Take a look at my SleepyHead data?

[RandMan]

Hi,

I've been struggling for a while now - AHI's normally in the 8-12 range every night. I've been meaning to get back on this forum and try to get some help from you guys and gals. Here is my data from last night; I'd appreciate any insight I can get.



-Randy

[Pugsy]

Do you take any medications of any kind? If so, what?

Are you experiencing several wake ups during the night and do you lay there with mask on when you experience those wake ups? If so, approx how many times do you wake up and how long do you stay awake before falling back to sleep?

Or do you sleep soundly and once the lights go out you go right to sleep and stay asleep all night long until time to get up?

Your AHI is primarily Central/Clear Airway. We can't fix those with more pressure. There's a very remote chance that the centrals could be triggered by your EPR but that's very remote. If you say you think you sleep soundly all night...might try turning EPR off and see what happens.
But if you report you wake often and spend a lot of time with mask on while awake then it is possible that the centrals/CAs are just awake/semi awake (called Sleep/Wake/Junk) breathing irregularities and if that's the case we ignore them and work on improving sleep quality so you don't spend a lot of time awake/semi awake wearing the mask.

Some medications mess with sleep architecture which can also mean several wake ups during the night.
Also some medications can suppress respiration a bit and might cause some real centrals.
That's why the medication question.

[RandMan]

Do you take any medications of any kind? If so, what?

Are you experiencing several wake ups during the night and do you lay there with mask on when you experience those wake ups? If so, approx how many times do you wake up and how long do you stay awake before falling back to sleep?

Or do you sleep soundly and once the lights go out you go right to sleep and stay asleep all night long until time to get up?

Your AHI is primarily Central/Clear Airway. We can't fix those with more pressure. There's a very remote chance that the centrals could be triggered by your EPR but that's very remote. If you say you think you sleep soundly all night...might try turning EPR off and see what happens.
But if you report you wake often and spend a lot of time with mask on while awake then it is possible that the centrals/CAs are just awake/semi awake (called Sleep/Wake/Junk) breathing irregularities and if that's the case we ignore them and work on improving sleep quality so you don't spend a lot of time awake/semi awake wearing the mask.

Some medications mess with sleep architecture which can also mean several wake ups during the night.
Also some medications can suppress respiration a bit and might cause some real centrals.
That's why the medication question.

Ah Pugsy! I was hoping you would see this and pop in for a visit. To answer your questions:

>I take 10mg of Lexapro and 50mg of Vyvanse daily. Lexapro for anxiety/mild depression and Vyvanse for ADHD.
>I also take multi-vitamins, vitamin B complex, and lots of fish oil daily
>When I'm out, I am out. I fall asleep very quickly and hardly ever wake up during the night (from what I can tell at least). I sleep extremely deep and I can sleep through loud alarms; most days I feel really groggy and out of it for about the first three or four hours after I finally get out of bed then I finally start feeling somewhat normal and ready to tackle the day. I usually get very exhausted in the evening, much earlier than I would like to.
>Don't know if any of this matters, but I am male, 35 years old, 6 feet tall, and weigh about 175-180 pounds

I will try turning the EPR off tonight and see what happens. What do you think about my pressure range that I currently have set (12-15)? Think that's good where it is for now?

Thank you so much for responding.

[rkl122]

Hi,

...........AHI's normally in the 8-12 range every night. ...........

Usually due to heavy predominance of CA's (as in the posted data)? Is that pressure range Rx'd, or self-determined? You might try lowering the min, since, excessive pressure can cause CA's (or so I've read).

OTOH, your inspiration/expiration ratio is >1, the respiration rate may be a tad low, and what shows of the events graph implies that the "CA's" are clustering - all consistent with Pugsy's speculation.

[Pugsy]

Okay...research your meds for potential side effects.

Your meds for ADHD...look up the side effects for amphetamines. It's going to mess with sleep and even though you are reporting that you feel you sleep soundly it possibly could be causing some arousals that you don't remember.
https://en.wikipedia.org/wiki/Lisdexamfetamine

Your Lexapro...research it also. All those type of medications will mess with sleep architecture and affect the sleep cycles...plus it often causes the daytime grogginess thing.
So you get it from 2 culprits...you don't get the normal sleep cycles (it reduces deep sleep and REM) which will of course mess with the restorative powers of sleep and it also causes drowsiness.

