Apneas after a sigh

[Lightweaver]

I've noticed that I have quite a lot of post-sigh apneas, usually 3-4 per hour. The machine marks them as either central or obstructive. I realize that some sighing and post-sigh apneas is normal, is there a point when it becomes too many and worrisome?
Can frequent sighing be a sign of low oxygen or too high CO2?

[Miss Emerita]

Hello, Lightweaver. It'd be very helpful if you could do a couple of things.

First, could you fill out your profile with information about your machine and mask?

Second, it sounds as though you may be using Oscar. If you are, could you post a daily chart plus a zoomed-in view of the phenomenon you're describing?

These steps will help people give you the answers you're looking for.

[khauser]

I've noticed that I have quite a lot of post-sigh apneas, usually 3-4 per hour. The machine marks them as either central or obstructive. I realize that some sighing and post-sigh apneas is normal, is there a point when it becomes too many and worrisome?

Post-sighing ... as in while awake? Or are you sighing in your sleep? If the latter, I assume this is as reported by your sleep partner.

Please clarify, and please follow Miss Emerita's advice. Can't go much further without that...

[Lightweaver]

autoset1.png (635.33 KiB) Viewed 1072 times

[Lightweaver]

The bigger half of the events look like these

Screen Shot 2020-08-11 at 02.26.13.png (23.28 KiB) Viewed 1071 times

Screen Shot 2020-08-11 at 02.25.07.png (20.71 KiB) Viewed 1071 times

Screen Shot 2020-08-11 at 02.30.30.png (23.84 KiB) Viewed 1071 times

Again, I understand that some events like this is normal, but I seem to be doing it all night long.

[khauser]

I'm curious what the more experienced flow interpreters will say. To me it looks like something is waking you up (not all the way) and your breathing changes, causing the machine to misinterpret.
You're definitely bumping against your max pressure but increasing it might not be the first thing to try ... I'm unclear why the machine wants to increase pressure.
Please review wiki/index.php/Oscar:organize so the images have the information needed.

[palerider]

I'm unclear why the machine wants to increase pressure.

Because, in the third example, the machine registered a blocked airway.

[Pugsy]

Remember the machine only measures air flow....it has no way to know sleep or awake status.
It can and will react to awake flagged stuff like OAs and hyponeas just like it reacts when we are asleep because it doesn't know anything different to do.

So when it flags an OA even if it is an awake post arousal flagged event....there's a good chance it will increase the pressure if something else is also happening to make the machine think that the airway is closing off like a snore, FL or a recent OA/hyponea flagged close by.

When I see big gulps of air just prior to any flagged event I just assume arousal related. Something along the lines of a turn over in bed thing that we probably don't remember. Arousal/big gulp of air and hold our breath while turning over or changing position and then the flag....and then back to sleep. I mentally toss those out the window. Now the machine can't do that if it sees very many of them or something else is maybe going along with the turn over in bed pause in breathing or whatever. It only knows to respond per the algorithm...
For central apnea flags....it won't do anything but it might do something when it flags OAs or hyponeas depending on other potential factors also going on....no matter if we are asleep or awake.

[Lightweaver]

Remember the machine only measures air flow....it has no way to know sleep or awake status.
It can and will react to awake flagged stuff like OAs and hyponeas just like it reacts when we are asleep because it doesn't know anything different to do.

So when it flags an OA even if it is an awake post arousal flagged event....there's a good chance it will increase the pressure if something else is also happening to make the machine think that the airway is closing off like a snore, FL or a recent OA/hyponea flagged close by.

When I see big gulps of air just prior to any flagged event I just assume arousal related. Something along the lines of a turn over in bed thing that we probably don't remember. Arousal/big gulp of air and hold our breath while turning over or changing position and then the flag....and then back to sleep. I mentally toss those out the window. Now the machine can't do that if it sees very many of them or something else is maybe going along with the turn over in bed pause in breathing or whatever. It only knows to respond per the algorithm...
For central apnea flags....it won't do anything but it might do something when it flags OAs or hyponeas depending on other potential factors also going on....no matter if we are asleep or awake.

According to my partner, these are just sighs, no movement or other signs of waking up. Is all this sighing normal then? It happens every 15-20 min. Could it be a sign of low oxygen or too high CO2?
They also bump my pressure up needlessly

[Pugsy]

Is all this sighing normal then? It happens every 15-20 min. Could it be a sign of low oxygen or too high CO2?

I don't know the answer to those questions. To me they are signs of a very minor arousal but as to what caused the arousal....no way to know.

And yes...the machine can and will increase the pressure even for arousal/awake related stuff. I have seen it myself too many times to deny it. It doesn't have any way to know if we are asleep or not.

[SQD2020]

I have the exact issue as Lightweaver. I have an average AHI of 12 per my DreamMapper app with 8 of those being centrals. I would say over 90% of all of my apneas flagged on Oscar are preceded by a sigh. I'm showing over 50% variable breathing due to how this effects my breathing patterns. The good thing i guess is that my SPO2 stays above 90% so it doesn't seem to impact my oxygen levels however, I'm sure I'm not getting the best sleep because of it happening every night. I sent a screenshot to my doc and will let you know what I hear back. I would like to know if anyone finds out what the possible causes are of so many sighs while sleeping. Thanks Pugsy for all of your advice along the way - just joined but have been keeping up with your and other posts with advice for some time.

