Help needed.

[Albatros]

I would appreciate the opinion of the experienced "elders", eg Pugsy, regarding the origin of my AHIs.
I have attached exploded views of the typical situations of my nights.

My background:
CPAP for a year
Acceptable nights, even if not dramatically better than before
AHI around 1.5
Pretty good understanding of therapy thanks to the forum and You tube
Rather restless sleep, with frequent changes left side, right side
95 % of the time, OA cluster after one hour (REM stage after Deep sleep stage ?).

My sleep test indicated "restless legs syndrome" as the likely culprit for my apnea. Even if I don't feel anything in my legs.

My question:
most of my OA, H, which are real, are preceded/accompanied by bizarre, exotic respiratory flows. What does it mean ? Are they generated when I am half awake/asleep ?

Great Thanks

[Albatros]

A more precise title.

[Miss Emerita]

Lots of arousal breathing there. You might want to take another look at this thread, which I see you had posted to earlier:

viewtopic/t186231/Examplesmouth-breathi ... gging.html

[Pugsy]

most of my OA, H, which are real, are preceded/accompanied by bizarre, exotic respiratory flows. What does it mean ? Are they generated when I am half awake/asleep ?

Bizarre, exotic respiratory patterns preceding flagged events of any kind indicate arousal/awake breathing.
They aren't "real asleep" events when this happens.
If you aren't asleep they aren't real asleep apnea events because it's called "sleep apnea" for a reason...we gotta be asleep for them to be sleep apnea related events.

Half awake...they aren't real sleep apnea related events. They are instead just normal irregular awake/arousal breathing.

All this stuff you posted...first thing I think of is crappy sleep in general.
Now why the crappy sleep??? Million dollar question.

You have to remember that these machines only measure air flow and awake/arousal breathing air flow can be very irregular when compared to asleep breathing.
These machines can and will flag arousal related breathing patterns as some sort of apnea event but you have to remember if you aren't sound asleep they aren't "real" and they don't count other than make us wonder why someone isn't sleeping soundly for the bulk of the night.

[Pugsy]

If you want to change the subject line...go to your first post in this thread and edit that first post and it will let you also edit the subject line.

Right now what shows up for everyone to see is "help needed"....you can change that but it has to be done with the very first post.

[Albatros]

Thank you Pugsy.

If I understand you well, most of my OA's/H's happen when I am not fully asleep but mostly awake.
It may mean that my problem, a crappy sleep, is out of the scope of CPAP. ?
Another way to say it, is that I may not need a CPAP therapy per say, and that the question is, why a crappy sleep ?

The fact is that I will meet tuesday my sleep specialist doctor in Paris, and your input will be very useful.
I sent her, by mail, the same data that I posted in the forum.

I will keep you informed of the result of the meeting.

Thank you again

[Pugsy]

It may mean that my problem, a crappy sleep, is out of the scope of CPAP. ?

CPAP can only fix sleep problems that are related to the airway.
Sleep apnea isn't the only reason in the world for us to have crappy sleep and all those other reasons for crappy sleep (besides sleep apnea) the best cpap therapy in the world isn't going to help.

I have crappy sleep quality myself but it is totally unrelated to my sleep apnea.
My machine treats my sleep apnea very well but does absolutely nothing for my crappy sleep that is caused by something other than sleep apnea.
It fixed one problem...the apnea issue...but I have other problems that mess with my sleep and the machine is useless for fixing the other problems.
I wish that the machine could work that miracle but it just can't.

Common misconception that cpap will fix all sleep problems but that's an unrealistic expectation. CPAP can only fix the one airway/apnea problem.
Doesn't/can't do a damn thing for the other potential causes of crappy sleep and the list is quite long....no matter how much we want it to or expect it to.

[Albatros]

Pugsy, I would like to return to a point in the discussion.
Whatever the cause, at some point, asleep or awake, I no longer breathe. This is a fact. Which implies that my throat is closed. So CPAP remains necessary to help open this closed throat?

[Pugsy]

Here's a good example from one of my old reports.
2 real asleep flagged OAs.
Note the very regular and rhythmic breathing both prior to the flags and after.
I slept right through it all.



Those are rare for me...the bulk of any flagged events that I see are most definitely arousal/awake related.
I may or may not be aware of the arousal. We don't always remember all the arousals.

See this one below. I circled the asleep breathing in red. All that other stuff I wasn't sound asleep and that includes the flagged events which means that they are NOT REAL asleep events.



and a more zoomed in view of the same time frame.

[Pugsy]

Whatever the cause, at some point, asleep or awake, I no longer breathe. This is a fact. Which implies that my throat is closed. So CPAP remains necessary to help open this closed throat?

Not necessarily. Pauses in breathing don't always mean we need cpap. Lots of factors involved.....how many times...how long does it last...do desats in O2 levels happen...etc.

You need to be having this discussion at your upcoming doctor visit.

[ozij]

Rather restless sleep, with frequent changes left side, right side
95 % of the time, OA cluster after one hour (REM stage after Deep sleep stage ?).
[...]
My sleep test indicated "restless legs syndrome" as the likely culprit for my apnea. Even if I don't feel anything in my legs.

Your "restless leg syndrome" should be observed by professional while you're asleep and using your CPAP.

Restless leg syndrome does not affect your airway. It does not cause sleep apnea. It causes fragmented, interrupted sleep, and irregular breathing which your maching doesn't know how to interpret.

Pugsy, I would like to return to a point in the discussion.
Whatever the cause, at some point, asleep or awake, I no longer breathe. This is a fact. Which implies that my throat is closed. So CPAP remains necessary to help open this closed throat?

No it does not mean your throat is closed.
It means your breathing is irregular. When restless legs cause arousals from sleep, your breathing becomes irregular.

[Albatros]

I want to thank you warmly.

I had been diagnosed with sleep apnea.
By mistake ?
Thanks to you, I'm going to have a real discussion (with arguments) with my sleep doctor.
I will keep you informed.

[ozij]

I had been diagnosed with sleep apnea.
By mistake ?

No mistake. Both can disrupt sleep independently. Solving one without solving the other will not give you good sleep. Both have to be treated.

[Albatros]

I met my sleep doctor.
She acknowledged that there are still unanswered questions and that more information is needed.
She proposed doing a new sleep test with CPAP that would combine data from the machine and from the system collecting the data during a regular sleep test.

One more painful night .....

[Miss Emerita]

You might want to double-check that the test will include quantifying leg movements. If you're concerned that you won't be able to sleep much, you might ask the doctor whether using a mild sleeping pill would be a good idea. I hope the new test will shed light on your sleep problems!