Daughter's Data

[SleepyonMagnoliaSt]

I'm not sure they are using the right pressure for her or the right mask at all. Then again I'm new to all of this. At 2 weeks of using the cpap (last night) There have only been 5 days where her AHI is below 5. Then again she also has some nights with wild leaks. Would this play into the readings too? She's sleeping amazingly long so I'm just wondering what it all means







Would love some insight and thoughts about this all?

[karessamom]

How did you get those screen shots into your post??

[SleepyonMagnoliaSt]

How did you get those screen shots into your post??

I uploaded them to tinypic and posted them

[khauser]

Actually the leaks look pretty low. The machine you are using reports total "leakage" which includes the leakage that is caused by the vent on the mask. This leakage can be substantial, and it's there for a good reason (just so we're clear, I'm saying don't block it to reduce leakage).

Your daughter has interesting data. One day the majority of events are central and the next they are obstructive.

In the end, I'm thinking she's going to need a more sophisticated machine, but 2 weeks is too soon to begin tinkering, in my opinion. Further, I wouldn't know HOW to begin.

You've put up three days of graphs ... if you look over the entire two weeks are there any obvious trends, like maybe the one day with CAs was unusual?

I'm sure you'll hear more from, for instance, pugsy....

[Pugsy]

Those leak lines shown? Not wild leaks at all. All are well within the machine's ability to handle.
SleepyHead tends to make mountains out of mole hills due to the scale involved. Large leak territory...somewhere around 75 to 85 L/min with the 60 series machine.

Not sure what to make of the AHI....if we remove the Clear airway events (remember we don't treat CA events with more pressure with this type of cpap/apap machine) the obstructive component of the AHI isn't quite so ugly and below 5.0 on these reports.

My first thought was maybe the OA events are causing some low level arousal and maybe those CA events are centrals during sleep stage transition (which would be a normal occurrence) and if the arousals were reduce then maybe the CAs would reduce also.
Assuming there was no history of central apneas during her sleep studies....
So maybe even though she appears to be sleeping soundly perhaps the OAs themselves are still a bit disruptive to sleep (causing minor arousals) and if that is the case then you are probably correct in thinking that the pressure being delivered is not quite optimal.
Perhaps something to talk with her doctor about??? Maybe a little more pressure to see if the OAs reduce (though they aren't horribly horrible now) and maybe get lucky and have the CAs reduce as a by product of less OAs.
I have seen it happen more than once so it is possible.

I hesitate to go dial a wingin with kids but if it were my child...I would most definitely be bringing up the idea of a little more pressure with the doctor and if he/she agreed then I would be keeping an eagle eye out on those CAs(centrals).
If more pressure actually increased the CAs...then we get to have a different discussion right now too soon to have that discussion when a viable option is available to see if the centrals are perhaps a real problem or not.

[SleepyonMagnoliaSt]

Actually the leaks look pretty low. The machine you are using reports total "leakage" which includes the leakage that is caused by the vent on the mask. This leakage can be substantial, and it's there for a good reason (just so we're clear, I'm saying don't block it to reduce leakage).

Your daughter has interesting data. One day the majority of events are central and the next they are obstructive.

In the end, I'm thinking she's going to need a more sophisticated machine, but 2 weeks is too soon to begin tinkering, in my opinion. Further, I wouldn't know HOW to begin.

You've put up three days of graphs ... if you look over the entire two weeks are there any obvious trends, like maybe the one day with CAs was unusual?

I'm sure you'll hear more from, for instance, pugsy....

On a lot of days. Her centrals are actually quite high. It's odd because in her sleep study nothing was mentioned about centrals. But this shows her having them.

