CPAP for a shallow breathing condition? Is my Dr. right?

After a sleep study and a follow on session wearing a CPAP, the results were only marginally improved. I am a VERY light sleeper, very tired, low energy, and been going down hill (energy wise) for since my mid-20's (now early 40's).

My Dr. seems to agree with the specialist, that CPAP may make the difference. It's a big chunk of change, and this is experimental to me (since I'm not a "lock" for Apnea). Certainly the study showed poor sleep efficiency, so something is going on here.

And of course a strange observation that I have a larger than normal uvula.

I'd appreciate any comments with respect to
1.) the effectiveness of CPAP in the "shallow breathing" scenario
2.) and any input as to vendors that offer CPAP "trial" or "rental" options (especially in Canada or for Canadians)

Thanks!

Tom2h

What was your Oxygen level during the study ?

I interpret shallow breathing as Hypopnea, meaning your oxygen intake is 50% less than what you normally breath, for more than 10 seconds with a subsequent drop in Oxygen < 3 %. (I too am a very shallow breather)

If your Oxygen is constantly dropping through the night, it could explain your symptoms.

I had no Obstructive Apnea or Hypopnea's during my study, had a few Centrals of both and a very large number of UARS. (Upper Airway Resistance Syndrome) In Canada it's referred to as UAWRS.

I've been using an Auto CPAP for about 2-3 weeks now, and other than getting a few short periods of high energy in the morning, I don't notice any major improvements that others often have experienced.

My Oxygen was dropping to around 90 %, which from what I have seen is not that low, but may be enough to cause my fatigue and brain fog.

With that in mind, it is possible that my oxygen actually drops lower, just not during the study. I don't suppose there are many people who can claim that the way they slept in the lab was indicative of the way they sleep at home. I only "slept" about 4.5 hours and with a high amount of anxiety.

I suspect my AHI would be higher if I had been studied at home.

It could be the same with you...

Regards

I can't offer any insight regarding shallow breathing (you need to talk to Rested Gal -she's the bomb!) but I can offer some info regarding rental/loaner machines here in Ontario.

I'm in Toronto and found that you can rent Respironic and Puritan-Bennett machines from MediGas (416-847-1272) for $150/month. If you rent an auto-machine (and you should) you will get a copy of the data that the machine records. Make sure that they will give you a copy of the data as it is important info for your doctor to review. They may want you to purchase a mask rather than loan one to you.

If you want to trial a ResMed machine, you HAVE to deal with VitalAire (905-890-7100) who will also charge you $150. for the rental of an autoset machine (either an upgraded S7 or a Spirit) but they will tell you that it is only for a week even though the contract that they will have you sign will say that you can have the machine for a month. You need to queeze them a little to let you have the machine for more than a week and, for $150. you SHOULD have the machine for more than a week. VitalAire will loan you a mask. If you go to the VitalAire office, you can try on a range of masks, but they don't have a couch/bed for you to lie on while doing this. This makes a huge difference because the fit of the mask while sitting is very different from the fit of the mask while laying down. The guy at VitalAire told me I could lie on the floor if I wanted -try to imagine what I wanted to tell him...

Anyway, getting the right mask makes a HUGE difference. So too, does getting the right machine. I purchased a RemStar Plus with C-Flex (pressure of 15) and had a really hard time with CPAP, even though I was using the C-Flex at a setting of 3. So I have been trialing the different autoPAP machines and have found some siginificant difference between how I feel using the different machines.

The Respironics RemStar Auto left me feeling tired during the day. It is quiet and the humidifier is easy to use. It will leak, however, if you forget to turn on the heater plate. (The heater plate makes the metal base of the water tank expand slightly -this creates the seal) This machine is quiet, has keys that are lit and easily found (both sight and tactile) in the dark. No clinical information is given on the screen. You have to buy the Encore software to get data out of the RemStar.

The ResMed AutoSet Spirit left me feeling great during the day and, the Spirit gives you lots of clinical info right on the screen. You can buy their AutoScan software and get even more data if you want it, but you don't have to. The Spirit is, however, pretty big and the humidifier is a bit of a pain in the butt to take apart and clean. This machine is also quiet and the keys are easily found and operated in the dark.

I'm currently trialing the Puritan-Bennett 420E. Unfortunately, I don't have a humidifier to use with it adn I suspect that I would be even more comfortable using it if I had the humidity. It is doing a good job but I don't feel quite as well rested with it as I did with the ResMed Spirit. I feel more rested with the PB 420E than I did with the RemStar. It is really small, and not a quiet as I would like it to be; I find that the noise of the machine seems to "telegraph" up the hose to my face. It does not give info on the screen regarding clinical data but you can buy the SilverLining software and get lots of data. Rested Gal helped me to understand the bit of tweaking that can be done with the 420E regarding flow limitations, etc., but I have not needed to adjust these. I believe that this machine is a good performer and some say that it might be more accurate as it has a separate tube inside of the hose that functions as the conduit to the flow sensor that actually measures your breathing. My partner tell me that I get about 1.5 snores out before the machine adjusts the pressure such that the snoring stops. Not bad, in my opinion.

