umm....OK, then I have disturbed breathing over 100 times a night
Nope, that's not quite the right interpretation of your numbers. Technically the "disturbed breathing" includes the CAs, the OAs, the Hs, and the RERAs. The FLs and snoring are called "precursor events"---they indicate that the airway may
be in some danger of collapsing. The PPs are nothing more than the System One's way of testing whether the airway is open or obstructed. The first PP is usually sent out about 6-7 seconds after the airflow into/out of the lungs drops to almost 0. And it repeats the PP about ever 7-8 seconds until breathing resumes. So a typical 15 second apnea will likely have two PP.
Headintheclouds wrote:Hi there. Just downloaded the Sleepyhead software and can't really make heads of tails...(I'm not too familiar as I'm new)
On the Events panel for last night it says thisL
• Clear Airway Apnea 26 events
• Flow Limitation 14 events
• Hypopnea 10 events
• Obstructive Apnea 2 events
• Pressure Pulse 100 events
• Resp. Effort Related Arousal 7 events
• Vibratory Snore #2 17 events
• Vibratory Snore 6 events
What does that mean? There're rather a lot of Pressure Pulse events and Clear Airway Apnea
What are Pressure Pulse events?
Does that mean I have Central Apnea as opposed to obstructive sleep apnea?
If so would CPAP be effective treatment in the future?
How long did you sleep for the night? We need that to put these numbers in context. If you slept for at least 5-6 hours, all the numbers except for the CAs look very reasonable, and the OAs look excellent since the numbers under the events tab are the actual numbers of the events for the whole night, and not the "indices" that measure average number of events per hour
Yes, the CAs look a bit high. But it is hard to tease apart "real CAs" from "false CAs" based on just the airflow. Wake breathing is quite different from sleep breathing, and it is pretty common to have what are call "transition centrals" as you are dropping off to sleep or just waking up. On a PSG these kinds of CAs aren't even scored as part of sleep disordered breathing---if they are relatively few in number and don't seem to interfere with dropping off to sleep. But in some people, apneas during that period can lead to sleep instability and real problems with finally getting into a real sleep. Is this the case with you? It's impossible for us to say---particularly since we have not seen the results of your sleep test nor the wave form data from your CPAP.
Question is, how can I address this problem? Sounds like I have Central as well as Obstructive Sleep Apnea...
It's way too early to start worrying about whether you've got Central Sleep Apnea or Complex Sleep Apnea yet---unless your diagnostic sleep test mentioned CAs being a problem.
Yes, a small number of new CPAPers (10-15%) develop problems with "emergent central apneas" (Complex Sleep Apnea) once they start CPAP. But unless the problem is very severe
, docs tend to take a "prudent watchfulness" approach since sometimes the centrals disappear on their own as the patient's brain relearns how to interpret the nighttime CO2 levels while PAPing. (It's the CO2 levels that are the trigger the brain uses to send the message "Inhale" to the lungs and diaphragm.)
And at this point, your CA numbers are nowhere close to severe
. The usual point where docs here in the states start to worry about CAs in patients on CPAP is when the CAI (all by itself) is consistently above 5 (for several weeks) AND when the CAs make up at least 50% of all the events in the overall AHI. Since your CAI < 5 and your CAs make up only 1/3 of your events, there's no need to jump to the conclusion that you need to be put on an ASV machine yet. Give it some more time to see if your body adjusts. And keep in mind that ASV machines are not only significantly more expensive than CPAPs and BiPAPs, they are much trickier to set up and they can be much, much harder to adjust to since they use very large pressure variations on each breath cycle as a way of breaking the so-called overshoot/undershoot cycle that is at the heart of CSA and CompSA.
During the day I feel better than I was after using CPAP, but not fantastic because I get repeatedly woken up in the morning.
I know that you're saying the real problem with your sleep continuity are those pesky "hypnic jerks" that kick in when you are trying to get back to sleep towards morning. Some important questions to ask yourself and your sleep doc (and other docs) about those jerks, the early morning restlessness/wakefulness, and the early morning clusters of what your machine is labeling CAs:
1) Did your diagnostic sleep study mention anything about centrals? If not, then you don't need to be worried about CSA.
2) Did your titration sleep study (if you had one) say anything about CAs? If you had some CAs scored on that study, then the possibility of developing CompSA is higher.
3) Did either sleep study say anything at all about the hypnic jerks? What about PLMD? What about restless legs?
4) Have you mentioned the frequency of the jerks to your docs? As others have said, a jerk or two now and then is perfectly normal. (I had one last night just as I was drifting off.) But a whole series of them in a 15-30 minute period every night probably does indicate some kind of a problem. And if there's usually a cluster of machine-recorded CAs at the same time as the jerks, some detective work may need to be done to get an idea of whether there are two independent problems or whether the CAs and the jerks are relate. And if they are related, then the causation
relation will need to be determined: Does a CA cause the jerk which causes the wake? Or does the jerk cause the wake which then results in a (normal) transitional CA being scored by the machine?
5) Did the jerks start after you startedf CPAP? Did they get worse after you started CPAP?
6) You write:
I manage to sleep untroubled at night because I use sleeping tablets and an anticonvulsant that has sedating quality.
There's also a chance that either the sleeping tablets or the anticonvulsant drug is adversely affecting the quality of your sleep towards the end of your sleep period. Discuss the effects of both meds on your sleep patterns for the whole night. Many people find commonly prescribed sleeping pills help with getting
to sleep, but do not help keep them asleep all night. And anticonvulsants are strong meds with lots of potential side effects. It may be that your dose needs to be adjusted. Or that you need a different anticonvulsant altogether. Please discuss the sleep situation with thd doc who prescribed the anticonvulsant.
7) This will sound like a truly crazy idea, but I have to say it: Perhaps you are trying too hard in the morning to squeeze out just a bit more sleep---sleep that your body doesn't actually need now that it no longer has to wake itself up repeatedly to open up the airway. If this restless period with all the hypnic jerks and CAs starts 30-60 minutes before you want to get up, perhaps the real solution is to just go ahead and get up for the day instead of trying to force a bit more sleep to happen. If you get up and function decently in the day, then you can conclude that maybe you just don't need that last hour of really bad quality sleep.