[SQD2020]

Example of sighs starting a series of flagged apneas.

[Pugsy]

Example of sighs starting a series of flagged apneas.

Awake or arousal breathing irregularities being flagged by the machine. SWJ or sleep/wake/junk. False positives. You were awake and other than why were you awake...they mean nothing.

The machine only measures air flow. It doesn't have a clue if you are awake or asleep.

You have to actually be asleep for them to matter and it's very obvious that is not asleep breathing going on.

The big gulp right BEFORE the first flagged event....that's awake/arousal related and all that stuff afterwards you weren't asleep. Now you may not remember being awake but you weren't asleep.

Now as to what caused the arousal or awake time that started all that mess...that's the million dollar question.

When I see stuff like this I shrug my shoulders and move on. It's not airway related and the machine can't fix it. It's related to sleep quality in general and for me it usually means I woke up a bit and turned over to relieve back pain by changing position.

[SQD2020]

Thanks Pugsy! A huge relief to get your assessment here. I thought for sure I a CA issue. I now need to figure out why I'm getting so many sleep arousals creating SWJ every night? You are spot on that I do not remember waking but obviously I am. Over the past year I've adjusted my pressures and even turned EPR off thinking I had treatment emergent CA. Whenever I make the slightest adjustment to things it just seems to give me more of these arousals followed by a host of flagged CAs. I'm thinking maybe I'm just super sensitive to pressure of CPAP and I go in and out of sleep. Assuming this disrupted sleep is not allowing me to have sound sleep do you think ASV would better regulate my breathing?

[Pugsy]

Thanks Pugsy! A huge relief to get your assessment here. I thought for sure I a CA issue. I now need to figure out why I'm getting so many sleep arousals creating SWJ every night? You are spot on that I do not remember waking but obviously I am. Over the past year I've adjusted my pressures and even turned EPR off thinking I had treatment emergent CA. Whenever I make the slightest adjustment to things it just seems to give me more of these arousals followed by a host of flagged CAs. I'm thinking maybe I'm just super sensitive to pressure of CPAP and I go in and out of sleep. Assuming this disrupted sleep is not allowing me to have sound sleep do you think ASV would better regulate my breathing?

Using ASV just to "regulate" breathing doesn't necessarily mean it "improves" sleep quality. The machine will respond to awake/arousal related stuff because it doesn't know any different but that response in itself can also disrupt sleep in people that are what I call "sensitive sleepers" or easily aroused from whatever. It opens up a whole other can of worms for potential sleep quality issues and unless someone just has to go to ASV for a reason or they know they can sleep through a hurricane then I don't advise just going to ASV in an effort to fix sleep problems.

It all comes down to what I have said so many times before.....to fix a problem we first have to identify the cause of the problem in the first place. Trust me...been there and done that myself and it isn't always easy to first identify the problem and then fix it.

If you are seeing a lot of arousal evidence in your flow rate we start with the basics.

Medications....are you on any meds (even OTC) and if so...what are they. Medication side effects is always my first suspect when someone isn't getting good quality sound sleep. Just about everything out there in the form of any medication impacts either sleep or how we feel during the day in some way or other. Heck, even my own little BP med does. Even a little Afrin can mess with sleep. Some people are just very sensitive to just about everything.

And second suspect...other health issues maybe impacting things. I am 68 years old....bad back, broken up pelvis...lots of arthritis. Hurt like hell most of the time. Can't sleep on left side because of left shoulder pain...can't sleep well on my back because of back/pelvis pain...can't sleep on my stomach because it makes back pain worse. That leaves the right side and sometimes it doesn't work out so great either. Then if all other things fall in line the damn cat wants to sleep on my hip and the dog doesn't like it and I have something else that causes a wake up. My pain meds actually cause sleep problems instead of making me drowsy.

If your sleep problems aren't related to airway issues (and I haven't seen enough of your reports to even form an opinion) then cpap can't fix them. I know we want so much for cpap to fix all our sleep problems but the cold hard fact of life is the machine can't fix a problem that isn't related to the airway itself.

There are 2 kinds of arousals....arousals related to airway issues and cpap can fix those...and spontaneous arousals and the best cpap therapy in the world can't do anything about those. Spontaneous...no known cause and it's a bitch trying to first figure out the cause and then fixing it. Often people expect cpap to fix spontaneous arousals and blame cpap failure when it doesn't...when in fact the machine simply can't fix a problem not related to the airway itself.

Your one little snippet above....looks like you were asleep and all the sudden you weren't. No reduction in air flow or breathing.
Nothing on that points to an airway issue. Now maybe other snippets might but that one....I just don't see that arousal being related to an airway issue. ASV won't prevent spontaneous arousals if that is indeed what you are having happen.