I'll write down her info so far starting with the first night

June 25:
AHI 9.08

Hypopnea .76
Obstructive 5.16
Clear Airway 3.15

June 26:
AHI 5.51

Hypopnea 0.42
Obstructive 3.43
Clear Airway 1.66

June 27:
AHI 6.17

Hypopnea 0.58
Obstructive 3.37
Clear Airway 2.22

June 28:
AHI 7.26

Hypopnea 0.54
Obstructive 4.66
Clear Airway 2.06

June 29:
AHI 4.37

Hypopnea 0.49
Obstructive 2.33
Clear Airway 1.56

June 30:
AHI 4.73

Hypopnea 0.23
Obstructive 3.53
Clear Airway 1.01

July 1:
AHI 8.13

Hypopnea 0.69
Obstructive 4.86
Clear Airway 2.58

July 2:
AHI 7.34

Hypopnea 0.65
Obstructive 5.04
Clear Airway 1.65

July 3:
AHI 9.51

Hypopnea 0.71
Obstructive 6.27
Clear Airway 2.53

July 4:
AHI 6.23

Hypopnea 0.98
Obstructive 3.44
Clear Airway 1.80

July 5:
AHI 4.34

Hypopnea 0.38
Obstructive 2.83
Clear Airway 1.13

July 6:
AHI 4.88

Hypopnea 0.64
Obstructive 2.97
Clear Airway 1.27

July 7:
AHI 6.76

Hypopnea 0.60
Obstructive 3.68
Clear Airway 2.48


So yeah..... I really have no idea what's going on. We don't see the sleep doctor pulmonologist until August. I'm just trying to get a hand on what to talk to the doctor about

[khauser]

It's possible they aren't central apneas at all. During a sleep study the therapist has the advantage of seeing the patient's EEG at the same time as seeing apnea-related data. It's not a central apnea unless the EEG also indicates the problem.

I like Pugsy's thought that these aren't real central's at all, but I would re-emphasize that tuning your child's therapy on your own isn't to be encouraged. I don't have a clue what differences exist between child and adult physiology, but I know there are differences. Even with adults the possibility exists that increasing pressure can cause unintended side effects (CAs are only one), some of which are downright harmful.

I'm not trying to scare anyone from tuning their own data (especially since I did that with a great deal of success myself, with the aid of people here, especially Pugsy) ... but the vast amount of knowledge available here seems to be oriented towards the adult population (perhaps the use of xPAP in kids is relatively new, I'm not sure).

August isn't too far away, and even at AHI's above 5 (not far, I hope) she should be good for now...

[Pugsy]

Sleep onset centrals...during the transition from awake to sleep are normal and part of life. They are real in the sense that the airway is open but there is no respiratory effort. They normally are not considered to be a problem unless there are a truck load of them and causing oxygen level drops or causing a person to continuously wake up and thus seriously disturbing the normal sleep cycle.
There's no way to tell from the data available to us from our machines exactly what is going on. Are these turn over in bed hold your breath centrals...thus not a "real" central in the strict definition of the term? Or are they something else?

Even if those "centrals" are the kind that we might worry about at this point there may not be enough of them to get alarmed about this early into therapy. Most doctors would likely offer a "let's see what they do" approach. Now if the CAs were consistently above 5 per hour by themselves then yes we would for sure be looking a lot more closely.
I don't know enough about the respiratory drive of kids...for all I know this might simply be a normal thing for kids and that's why I say talk to her doctor about them. If you don't feel like waiting...call the DME and ask them to run interference and get a report to the doctor sooner. Explain your concerns and see if they will get the report to the doctor sooner....and thus hopefully reduce your anxiety.

With kids....and OSA I just don't know what is "acceptable" for kids in terms of the data that gets shown.
I am with you though...the overall AHI is higher than I would be comfortable with if it was my child but I would enlist the help of the DME and the doctor and get their input on what to expect and I would do it now. They may not want to do anything right now but I would still do it so I would have my concerns on record.

[SleepyonMagnoliaSt]

It's possible they aren't central apneas at all. During a sleep study the therapist has the advantage of seeing the patient's EEG at the same time as seeing apnea-related data. It's not a central apnea unless the EEG also indicates the problem.

I like Pugsy's thought that these aren't real central's at all, but I would re-emphasize that tuning your child's therapy on your own isn't to be encouraged. I don't have a clue what differences exist between child and adult physiology, but I know there are differences. Even with adults the possibility exists that increasing pressure can cause unintended side effects (CAs are only one), some of which are downright harmful.

I'm not trying to scare anyone from tuning their own data (especially since I did that with a great deal of success myself, with the aid of people here, especially Pugsy) ... but the vast amount of knowledge available here seems to be oriented towards the adult population (perhaps the use of xPAP in kids is relatively new, I'm not sure).

August isn't too far away, and even at AHI's above 5 (not far, I hope) she should be good for now...

No worries. I wouldn't even think of messing with her therapy stuff.

I'm just trying to get a handle on what exactly to talk to the doctor about