disruptive periodic breathing pattern?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
awakeinnj
Posts: 25
Joined: Sun Jul 20, 2014 1:20 am

disruptive periodic breathing pattern?

Post by awakeinnj » Tue Mar 24, 2015 11:03 pm

Hi. I've been on CPAP for about a year, and it's essentially eliminated the obstructive apneas and hypopneas, and using the machine is better than not doing so. Yet, I still look for reasons I'm still very tired and have morning headaches most of the time.

I noticed from the beginning that I have what seems to be a noticeable pattern during dream sleep. Yes, the AHI goes up a bit, but the breathing pattern certainly changes sometimes. Sometimes I wake up hyperventilating and often it's concurrent with dreaming. Sometimes central apneas register during the shallow breathing part of the cycle (I guess if it goes on long enough) and sometimes not. I don't seem to have oxygen desaturations, although I don't seem to keep that device on that well during the night.

Sleepyhead screenshots are attached below showing normal breathing, the central apneas, then the unusual pattern in question, and then I woke up shortly afterwards. The second is just a more detailed subset of the first.

http://s1265.photobucket.com/user/awake ... sort=3&o=1
http://s1265.photobucket.com/user/awake ... sort=3&o=0

This doesn't go on for most of the night, but it does seem to appear when I dream a lot and when my sleep isn't restful. Would you recommend looking into this further? Thanks for any input.

_________________
Mask: Wisp Nasal CPAP Mask with Headgear - Fit Pack
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: pressure = 8; humidity = 2.5 (0 to 6 scale)

Guest1

Re: disruptive periodic breathing pattern?

Post by Guest1 » Wed Mar 25, 2015 12:38 am

If your CA index is more than 5 every night, you should get titrated for a bipap or an ASV machine. If not, then:

One thing you can try with your S9 elite is to use EPR at 1,2,3 incrementally and see how the AHI responds. If your current pressure is 7 and EPR is zero, then currently your IPAP = EPAP = 7. EPAP is what eliminates Obstructive events and IPAP is what eliminates Hypopnea events. Your EPAP is sufficient but your IPAP is not enough to eliminate hypopnea events.

You can try this:
1) Raise pressure to 8 and EPR to 1. This essentially makes it a bipap with IPAP = 8 and EPAP = 7 (your current EPAP). This will help eliminate hypopneas that are still there in your AHI. Use this setting for 10 days and see how your AHI profile responds.
2) If needed, raise pressure to 9 and EPR to 2. This essentially makes it a bipap with IPAP = 9 and EPAP = 7 (your current EPAP). This will help eliminate hypopneas that are still there in your AHI. Use this setting for 10 days and see how your AHI profile responds.
3) If needed, raise pressure to 10 and EPR to 3. This essentially makes it a bipap with IPAP = 10 and EPAP = 7 (your current EPAP). This will help eliminate hypopneas that are still there in your AHI. Use this setting for 10 days and see how your AHI profile responds.

If central events increase to an unacceptable level in any of these 3 steps, then you will need to speak to your sleep doc/pulmonologist.

awakeinnj
Posts: 25
Joined: Sun Jul 20, 2014 1:20 am

Re: disruptive periodic breathing pattern?

Post by awakeinnj » Thu Mar 26, 2015 3:39 pm

Thanks. My AHI is consistently between 2 and 5 around this CPAP pressure (7, , so AHI alone isn't the reason why I feel much worse on some nights than others. Per the suggestion, I'll search around and see how I can hack and tweak the settings to mimic a bi-level. I'm looking to try anything at this point. Within the next few days, I want to take a look at some other stats and patterns and may follow up if I notice any anomalies not already discussed.

_________________
Mask: Wisp Nasal CPAP Mask with Headgear - Fit Pack
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: pressure = 8; humidity = 2.5 (0 to 6 scale)

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Darth Lady
Posts: 249
Joined: Mon Feb 02, 2015 3:34 pm
Location: Jersey City NJ

Re: disruptive periodic breathing pattern?

Post by Darth Lady » Thu Mar 26, 2015 9:08 pm

I was interested to see this because I also get this type of breathing pattern, apparently when in REM, and also feel unrested most mornings. I'm not sure there is a connection there or not. AHI generally under 1. Maybe it's life in NJ (I live there too)? I use an ASV machine, so it hardly ever grows up to be centrals. I hope that tweaking helps, but if not, BiPAP or ASV (more the latter, really) might turn the periodic pattern down if you can get them.

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Mask: AirFit™ F10 Full Face Mask with Headgear
Additional Comments: PR System One 960 BiPAP ASV Advanced
Seeking the Dark Side 8 hours a night... complete with sound effects!

awakeinnj
Posts: 25
Joined: Sun Jul 20, 2014 1:20 am

Re: disruptive periodic breathing pattern?

Post by awakeinnj » Sun Mar 29, 2015 9:26 pm

I'm sure NJ isn't helping matters, but I don't see leaving here for at least another 5 years, if ever.

So you were given a special type of machine that's supposed to help with this, but you don't actually feel better? That's a little disheartening. What are your next steps? I'm overdue for a follow-up with the pulmonologist but I wanted to see if I could try a few other things first.

_________________
Mask: Wisp Nasal CPAP Mask with Headgear - Fit Pack
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: pressure = 8; humidity = 2.5 (0 to 6 scale)