"Hypopnea Clusters".

[Zeke351]

Good Evening All,

In looking at my data over the last week I noticed a trend in my AHI measurement. WHile I am averaging around a 1.6 AHI overall, there have been a number of days that have what I call "Hypopnea Clusters". Looking at the below graphs you will see what I mean. If it weren't for the clusters of Hypopneas my AHI would be even lower.

Do many of you get this/ What causes this? I compared it to my leak rate and there does not seem to be a correlation.

Thanks in advance for your input.

Zeke351

[Emilia]

I think these are probably occurring during your REM stages throughout the night. We cycle through the stages of sleep in about 90 to 120 minutes with REM being the last stage. I tend to show small clusters of hypopneas at those approximate times, too. With an AHI of 1.6 (mine averages about that, too), it really isn't anything to worry about.

Glad you are doing so well!!

[jonquiljo]

Those clusters are not so small! I get the same thing too at times. And, like you, most of what I see are hypopneas.

What do you call it when most of what you have are hypopneas? (no Calist responses, please!) I am serious and cannot get a good answer from my sleep Dr. (or even Mr. Google).

[-SWS]

Do many of you get this/ What causes this?

There are a variety of possible explanations for that pattern. Looking at your report, we have no way of knowing if those are obstructive or central hypopneas. We don't know if they are based in sleep position or specific sleep stages. We don't know if they are based in a UARS type etiology (high upper airway resistance). We don't know if they are somewhat ordinary central-respiration instability---the kind that can occur during wake/sleep transitions throughout the night (I experience those). We don't know if you present slight central- or obesity-related hypoventilation at times---thus breathing patterns that your machine might score as hypopneas. We don't know if they are measurement artifacts or calculation type errors---since erratic breathing patterns can be algorithmically challenging to baseline regarding wildly changing recent-flow.

Some people here would experimentally raise their pressure to see if those hypopneas become better-addressed or even worsen. I advocate doing that with your doctor in the loop.

What do you call it when most of what you have are hypopneas? I am serious and cannot get a good answer from my sleep Dr. (or even Mr. Google).

Aside from what I mentioned above, they are sometimes just called "shallow breathing". The question is are they simply benign breathing patterns? Or are they instead associated with oxygen desaturations and/or sleep deterioration? Those kinds of breathing patterns, IMHO, are best diagnosed in a PSG. And, jonquiljo, I would also suggest trying to get your breathing pattern into Stanford since you live in the Bay area.

But even if you have mostly (confirmed) hypopneas versus apneas, it's still called:
http://www.google.com/search?hl=en&biw= ... =&gs_rfai=

Good luck to you both!

[cwied]

What do you call it when most of what you have are hypopneas? (no Calist responses, please!) I am serious and cannot get a good answer from my sleep Dr. (or even Mr. Google).

I had only hypopneas during my sleep study. The diagnosis was "OSA/OHS". If you want to make the distinction, I guess you could call it OHS, but it's not treated any differently, so it doesn't seem to make a difference.

[Big Daddy RRT,RPSGT]

Technically you have obstructive sleep hypopnea but that is not used commonly. Since the cause is the same for most people, either partially obstructed or fully obstructed airway, the cause is the same and the treatment is the same, so it gets lumped under th same diagnosis code for OSA. Your Dr might call it mild or describe it more fully in the dictation of your sleep study but simply put you have OSA.

As for the hyponea clusters, in the sleep lab this is very common in REM for many people, this is why you only need 10 during Non REM but 14 during REM (or whatever pressure). So if we order straight CPAP we order 14 even though you don't need it all the time. But If we order Auto I might order 8-16 so it's as low as possible all the time but as high as needed when the time comes. If you drink or use narcotic pain killers I might order 8-20cmH2O to allow for more pressure as required.
How this helps your understanding.

[Junebug999]

I too have these hyponea clusters. Is there a way I can tell by looking at my data whether or not the machine is catching and stopping those hyponeas?

[Muse-Inc]

I have severe apnea based on numbers of events...mine were strictly hypopneas in my PSG. I desaturated down to 83%..I'd call that really shallow breathing in my most generous moments I had no REM sleep (so who knows how bad my numbers might have been or how many apneas I might have had if I'd had any REM sleep) and only slightly over a single minute of slow wave (Stage 3) sleep (no Stage 4 tho now Stage 3 & 4 are combined).

My doc explained it sorta like this: you have severe apnea, you were not able to breathe deeply enough for a single breath to maintain normal oxygen levels. Got my attention althought truth be told by the time I met with him following my PSG I was hooked on breathing well throughout the night as a hosehead. Looking at the EEG panicked wave tracing were plain out freakingly scary -- if I weren't a convert following my great sleep hooked up in my PSG, seeing my poor brain freak out convinced that I was suffocating woulda done the trick -- I highly recommend this approach for all in De Nile, seeing the reality of what is happening while you sleep sorta puts a whole new spin on having apnea. Apnea...if ya got it, ya got it. There's effective treatment for the night-time suffocation that apneics experience -- it's called CPAP therapy.

Edit I get lots of hypops following hypops, the durned graph looks like a solid line then poof they stop...not related to leaks and rarely followed by pressure increases...they just happen. Hypoventilation of the obese? Sleeping on back and propped up due to injured shoulders? Likely both contribute to these 'clusters of hypops' right now.

[williamco]

my experience is that random clusters (those that don't happen on a daily basis) are sleep disturbance (insomnia, emotional dreams) that causes central disruption of breathing and should not be considered from the bulk of apnea problem that you need to tackle

[linagee]

I have an interesting data point to share. (Not sure if it's even done in a study anywhere, just something fun I noticed.) When I went from fixed at 7.0 (my titrated) to APAP 6.8 to 8.4, my AI (centrals and obstructives) seems to almost stay constant with the last month of data where the AHI seems to have decreased. (AHI - AI = hypopneas, the white area above the red are hypopneas.) It could be that the APAP adjusting to my needs all night long has caused most of the hypopneas to decrease.