What Could This Be?

[bayareacpap]

Anyone know what might be going on with my flow rate graphs below during these times? There are no event flags at these times and my breathing looks pretty normal to me right before the change but then it looks like I start gasping for air.

Relatively tame here:



A little worse here:


Even worse here:



In terms of my question, I am really wondering if it is something I need to resolve that would affect my health or if it is something that is probably pretty typical (i.e. turning over or something) since I know that it may be hard to determine the exact cause of it. Please let me know if it would be helpful to see other sections of sleepyhead software during this time. Thanks!!!

[Wulfman...]

I'm not that familiar with some of those reports, but can you match it up with anything from the other reports......like snores or flow limitations? (I realize you said no "event flags") That's the only thing I can suggest. We're looking at only one portion of those nightly reports.
Maybe you had been breathing shallow and those are some deeper breaths. Or, you turned over or changed positions, or had a slight wake-up.......etc., etc.


Den

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[Pugsy]

My guess would be arousal especially the "worst" looking one. Maybe related to turning over in bed..maybe related to a partial arousal that you likely don't remember.
If these are random....and not frequent...I wouldn't worry about them.

My guess is just a guess...and evaluating air flow at this level under the microscope is not one of my strong suits but I don't think it is anything to worry about.
If it bugs you too much ask your doctor about them the next time you see him.

My vote would be for some sort of arousal or movement in bed causing you to breathe less rhythmaticly.

[bayareacpap]

Den and Pugsy,

Thanks so much for following up. Glad to hear you don't think it is serious. I will follow up with my doc at some point about this just to close the loop.

I did have one other question. Given that I am working on a fixed pressure "trial" on my own at this point, is there anything else I need to be aware of in terms of the numbers on Sleepyhead while I am titrating to different pressures. I am asking because Den really helped me in thinking about moving from APAP to fixed pressure and the results were pretty much immediate (feeling great). So now I am wondering what else I don't know given that no one told me about APAP being a problem for some people until I came to this website. Am I generally good if my AHI is low (mine is usually under 1) and my large leaks are under control? I guess I am curious about what I might see if I drop the pressure a bit as centrals can be a problem sometimes and the higher the pressure, the more difficult it is to deal with my nasal congestion and large leaks. I am a bit above the fixed pressure suggested by the sleep study because I wanted to be safe, and I had limited sleep/REM in my last study so the doc wasn't sure how I would do during REM (not big variances in my other past sleep studies). What will I typically notice first, if I am going in the wrong direction pressure wise (I will go in very small increments)? My snore is Med: .02, 95%: .04, Max: around .1, 95% leaks have typically been 10-20 with max at around low 20-30s (usually 0-2% of time over 24). I understand the concepts of tidal volume, inhale/exhale time, and resp rate but not sure exactly what these numbers should be (I have never had a doctor bring this stuff up anyway). Anything else that might go south numbers wise as I lower the pressure?

[Pugsy]

If you lower the pressure those tidal/minute volume numbers won't change...the machine isn't doing that for you...those are just what you are doing on you own and the machine is just reporting what you do on your own. Your machine isn't working like a ventilator..it can't. That's part of the reason I never bother to try to evaluate those other graphs (other than events, flow rate, pressure, leaks and maybe flow limitations on ResMed machines)...all those other graphs have a wide range of what is "normal" and if they show grossly abnormal results then it means something is going on with the lungs and that's not a cpap problem. That's a lung problem and someone would already most likely be aware of it and having treatment for it.

If you lower your pressure look to see if the obstructive components of sleep apnea (OAs, hyponeas, snores or Flow limitations) increase in numbers at all. There's likely a point where lower doesn't hold the airway open well enough to prevent the airway collapse. It might work okay when sleeping on your side or not in REM sleep where it's common to maybe need more pressure.
Not everyone sees a change in pressure needs during REM or when sleeping on our backs. Back sleeping doesn't change my pressure needs one bit but REM sleep sure does.
Heck your pressure needs might not change at all during REM on when on your back.
Only way to know is to try it...start going downwards with that fixed pressure and see where you get to before the OAs and hyponeas (and snores and FLs which aren't included in the AHI) start creeping upwards.
The centrals we don't expect to respond to pressure so don't use them as a guideline when evaluating pressure vs AHI.

Your AHI is already quite low and I suspect you probably have some considerable wiggle room before you start seeing OAs and hyponeas increase if you reduce the pressure. How much wiggle room we have no way of knowing.
Plus it depends on where you want to put your own line in the sand for your AHI...you know below 5 is considered acceptable. You might find that AHI of 3 still lets you feel great...or heck maybe even 4.5 AHI or you might suddenly feel like crap if the AHI goes over 3.0. Just something you have to sort of figure out on your own.

Some people find that they actually feel better using a little more pressure than they might technically need (meaning that have a nice low AHI at a lower pressure) but they still choose to use a little higher because they feel better. That's okay too. There's no law that says a person just has to use the lowest possible pressure that gives them X AHI. The important thing is how you feel and how well you sleep.

[sleepstar]

Mask leak? Breathing through mouth?