tested it out. Bonjour's suggestions are spot on, as always. I would suggest at least reducing EPR to 1. You will not notice much of a difference in results or even comfort from 3 to 2.

Your comment about having 64 OSA and 32 OSA at a treated pressure of 12 sounds very suspect to me. Not saying that you are lying at all, just that there has to be some other explanation for those numbers. You are not experiencing near those figures at 14 which is not such a huge jump.

When I have experimented with higher pressures (for example 10 or even 9.6) invariably my AHI scores were always higher with more OA, CA and Hypopnea events than when I finally settled on my "perfect settings" 8.6-15. I now consistently get below 1 every night and most often below .5. Higher pressures do not necessarily equal lower events.

My ultimate recommendation would be to follow Bonjour's suggestion. Try setting the machine to 11 and removing the EPR entirely. Now that you have had a bit more practice with using your machine, you may find these settings easier to tolerate and I suspect you will attain better results.

Keep in mind, there are many things that can influence your sleep and sleep scores. Certainly holidays and sleeping in different locations as well as all the stress those horrible incidents in London must have caused you will definitely have some impact on your sleep.

One last thing. I would also suggest that you follow the instructions in my signature on how to arrange your sleepyhead charts to show us all the data that is useful. Make sure to remove the pie chart and shorten up the graphs to show all the graphs suggested.

[Gideon]

The chart you presented shows CPAP mode Fixed at 14. Your mask pressure shows a range of 14 and 11 (14-3) which implies an EPR of 3. In BiPap it is the Epap, the exhale pressure, that supports obstructive events. Your chart here shows very few obstructive events which means that the 11cm is likely supporting/preventing obstructive events. Also usually EPR triggers CA events so where we see that we try to minimize it or eliminate it. You are doing great number wise so only small changes. IMHO this should be to adjust just the EPR. Longer term this chart implies that a pressure of 11cm should work fine for you. So after the EPR change you should consider small changes down from he 14cm you are showing at now. Your history may contradict this but you don't have any here.

There is no history in this thread which is why we like you to continue posting in the same thread.

[Apnea Infant]

Hi Marillion

I will try to attach the results of May 14th when I had 64 OSAs and 32 CAs with IPAP of 12

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My AHI was 13.58  for that night. I would dearly like to know what caused that blip but whatever that was, those settings did not suit at all. Most importantly I remember how I felt after that night.

[Marillion]

Please read Bonjour's reply just above your post for an excellent explanation on your numbers.

But your most recent posted chart from that bad evening shows strong clusters for the most part which would indicate positional Apnea events were happening that night. A situation whereby your chin was tucked in towards your chest a few times restricting your airway and increasing the odds of multiple events occurring very close together.

In a case like that, usually we would recommend the use of a soft cervical collar to keep the neck aligned and/or possibly changing your pillow if it is of a deep soft variety. You may be making yourself much more susceptible to these positional apneas with the type of pillow you may be using. I would recommend a buckwheat hull pillow or a more firm memory foam pillow. It really helped with my event clusters.

[Apnea Infant]

Thanks for that Bonjour. I understand you much better now. 

I am now better able to manipulate sleepyhead data and have been more directed in my wiki searches. There has been a lot going on in the past 2 months since CPAP therapy-2 trips to Europe, the recent events in London not to mention the election results coming in right now which is also distracting.

My general understanding of my therapy has been darting about due mainly to it not working so well for the first month with the FFM, the leaks causing many awakenings making me feel like the undead despite CPAP therapy.

I started a thread querying whether APAP would be better for me rather than CPAP since my sleep study result was REM apnea @ 20 cmH2O. I felt that thread title would not suit my queries now.

I do look forward to pressure coming down but shall do so with gentle changes as suggested and will report in this thread.