Advice for Clear Airway AHI of under 5

[padster]

Have you made any progress?

Hey Liz, it's been over 2 weeks and the Centrals are a little lower, between 1 and 3, when they were between 2 and 5 previously, but even after using a 4cm CPAP setting, the OSAs are still almost non-existent, which is why i posted a new thread asking about whether such a low pressure can fully knock out OSAs in viewtopic/t80934/Is-it-possible-for-4cm ... -OSAs.html

Not sure what else to do. I thought i would try this new setting for a week or two before reporting back, and it appears there's a marginal improvement, but the overall situation of OSAs+No-Centrals in the sleep study vs Centrals+No-OSAs while on CPAP is still puzzling. My last resort is to have a full sleep study done with EEG to see if it can provide a clearer picture.

Hi padster!

Try this simple experiment. While at your desk after doing something that you love to do for at least five minutes (look at favorite pictures or whatever) breath out gently and then stop and count seconds - - until you feel the urge to breath --- until the first diaphram muscle pull against your willfully closed airway. If time to urge to breath is over ten seconds and if time to diaphram muscle pull is longer than 15 seconds then consider that what you are dealing with may be simply a more healthy chemoreflex system that the average CPAP user. "Centrals" as you call them here are simpy times when you do not breath at night even though your airway is clear. It is not necessairly a bad thing at all. Indeed, it may be an indicator of health.

Simply, something to think about,

Todzo

Hi Todzo, yes that's a very interesting thought. I'm not too sure about the 2nd part "until the first diaphram muscle pull against your willfully closed airway", but that urge to breathe is often over 10 seconds especially if my mind is focused on something else. When i do the experiment and think about breathing, then there's an urge to breathe at about the 7-9 seconds mark, but i'm quite sure that normally it can go over 10 seconds when i'm concentrating on something.

For example, when in bed and with the CPAP running, before falling asleep, there are quite a few times when i feel the mask vibrating a little (i presume that's when its approaching 10 seconds or when the gush of air is about to kick in) ... and i find myself thinking, hey, i don't feel like i need to breathe yet, so why's this machine getting all frantic. So, i guess i may have a tendency to hold my breath or take longer than average pauses between breaths at times.

I think i also have a shallow breathing habit, where i only find myself taking deep breaths when i consciously think about it. Now, together with this shallow breathing, when i breathe out, it can be quite slow and prolonged, to the point where in the final few seconds of the exhale, there can be very little air coming out ... and i'm wondering whether the CPAP machine is even able to detect these final few seconds when i exhale very lightly .... because if it can't, and i add these 2-4 seconds onto the 5-7 seconds when i stop breathing in between breaths, it may start to account for the Clear Airway events i'm getting. Furthermore, if we factor in another few seconds of extremely light/shallow breathing in after the pause in between breaths, i'm seriously wondering if this could be the cause of my Clear Airway events.

Does anyone know if there has there been any discussion or analysis on whether (extremely) shallow breathing could be causing Clear Airway events for CPAP users?

[JohnBFisher]

... Does anyone know if there has there been any discussion or analysis on whether (extremely) shallow breathing could be causing Clear Airway events for CPAP users? ...

By definition, slow and shallow breathing is hypoventilation and not central apneas. However, this is an example of where a machine might get it wrong. It might score a hypoventilation (if it is slow enough) as a CA event.

If this remains an ongoing issue, you may need to talk with a pulmonologist. I suspect that therapy (breathing exercises) would help improve your performance.

[Todzo]

Hi padster!

Try this simple experiment. While at your desk after doing something that you love to do for at least five minutes (look at favorite pictures or whatever) breath out gently and then stop and count seconds - - until you feel the urge to breath --- until the first diaphram muscle pull against your willfully closed airway. If time to urge to breath is over ten seconds and if time to diaphram muscle pull is longer than 15 seconds then consider that what you are dealing with may be simply a more healthy chemoreflex system that the average CPAP user. "Centrals" as you call them here are simpy times when you do not breath at night even though your airway is clear. It is not necessairly a bad thing at all. Indeed, it may be an indicator of health.

Simply, something to think about,

Todzo

Hi Todzo, yes that's a very interesting thought. I'm not too sure about the 2nd part "until the first diaphram muscle pull against your willfully closed airway", but that urge to breathe is often over 10 seconds especially if my mind is focused on something else. When i do the experiment and think about breathing, then there's an urge to breathe at about the 7-9 seconds mark, but i'm quite sure that normally it can go over 10 seconds when i'm concentrating on something.

