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+--- Thread: Can opthalmic beta-blocker increase central apnea events?? (/Thread-Can-opthalmic-beta-blocker-increase-central-apnea-events)
RE: Can opthalmic beta-blocker increase central apnea events?? - SarcasticDave94 - 02-09-2021
I'd say it's your call to drop a whole point or a partial. Drop the PS to 3.0 and see how it feels. Look at OSCAR as well. If it feels worse go back up a few clicks as in .2 or .4.
Yes that's the concept on Hypopnoea. They're roughly a 50-80% strength Apnea. If you're getting more of those than Obstructive Apnea, that's likely from moving pressure up some and it's changing Apnea to Hypopnoea, meaning low pressure needs to go up just a bit more IMO. Then pressure will be enough to combat Hypopnoea. However given these results on that last chart with AHI of 1.X you may want to leave it as is and see what trend you get in a day or so. I'm assuming it's OK on therapy comfort.
RE: Can opthalmic beta-blocker increase central apnea events?? - Sleeprider - 02-09-2021
I don't see any reason to reduce pressure support. There is not a single CA event with the high trigger sensitivity. I'm certain the remaining obstructive apnea are chin-tucks or positional. Flow limitation is practically non-existent so these events just arise out of periodic chin tucks and that is keeping your pressure relatively high.
RE: Can opthalmic beta-blocker increase central apnea events?? - verysincere - 02-09-2021
(02-09-2021, 05:00 PM)SarcasticDave94 Wrote: If you're getting more of those than Obstructive Apnea, that's likely from moving pressure up some and it's changing Apnea to Hypopnoea, meaning low pressure needs to go up just a bit more IMO.
Even with the recent emergence of hypopnea events (as my other numbers have gotten better), my hypopneas are always far fewer than my obstructive apnea events.
Quote:However given these results on that last chart with AHI of 1.X you may want to leave it as is and see what trend you get in a day or so. I'm assuming it's OK on therapy comfort.
I like to change one variable at a time and collect at least 7 to 10 days of data before making the next change.
Thanks for your help!
RE: Can opthalmic beta-blocker increase central apnea events?? - verysincere - 02-09-2021
(02-09-2021, 05:14 PM)Sleeprider Wrote: I don't see any reason to reduce pressure support. There is not a single CA event with the high trigger sensitivity. I'm certain the remaining obstructive apnea are chin-tucks or positional. Flow limitation is practically non-existent so these events just arise out of periodic chin tucks and that is keeping your pressure relatively high.
My sleep position is 100% supine. I was a side-sleeper until I had chronic pain issues at middle-age. (It took many years for the doctors to discover that my strange neurological and pain problems were actually caused by apnea.) Now I find sleeping on my side impossible but I'm basically happy on my back. (It is usually quite comfortable. Plus, it allows elevation to prevent GERD issues---and the more I elevate, the fewer OAs I have.)
I had not considered chin-tucks because of my supine position. I use a relatively flat pillow and I had considered using no pillow at all but spinal specialists apparently generally prefer some kind of pillow in order "to preserve the natural curvature of the neck/spine." (And I have some neck vertebrae which show up as "aged a bit" and some notable stenosis.) Nevertheless, I'm open to suggestions.
I don't know if this provides any clues but whenever I have an outpatient surgery where I'm heavily sedated I always get held overnight "for observation"---because the anesthesiologist usually tells me something like "Your breathing required a lot of monitoring in recovery."
FYI,FWIW: I'm not significantly overweight, I follow a daily exercise regimen, and have a healthy diet. (I'm 6'4" and 203 lbs. Age 65.)
By the way, I had fewer obstructive apneas (and lower AHI in general) before this pandemic when I was able to go to the gym and do very intensive workouts. My home regimen lacks the heavy muscle work of gym machines. I've read a lot of the medical journal articles about heavy exercise and AHI so I plan to return to the gym as soon as I can do so safely. The physiology is not well understood but scientists claim that heavy exercise with resistance weights improves the tone of airway structures and helps counter/slow the airway changes which tend to come with age. Before the pandemic my AHI was usually below 3 but by summer it was drifting up to where 6 to 9 was typical and an occasional night would be above 10. My sleep was also becoming more fractured, and getting more than 5 hours per night was difficult---so I often had to crash during the day to try to fight off sleep deficit. By October I was moved from CPAP (Resmed AirSense) to bilevel (AirCurve.)
Also FWIW: For a while I tried some of the pharyngeal exercises described in the medical literature but decided that singing had many of the same advantages. (I was a crooner long ago and still perform now and then. Producing music makes the exercise routines far less tedious.) I think some of my AHI drop in the past month has come from that muscle tone work.
Thanks much for your input, Sleeprider.
