[split] 0.00 AHI with a lot of arousals. What's next?

[Boudou123]

Dear All

I really need help.

I am new to this Board but I have been a steady user of CPAP for the past 5 years.

My initial sleep study revealed Severe Sleep Apnea at 31 AHI (apneas episodes of 2.5 minutes...). I was immediately put on CPAP therapy and with the assistance of my Sleep Dr, we progressively improved the AHI to below 5, going through a combination of different masks and contraptions (mouth leaks, etc), to finally reach a situation where I am not bothered at all sleeping with my CPAP.

Over the past year, my nightly AHI reading have been consistently below 1.5 and on average below 1. According to my machine, my sleep apnea seems to be under control but I feel completely the opposite. I am sure that many of you have had similar experience.

I wake up after 8 hours of sleep, my Airsense 10 shows a AHI of 0.5, and I feel completely tired and this feeling lasts the entire day. Like I am wiped out.

Please note that I have just ran a complete physical exam including blood work and I am deemed to be perfectly healthy. I exercise every day, I eat well, I dont drink, I go to sleep early every day and follow a steady sleep schedule, but unfortunately, my sleep is really terrible.

Another indication that my low AHI may not tell the full story is that my heart rate during my sleep basically increases when I am sleeping vs awake. My REM Sleep is also very low and if you look at the REM sleep portion on Oscar, the data seem quite erratic. This is obviously not normal.

I have shared my CPAP data with a friend who told me that it appears that I may experience several awakening during my REM sleep that the machine is not detecting. He calculated 15 in 30 minutes. 
His hypothesis was that my CPAP was maybe not supporting me sufficiently during the Exhalation Phase and that I should try a BI PAP.

In the following, I will post last night sleep with my CPAP. You will notice that I am using high pressure of 19cm and I have included a V-COM on my line to reduce Aerophagia. I will also post some pics of the zoomed in portion of the REM sleep to get your advise.

   

   

   


Thank you very much in advance for any guidance you may give.

[BoxcarPete]

Do me a favor and drag your Tidal Volume chart up to where snore is and post the screenshot again. If you can fit respiration rate and minute vent in the frame as well that's even better. Sometimes it's possible to correlate REM cycles with respiratory stats, and if I can correlate flow rate with those other stats I might be able to see what's going on. No promises though: without proper EEG, determining sleep architecture is very much a guessing game.

You said you also had heart rate monitoring? Anything that might be compatible with OSCAR?

[Boudou123]

I hope this is what you are looking for.

   

Regarding the heart rate monitoring, unfortunately its not connected to Oscar.

Just one thought, would be so easy for one of the manufacturer to integtate a Heart Monitoring Device to the headgear and have the whole data synchronized in Oscar. I think we would learn a lot about what is happening during our sleep, especially for us, people sleeping under pressure 

[Boudou123]

This is more like it

   

   

[BoxcarPete]

Unfortunately, I am not able to say anything about your REM cycles with any kind of confidence. It's just too hard to tell them apart from partial obstruction/recovery cycles that are interspersed throughout the night. However, my best guess puts your first REM cycle right where it belongs, and nothing too far out of the ordinary after that, but it's FAR from exact, and definitely a guess from what I can tell. Your wearable device is guessing too, using different information so I'm not surprised it's getting a different answer. It's just too hard to tell for sure what's actually happening without any EEG channels.

Sorry I couldn't be more help, but I don't see enough evidence of REM irregularities to draw any conclusions from your charts.

[Boudou123]

Unfortunately, I am not able to say anything about your REM cycles with any kind of confidence. It's just too hard to tell them apart from partial obstruction/recovery cycles that are interspersed throughout the night. However, my best guess puts your first REM cycle right where it belongs, and nothing too far out of the ordinary after that, but it's FAR from exact, and definitely a guess from what I can tell. Your wearable device is guessing too, using different information so I'm not surprised it's getting a different answer. It's just too hard to tell for sure what's actually happening without any EEG channels.

Sorry I couldn't be more help, but I don't see enough evidence of REM irregularities to draw any conclusions from your charts.

Thank you BoxcarPete

I really appreciate your feedback.

So looking at the chart, you would say that the data looks overall acceptable?

[BoxcarPete]

Not really. I don't think it's a good thing that you're having these periods of chaotic and/or partially obstructed breathing with some correlation to heart rate spikes, but I don't think it's related directly to too much or too little REM. Things like this are not terribly uncommon, but they are usually hard to figure out. I hope you find some answers soon, I'm looking for them myself.

[Boudou123]

Anyone else would like to take a crack at this?

I am really in the dark as what to do next and have no resource locally to ask for support.

Thanks again.

[Boudou123]

Can someone could help me understand what is happening physically in the following area of the data (2nd attachment) to decide what is the next course of action regarding my settings?


Thank you for your help.

   

   

[Jay51]

This is just a guess.  I am like Pete in that your chart is hard to interpret.  

I wonder if you fixed pressure of 20 is causing the spikes in flow and tidal volume, etc.  What would happen if you lowered it from 20?  Would you have more OA's?  More H's?  It might be worth a try attempting to lower your pressure.  Try 19.  Then possibly down to 18, etc. and then lower as far as you can balanced against getting any OA's.  Do you wear a soft cervical collar?  Wearing one might enable you to decrease pressure.  

You may be getting so much oxygen with an epap 20, that you have to keep compensating during the night (changes in flow and tidal volume, pulse, etc.).   

This is the only thing that I can think of experimenting with.  If anyone sees anything else, please feel free to post.