For example, when in bed and with the CPAP running, before falling asleep, there are quite a few times when i feel the mask vibrating a little (i presume that's when its approaching 10 seconds or when the gush of air is about to kick in) ... and i find myself thinking, hey, i don't feel like i need to breathe yet, so why's this machine getting all frantic. So, i guess i may have a tendency to hold my breath or take longer than average pauses between breaths at times.

I think i also have a shallow breathing habit, where i only find myself taking deep breaths when i consciously think about it. Now, together with this shallow breathing, when i breathe out, it can be quite slow and prolonged, to the point where in the final few seconds of the exhale, there can be very little air coming out ... and i'm wondering whether the CPAP machine is even able to detect these final few seconds when i exhale very lightly .... because if it can't, and i add these 2-4 seconds onto the 5-7 seconds when i stop breathing in between breaths, it may start to account for the Clear Airway events i'm getting. Furthermore, if we factor in another few seconds of extremely light/shallow breathing in after the pause in between breaths, i'm seriously wondering if this could be the cause of my Clear Airway events.

Does anyone know if there has there been any discussion or analysis on whether (extremely) shallow breathing could be causing Clear Airway events for CPAP users?

Hi Padster!

I believe there is a strong misunderstanding about breathing in our society. Yes we do need to breath. No, we do not need to breath a lot.

In days past (think about 60 years or so back) air usage of 3 liters per minute (lpm) was often measured at rest most of the time. Today it is pushing past 6 lpm as an average.

After working on Optimal Breathing Training (as I call it) where I use a pulse oximeter to find the air use rate (breathing rate) which brings about the lowest heart rate while holding exertion constant I find myself a bit shocked at how little air is needed to keep the SpO2 levels above 94%. I also note that my nose is a lot happier, my feet are a lot happier, and the rest of me feels better as well when breathing at a rate which produces the lowest heart rates. Now a stuffy nose means breath less, sneezing now makes me stop breathing for a time and sets a lower rate. This summer I not only enjoyed the visual beauty of our flowers and trees, I enjoyed their olfactory beauty as well!

If I recall Padster, you mention doing good exercise and all. Your pressures are low and the original AHI seems to have gone away with even lowest pressures. It may be that you are indeed healthier than the average OSA patient.

If I were you and had the bucks I would obtain one of the new pulse oximeters with not just heart rate and SpO2 percentage measured but “perfusion” (amount of blood in the finger) measured as well. If the events you have at night do not produce blood oxygen desaturations I would worry a lot less about them. If the perfusion level stays the same or increases somewhat I think I would find them not a threat. Perfusion would tell, rather indirectly, if the event aroused you. An arousal is often accompanied by a stress reaction which pulls the blood to the core and so away from your finger. If that reaction is not there it is very likely you did not have an arousal and the “event” is not a real event. You are sleeping fine and simply giving your breathing systems a bit of rest with no ill effects. Perhaps your breathing reflexes have detected a bit too much breathing and are compensating with a pause. Either way they are not events negative to health.

Well now, I gotta go find one of those new pulse oximeters I noted actually on these forums. I now know I really need one. Funds are always an issue but this is important to me.

May we all have a lot of fun!!

Todzo

[padster]

... Does anyone know if there has there been any discussion or analysis on whether (extremely) shallow breathing could be causing Clear Airway events for CPAP users? ...

By definition, slow and shallow breathing is hypoventilation and not central apneas. However, this is an example of where a machine might get it wrong. It might score a hypoventilation (if it is slow enough) as a CA event.

If this remains an ongoing issue, you may need to talk with a pulmonologist. I suspect that therapy (breathing exercises) would help improve your performance.

That's interesting. If hypoventilation may be flagged as a CA event by these home machines, it could be relevant to me. I just read that hypoventilation may lead to too much CO2 (By definition it causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis.), but in my sleep study, my O2 sats were ok at about 96% ... do you know if high/good O2 stats rule out hypoventilation or not necessarily?

It's good to hear that breathing exercises may be a solution (rather than meds). I'm going to look into Todzo's Optimal Breathing training as well. When seeing a pulmonologist, do you know of any specific tests/exercises i should request for ie a 'lung function test'? I find it's useful to know what to ask when visiting medical professionals.

[padster]

I believe there is a strong misunderstanding about breathing in our society. Yes we do need to breath. No, we do not need to breath a lot.

In days past (think about 60 years or so back) air usage of 3 liters per minute (lpm) was often measured at rest most of the time. Today it is pushing past 6 lpm as an average.

Hey Todzo … that's really interesting that we use double the amount of air now compared to only 60 years ago. If you have any links/resources to share, i'd really like to find out more about the topic. I wonder if it's because our unhealthier bodies are 'using' the air more inefficiently now (and hence we need more of it) or whether it's caused by the poorer quality air that we breathe these days.