So, if you are spending the bucks out of your own pocket, it makes sense to trial the machines before you buy. Also, and this is really important, there has been a recent change to the ADP (Assistive Devices Program) here in Ontario such that the Auto-CPAP machines are now covered and, the price is capped. The equipment provider, no matter which one you go to, cannot charge you more than $1040. for a straight CPAP or AutoPAP machine with basic hose, mask and heated humidifier. Of this $1040., ADP will pay $780. So, you are only out of pocket $260. Your insurance, if you have any, should cover this unless they have a deductible.

The equipment providers are not amused about this and will try to tell you that you have to purchase "service packages" and/or other things like "maintence agreements" or extended warrenty. Also, the hose and mask that they will include will not be the best and, the mask may not fit you very well. If you have insurance, it should cover a better mask for you, so make sure that you check your insurance limits/deductibles/exclusions, etc., but if you don't, you will have to pay out of pocket.

Get the equipment provider to be very clear about what they are giving you for what amount of $ and, whether or not you HAVE to have it. Also, if you are paying their service fee (usually around $200-$250) make sure that you get hours and hours of time to try on masks, while lying down with a CPAP machine attached that is delivering the pressure that is prescribed for you. Also, have them attach a humidifier so that you are getting moist air so that your nose does not slam shut from the dry air while you are trialing masks.

Be aware that ADP will only assist you with the purchase of a machine once every 5 years so, get it right the first time. If you go to purchase another machine, from any provider, within the 5-year window, you will not get the ADP assistance and, you will not get the ADP price. This means that the equipment provider will charge you whatever they want and the prices are brutal.

Sorry that this is so long-winded, but if I had known then what I know now, I would have done a better job advocating for myself. Hopefully, this long message will help you, and others here in Ontario, get the equipment they need without being hosed over by the equipment providers.

Be well!
Paul

Great info, Paul. Great advice too.

Were you by any chance able to compare your AHI, AI, HI numbers from machine to machine?

Many people describe themselves as light sleepers. They can awaken with the slightest movement or noise. These folks tend to spend alot of their sleep night in the shallow sleep stages of 1 and 2. The deeper stages of 3 and 4 are not achieved and these people are tired often.

A person can have many sleep arousals or awakenings but not from actually stopping breathing. Could be a snore or narrowing of the airway causing these arousals and preventing any deep sleep from occuring.

The goal of CPAP in this situation is to stabilize the airway and eliminate any hidden arousals from happening. This is why your physicain ordered the CPAP and giving it a try is a good idea.

If you can't take a afternoon nap anymore then you know that you're probably getting more deep sleep at night.

Good Luck
Bob

Great information, Paul! Although I don't live there, what good suggestions you've given to help other Canadian cpap users. It's always interesting to hear the different approaches fellow cpap'ers have to take in various countries to get their treatment going.

I am 41 and I am a shallow breather...my blood oxygen level was 64 and I had 84 events in an hour. According to my doctor my hypopnia is quite dangerous. I didn't sleep through the night, I'd wake up 3 sometimes 4 times a night.

I have been on CPAP since October set at 12. My husband now has a problem waking me up in the middle of the night. (I have a tendancy to move into the middle of the bed when he's not there.) If he does wake me to move me over, its wake, move and back asleep in seconds. I don't snore anymore. And I sleep all night otherwise. My husband though didn't agree with me having it right away until he heard the outcome of the test, he says, I never stopped breathing as far as he could tell. He now is fully supportive of my using the CPAP and he's becoming quite used to the slight noise in the bedroom and my darth vader look.

My DME here in Ottawa is Access Therapy, I have no complaints. I tried a 1/2 dozen masks until I found the one I use. They made appointments for me at the drop of a hat. I had a 30 day free trial with my machine. And they bent over backwards to do and provide anything my insurance company wanted. The respirologists there (I dealt with 3 of them at any time) were going to sell me something that worked for me, not the most expensive system. I would recommend them to anyone. Now I know not all DMEs are as good as mine and I feel quite fortunate.

My insurance wanted first a copy of the doctor's diagnosis and a copy of the sleep test. Then they wanted a a quote/estimate from the DME supplier. You'll want to find out what your insurance wants before you just go out and buy your machine. Because I have a small nose, I had to buy a different mask that wasn't part of the basic package. For that my DME gave me a discount on the mask that I ended up buying and my insurance has agreed to pay for it.

-SWS wrote:Great info, Paul. Great advice too.

Were you by any chance able to compare your AHI, AI, HI numbers from machine to machine?

This info is available from all three of the machines via the software that can be purchased/loaded into your home computer AND/OR by having the equipment supplier do the analysis of the data. They will probably want to charge you for that.

The ResMed, however, will give you the data right on the screen. Linking with your computer gives more info.

Interestingly enough, I felt that the Respironics RemStar Auto left me feeling the most tired during the day and, it was the machine that delivered the lowest average pressure (9.2) and said that I had a low AHI. I felt best during the day after using the ResMed Spirit, which delivered an average pressure of 10.3 and reported a slightly higher number for AHI (average of 7-9).

What this tells me is that the different auto-machines do what they do in different ways (different algorithims) and that trialing the different machines before buying really mades sense.

Let me be clear that I am NOT suggesting that one machine is better than another. I'm suggesting that as individuals, each of us has specific needs and the different machines address/meet those needs in their own way. The machines are all good; find the one that fits you best. For me, I judge this moreso by how I feel during the night and during the following day, and less so by what the machine says.