RE: Can opthalmic beta-blocker increase central apnea events?? - Sleeprider - 02-09-2021
The events are in pairs or groups. There is no preceding flow limitation and it seems to meet the pattern we have come to expect. I have seen it in people that sleep on their side and just chin-tuck. With events at 2-4 per hour it's not particularly urgent, especially if event times are short as yours appear to be. Sometimes awareness is the solution.
RE: Can opthalmic beta-blocker increase central apnea events?? - SarcasticDave94 - 02-09-2021
Chin tuck can be from head/neck movement into airway restricting angles or too high/too many pillows can do this as well.
RE: Can opthalmic beta-blocker increase central apnea events?? - verysincere - 02-09-2021
(02-09-2021, 06:42 PM)Sleeprider Wrote: With events at 2-4 per hour it's not particularly urgent, especially if event times are short as yours appear to be. Sometimes awareness is the solution.
That brings up another question. For months now I've been printing my OSCAR report every morning, doing a few calculations, and annotating accordingly in pursuit of discovering trends and what helps/doesn't. Among my calculations is Total-Time-in-Apnea divided by (total CA + OA events) to get an average-apnea-event-duration. That number has tended to be between 20 and 22 seconds per event average. Of course, that average encompasses some events as short as 11 seconds and a few per night which can run in the 40's and 50's---even just under one minute. A 21-sec. average seems kind of high in one sense but I also realize that my machine has to work gradually to increase pressure and address the apnea event. That takes time. But I have no idea how such a duration compares to other people who have a similar AHI. Any ideas on this topic?
This is all very helpful to me.
RE: Can opthalmic beta-blocker increase central apnea events?? - sheepless - 02-09-2021
interesting question. obviously longer events are more problematic so it sounds like a useful metric but to my knowledge not one that's automated by machine or oscar. neither am I aware of any commentary, comparisons or red flag thresholds for average duration, or even max duration. of course we can look at the events list in oscar to see the duration of each apnea. I would be inclined to think my machine settings are not well optimized if I consistently had more than a smattering of events over 30 seconds during cpap use but that's based on nothing more than intuition.
RE: Can opthalmic beta-blocker increase central apnea events?? - verysincere - 02-09-2021
(02-09-2021, 07:44 PM)sheepless Wrote: interesting question. obviously longer events are more problematic so it sounds like a useful metric but to my knowledge not one that's automated by machine or oscar. neither am I aware of any commentary, comparisons or red flag thresholds for average duration, or even max duration. of course we can look at the events list in oscar to see the duration of each apnea. I would be inclined to think my machine settings are not well optimized if I consistently had more than a smattering of events over 30 seconds during cpap use but that's based on nothing more than intuition.
My longest obstructive event last night was 47 seconds. There were also two 34's and a 36. I have attached a screen shot of the event list.
Yes, in my searches of the medical literature (mostly in ncbi but even everywhere else) I have not seeing any discussions of average duration or maximum duration. It would be interesting to correlate durations with SpO2 drops. (That is, an 11 second event is likely to have much less oxygenation impact than a 59 seconds event like I had a few nights ago, obviously. However, in my case somnologists have always commented that I can go a long time without breathing and yet have little to no SpO2 drop.)
I do wish that SpCO2 could be measured as easily as SpO2 (for those of us who like to use sensors of various sorts for our own sleep studies at home.) Obviously, tracking SpCO2 could identify a lot of important patterns.
I don't wear my O2 sensor (and download the data into OSCAR) all that often because (1) my SpO2 is always high and healthy even during my worst apnea events, and (2) my unit goes through AAA batteries quite rapidly.
I wish I could have started OSCAR monitoring back in 2000 when I was first diagnosed. In those days I think my CPAP pressure was something like 6! The fact that nowadays I am over 20 at some point(s) just every night is sobering.
RE: Can opthalmic beta-blocker increase central apnea events?? - verysincere - 02-13-2021
(02-09-2021, 06:42 PM)Sleeprider Wrote: The events are in pairs or groups. There is no preceding flow limitation and it seems to meet the pattern we have come to expect. I have seen it in people that sleep on their side and just chin-tuck. With events at 2-4 per hour it's not particularly urgent, especially if event times are short as yours appear to be. Sometimes awareness is the solution.
Yes, since February 7 the higher Trigger-setting has virtually eliminated my CAs, and so the average of around 3.5 obstructions per hour is looking very encouraging. I've only had a total of THREE CAs in the past six nights. Amazing.
Unfortunately, my obstruction events are not all as short as I might wish. Indeed, last night I had an OA that was 79 seconds long. The night before that included a 59sec. OA. (Moreover, I am waking every morning around 4am and seem to have intermittent and/or shallow sleep after that point on most nights.) I have attached OSCAR captures for those long OA events.