After working on Optimal Breathing Training (as I call it) where I use a pulse oximeter to find the air use rate (breathing rate) which brings about the lowest heart rate while holding exertion constant I find myself a bit shocked at how little air is needed to keep the SpO2 levels above 94%.

A few months ago, i did bookmark a bunch of sites (ie breathing.com/optimalbreathing.com) when researching on 'breathing for better health' and have been meaning to spend more time learning about optimal breathing exercises and related topics such as meditation. But since i came across sleep apnea, had a sleep study done and got a CPAP machine, i've been engrossed in analyzing the data and finding out as much as i can about sleep apnea related issues. So thanks for pointing me back onto the importance of training to breathe better.

I thought that regular and deeper breaths are needed to maintain good SpO2 levels, and that my shallow breathing is generally unhealthy, so i'm really surprised to hear you mention "how little air is needed to keep the SpO2 levels above 94%" … presumably this is only after one has mastered the art of 'optimal breathing'?

If I were you and had the bucks I would obtain one of the new pulse oximeters with not just heart rate and SpO2 percentage measured but “perfusion” (amount of blood in the finger) measured as well. If the events you have at night do not produce blood oxygen desaturations I would worry a lot less about them. If the perfusion level stays the same or increases somewhat I think I would find them not a threat. Perfusion would tell, rather indirectly, if the event aroused you. An arousal is often accompanied by a stress reaction which pulls the blood to the core and so away from your finger. If that reaction is not there it is very likely you did not have an arousal and the “event” is not a real event.

I think that's sound advice and it makes sense. As you can see from my posts, i've been overly focused on whether the S9 data is correct and the effectiveness of home sleep studies. From what you've mentioned, i hope an oximeter which measures perfusion as well will provide sufficient information to put my mind at rest or confirm a need to get a full lab-based PSG.

Well now, I gotta go find one of those new pulse oximeters I noted actually on these forums.

I've just done a quick 2 minute search and Google doesn't come up with many options. Perhaps there's a better place to find them. This is the only one i've come across so far when searching for "buy pulse oximeter with perfusion":

Finger Pulse Oximeter OLED USB w/ Heart rate monitor, Perfusion Index, Internal Memory & Analysis Software Suite by Contec at Amazon
http://www.amazon.co.uk/Oximeter-Perfus ... B004LKANQQ

Contec appears to be one of the more prominent/affordale brands around when it comes to Oximeters, so maybe this is an option to consider. It's certainly not cheap though.

Are there any others that you've got your eye on?

[JohnBFisher]

... It's good to hear that breathing exercises may be a solution (rather than meds). ... When seeing a pulmonologist, do you know of any specific tests/exercises i should request for ie a 'lung function test'? I find it's useful to know what to ask when visiting medical professionals.

I know that it makes a difference due to my vocal background. In addition to choral music, I was a speech and theater minor. The choral music background included training during summer camps (many, many moons ago) at the Westminster Choir College. Part of what they taught was that all too often in our modern world we develop a habit of shallow breathing. They emphasized diaphragmatic breathing - using the diaphragm to drive our breathing. It takes time and exercise to develop this as a habit, but it does increase the depth and quality of our breathing.

Unfortunately, I am not aware of any specific tests. However, I would possibly suggest that you request a referral to a speech therapist, who should be able to help you implement an exercise regimen that will develop better breathing habits. Please understand this is something that even with concentrated work will take six months to a year to develop into a normal breathing pattern for you. But you should see an improvement over time.

Hope that helps.

[Pugsy]

http://www.pulseoxstore.com/Downloadable-Pulse-Ox.html

I found this when I was check for pulse oximeters that do perfusion index.
The CMS 50H. I don't know if that would be extensive enough for your needs. Kevin's software instructions that he sends out with his pulse oximeters are superior though. Makes things a whole lot easier.
$130...not cheap but not nearly as expensive as I thought it would be.

[Lizistired]

Pugsy, my 50H has an perfusion index on the screen, but it doesn't record any data. I think the 50i might but I haven't checked.

[Pugsy]

Pugsy, my 50H has an perfusion index on the screen, but it doesn't record any data. I think the 50i might but I haven't checked.

So you can spot check it but no recording through the night I assume? Hmmm. Maybe someone could send Kevin a note and ask him to confirm if the 50i would record perfusion during the night to show up on the software reports.

[Lizistired]

Correct. I just tried to check his website and it wouldn't load. I was wondering if there might be a newer software or firmware available.

EDIT, Apparently not on the "i" either.

■With SpO2 value and pulse rate value of storage, the storage data can be uploaded to computers

http://www.contecmed.com/paypal/product_show.asp?id=125

[padster]

... It's good to hear that breathing exercises may be a solution (rather than meds). ... When seeing a pulmonologist, do you know of any specific tests/exercises i should request for ie a 'lung function test'? I find it's useful to know what to ask when visiting medical professionals.