I suspect if we look at those centrals really close we will most likely see that they are related to an arousal or post arousal and that you weren't sound asleep when they happened.
So let's look at some of them really close. Go to the events tab and then the ClearAirway category and click on it. Once you have the long list of CAs in front of you pick a central/CA that has maybe a couple of CAs in front or afterwards real close in time to the one you pick out. Click on the one that you choose that will hopefully have 2 or 3 CAs close by. When you click on that one event the flow rate graph will change on the right and you will be zoomed in real close on your breathing.
Get me a screen shot of what you see zoomed in at that level. Hopefully you can catch 2 or 3 CAs on the same screen shot.

About your pressure...I don't think that your centrals are related to the pressure because if it were we would see a lot more centrals throughout the entire night and I also don't think that EPR is the cause but it won't hurt to try turning EPR off just to rule it out.
When we turn EPR off we are effectively increasing the pressure and your obstructive apneas are well controlled as it is now.
So I would lower the minimum pressure by 2 cm and see what happens. There's no urgent need to do anything with the maximum pressure setting at this time.
I don't think that you need 12 cm minimum even with EPR being used. How did you come up with these settings?

But to rule out the pressures being the cause and/or EPR being involved in the centrals it sure wouldn't hurt to try a lower minimum and/or turn EPR off.
If you turn EPR off...for sure you don't need the 12 minimum.

Get me the screen shot of a few centrals zoomed in at the level I described above.
Let's see if it looks like you are asleep or not when they are flagged. If it looks like you were asleep then we will dig deeper on trying to figure out a cause. If they are arousal related then we won't be so concerned.

[RandMan]

Get me the screen shot of a few centrals zoomed in at the level I described above.
Let's see if it looks like you are asleep or not when they are flagged. If it looks like you were asleep then we will dig deeper on trying to figure out a cause. If they are arousal related then we won't be so concerned.

Here you go Pugsy. This is from last night - I also turned EPR off and lowered my minimum pressure down to 10.

[Pugsy]

Try lowering the minimum again. Try 9 cm minimum and see what happens.
The Centrals don't look CSRish which was a concern. Couple of them look like you might have been asleep but a couple looks like maybe related to an arousal.
No need to do anything with the maximum. The machine doesn't seem to want to go there and it hurts nothing to leave it up there.

Then tomorrow post an image after the change to 9 cm minimum. Just do the regular detailed graph instead of the zoomed in graph the next time.

Were you okay with the pressure last night without EPR in terms of comfort breathing?

[RandMan]

Try lowering the minimum again. Try 9 cm minimum and see what happens.
The Centrals don't look CSRish which was a concern. Couple of them look like you might have been asleep but a couple looks like maybe related to an arousal.
No need to do anything with the maximum. The machine doesn't seem to want to go there and it hurts nothing to leave it up there.

Then tomorrow post an image after the change to 9 cm minimum. Just do the regular detailed graph instead of the zoomed in graph the next time.

Were you okay with the pressure last night without EPR in terms of comfort breathing?

Breathing has been fine without the EPR - no issues there whatsoever. Here is last night's data with my minimum lowered down to 9. Feeling pretty crummy today.

[Pugsy]

Feeling crummy how?
Any idea why?
Did you feel better yesterday?

[RandMan]

Feeling crummy how?
Any idea why?
Did you feel better yesterday?

Just incredibly groggy and lethargic all day long; I literally didn't do a thing today. Nothing. I keep yawning; it's 6:00pm my time and I'm already excited to go to bed tonight. When I'm feeling like this it also impacts my mood severely, and I feel depressed and quite moody. Yesterday was definitely not as bad.

I also noticed something quite interesting. I started combing back through old data in SleepyHead and looked through various times from last year and earlier. It seems that only more recently is my data showing CA dominated apneas. Scrolling through past times, most of the nights look something like this example from March of 2015; this is a very typical breakdown of a very large span of time of how the pie charts look:

[Pugsy]

Perhaps you should make an appointment with your sleep doctor and see what he thinks about the centrals.
Might also chat with him about the potential side effects those meds might have on both how you feel and your sleep architecture.

I would also be wondering how they came up with those pressure settings...sure seems like they have been using a sledge hammer on the obstructive stuff when a fly swatter would get the job done.

Pie charts don't tell me a lot.
You could have 2 apneas all night long..1 central and 1 obstructive and the pie would be cut in half in equal parts.
You could have 30 apneas all night long..15 central and 15 obstructive and the pie chart would still be cut in half in equal parts.