hypopneas

[Suzanne]

Well as I approach my one year anniversary as a CPAP user, there are some new things happening. I had a very difficult time adjusting at first - ended up developing insomnia during a very difficult time, finally got over that and started feeling decent. I have been exercising and have lost almost 20 pounds.
Now I have between 0 and 2 apnea events per night, but my hypopneas have gone up to as many as 30 per night. My AHI has gone up from as low as 1.1 up to as much as 6.4, with the new average of 3.0. I understand that this is not a "bad" average number, but I do not feel well again. I have frequent headaches, my energy is low and I am sleepy again in the daytime.
There have been no changes in pressure or humidity in several months.
Why would the number of hypopneas suddenly go up? Is this significant, or should I just worry if the apnea numbers go up?
I looked up the definition and see that hypopnea means slow or shallow breathing, I just don't understand how this fits with the whole obstructive sleep apnea diagnosis at this point when there are almost no flow limitations or apneas showing up on my charts?
Does anyone have any ideas?

[zonk]

Hypopneas and headache seems to me pressure is not optimal, followup with your sleep doctor

Edit: does the Icon score obstructive and central sleep apnea separately

[iSnooze]

If 20 pounds is a lot of weight loss for you, then you possible need to have your pressure adjusted. As Zonk recommended, see your sleep doctor.

[PaulaO2]

Hypopneas happen when the airway is starting to close. Not quite a full obstruction but enough that the airways is limited.

It really sounds like you need to see the sleep doc.

There's a few possible things happening.

Your weight loss, if it is big compared to your overall weight, could have resulted in you needing less pressure. But that doesn't make sense if you are having so many hypopneas. Sometimes a pressure that is higher than you need can result in increased number of central events which is why Zonk asked if the Icon can report the difference. But I don't think hypopneas happen with central events.

So, yeah, go see your sleep doc as soon as you can.

[Suzanne]

Thanks everyone for your comments.

The Icon Premo reports apneas, hypopneas, flow obstructions and leek levels. It does not report central vs obstructive events separately. It tracks compliance hours also. There is a feature called "sense awake". All of my hypopneas occur during the time that the graph is indicating that I am sleeping.

My sleep doctor discharged me a few months ago.

No matter what I reported to her about how I was feeling or how many reports I showed her, she focused only on the one number - the 30 day average AHI. She told me that as long as it was under 5, there was "nothing to worry about".

The thing is, I happen to like feeling well. So when I start to feel daytime sleepiness (I have a long commute to work), I do get worried. I don't like going around with headaches either.

I know that if I call and can get in to see her, which might take a while, she will say the same thing again since we have had several appointments that have had the same message.

I started out at about 236 pounds and am now down to 216, so not a huge weight loss. I was 220 when I saw the sleep doctor last, so where I am now is not much different that at my last appointment.

I just want to feel OK and am doing everything I can in terms of diet, exercise and 100% compliance with my CPAP therapy.

She gave my supplier a range from 6-8 for my prescribed pressure. I have been at 6 for the "sense awake" pressure level and 7.5 for the "asleep" pressure level for a few months now. The increased hypopneas have been occurring during the last 3 weeks or so.

Any ideas?

Thanks!

[zonk]

i would experiment turn sensawke off. sensawke is not EPR, all sensawke does drop pressure when the machine sense you,re awake so really you can do without as your pressure low anyway. now its bedtime for me

[Shastzi]

There is a possible solution, but it will cost you some $$. (what doesn't these days?)
Get a pulse oximeter for your finger (wristwatch style) use that for a week or two and see if you are getting any
blood O2 desaturations.
That will give you one piece to the puzzle.
The other thing you can do is get your own Resmed S9 autoset or the equivalent from Respironics.
Using the built in data logging capabilities and SleepyHead software you can build a case for yourself
that you really DO need to make some kind of change to your therapy. If any pulmonary issues come up they may be be manfested in the data as well. (racing heart, hyperventilation issues, leaking issues that can be traced to mouth breathing, etc)

Then you will be able to generate hard copy printouts to shove under the Doc's nose and say SEE! I TOLD YA SO!

Sometimes the Doc needs to be swatted with a 2 X 4 in able to get their attention.

Arm yourself with knowledge and you will begin to get results in your favor.

Good luck and stay in touch.

[PaulaO2]

Your sleep doc did what??

He can't "discharge" you. You still have sleep apnea. OMG. I can't believe that.

Get thee to another sleep doc, one that will listen, one that sees beyond the numbers.

In a way, yeah, the 30 day average is a good indicator, just like diabetics have the A1c. But the AHI is not everything. There's so many factors that go into a good night's sleep.

I agree about the 2x4 but I don't think his skull is what you should hit.

Icon is readable by SleepyHead, I think. It is a free download. Give it a try and get a complete look at your data. The flow limitiation will show if it is truly a HI event or if the Icon is reporting it incorrectly. I'm a visual person. I want to see graphs, not just numbers. If all I had were numbers, I'd use a spreadsheet to make a graph. Yeah, I'm weird.

[Shastzi]

What PaulaO2 said.

[zonk]

Do you sleep on your back, if so try sleep on your side
Tennis ball stuffed in a sock sewn/safety pin on back of pyjama top or bumbag filled with tennis balls may prevent rolling on your back


This from ResMed about Auotset algorithm but does apply in titration situation

How do the AutoSet devices handle hypopnea events?
AutoSet devices respond to obstructive hypopnea events when they are associated with flow limitation or snoring. Hypopneas that are central in origin (related to your central nervous system, not physical obstruction) should not be treated with increased pressure
http://www.resmed.com/au/service_and_sup...c=patients