I know that it makes a difference due to my vocal background. In addition to choral music, I was a speech and theater minor. The choral music background included training during summer camps (many, many moons ago) at the Westminster Choir College. Part of what they taught was that all too often in our modern world we develop a habit of shallow breathing. They emphasized diaphragmatic breathing - using the diaphragm to drive our breathing. It takes time and exercise to develop this as a habit, but it does increase the depth and quality of our breathing.

Unfortunately, I am not aware of any specific tests. However, I would possibly suggest that you request a referral to a speech therapist, who should be able to help you implement an exercise regimen that will develop better breathing habits. Please understand this is something that even with concentrated work will take six months to a year to develop into a normal breathing pattern for you. But you should see an improvement over time.

Hope that helps.

Yes, your comments have been helpful, thank you John. It's good that you shared how these exercises may not produce an immediate effect and that it could take up to a year, so that i do it with the mental preparation of sticking to it for quite some time before expecting results. As Todzo shared about his Optimal Breathing Training, perhaps monitoring heart rate and SPO2 levels before/during/after the exercises may provide some indication of how the regimen is progressing.

One thing does come to mind … i read that our breathing is controlled by different systems when we're awake and asleep (autonomic nervous system vs central?). If one trains to improve diaphragmatic breathing, i presume it will directly be relevant to our breathing when we're awake, but i wonder if it will it also spill over to our breathing habits while we're asleep.

[padster]

Pugsy, my 50H has an perfusion index on the screen, but it doesn't record any data. I think the 50i might but I haven't checked.

Thanks for sharing Liz, I would have probably jumped in to buy it, only to realize later that there's no recorded data to work with. It seems like the 50i has been around for a year or two as you noted in viewtopic/t57464/CMS-50I.html … unfortunately, there's yet to be any info on how someone has successfully used it to track perfusion data and correlate it with their CPAP info. Seems like Todzo is on the case though.

EDIT, Apparently not on the "i" either.
http://www.contecmed.com/paypal/product_show.asp?id=125

Although it mentions "Real-time data can be transmitted to computers", that's probably only referring to the SpO2 value and pulse rate.

If the data can already be viewed, surely it shouldn't be a huge problem to record it together with the other info. Hopefully.

[JohnBFisher]

... If one trains to improve diaphragmatic breathing, i presume it will directly be relevant to our breathing when we're awake, but i wonder if it will it also spill over to our breathing habits while we're asleep. ...

It will not impact respiratory drive and/or obstructions. So, if you normally obstruct, it won't change that. If you have central apneas, it won't change that. What it will tend to do is allow your diaphragm to work more effectively. You will be more inclined (even during sleep) to breathe more deeply. While it's good and will help (since if your airway is open and you are breathing you will get more air with less effort). Still it will NOT impact other issues with your breathing during sleep.

Hope that is clear.

[padster]

... If one trains to improve diaphragmatic breathing, i presume it will directly be relevant to our breathing when we're awake, but i wonder if it will it also spill over to our breathing habits while we're asleep. ...

It will not impact respiratory drive and/or obstructions. So, if you normally obstruct, it won't change that. If you have central apneas, it won't change that. What it will tend to do is allow your diaphragm to work more effectively. You will be more inclined (even during sleep) to breathe more deeply. While it's good and will help (since if your airway is open and you are breathing you will get more air with less effort). Still it will NOT impact other issues with your breathing during sleep.

Hope that is clear.

Very clear indeed, thank you John.

[Todzo]

... If one trains to improve diaphragmatic breathing, i presume it will directly be relevant to our breathing when we're awake, but i wonder if it will it also spill over to our breathing habits while we're asleep. ...

It will not impact respiratory drive and/or obstructions. So, if you normally obstruct, it won't change that. If you have central apneas, it won't change that. What it will tend to do is allow your diaphragm to work more effectively. You will be more inclined (even during sleep) to breathe more deeply. While it's good and will help (since if your airway is open and you are breathing you will get more air with less effort). Still it will NOT impact other issues with your breathing during sleep.

Hope that is clear.

Very clear indeed, thank you John.

For some time I have been looking for research which would prove or disprove JohnBFisher's statement. I have not been able to find any.

What I do know is that doing the optimal breathing training I have mentioned above my minute volumes are now 30% lower, I have increased energy and sense of well being, and the energy to move to a better situation and even loose considerable weight.

It has also been very pleasent to be able to smell the flowers this spring and summer, and not feel like going to the drug store for allergy meds.

FWIW,

Todzo