Help! Long hypopneas and frequent awakenings

[SleepyBobR]

I've been on CPAP since early January but I continue to struggle with frequent awakenings with elevated heart rate. This, despite AHI numbers that are quite good, often below 2. In fact, my AI is sometimes actually 0. These awakenings are quite distressing as I never get a good night's sleep and it has become increasingly difficult to get back to sleep after each awakening. I am sleep deprived and my heart feels overworked.

I have just now managed to get some detailed reports from my DME for the past week. I will get reports for the entire 3 months later this week (I don't have the Rescan software and reader so I have to rely on my DME for reports). I can't post the graphs I have for the past week but what they show, night after night, is a small number (sometimes 0) of short (10 seconds) apnea events against a backdrop of hypopneas, some of which are 15 or 20 minutes long. In looking at graphs posted by others, I observe that very low AHI scores usually include very few or even no hypopneas and a small number of apnea events; this is not what my results show. In my case, the apnea events are almost eliminated leaving only the hypopneas. I'm wondering if these long lasting hypopneas are causing my arousals as they occur quite frequently throughout the night. In any case, they are long in duration and must be causing me some distress if not actually causing the frequent awakenings. I am running my S8 Elite II at a pressure of 10.8. I have been reluctant to go any higher because of bloating and a (perhaps irrational) fear of induced centrals. I use a Quattro mask and my leak rate is between 0 and .02 L/S so I don't think this is a factor as it seems to be well controlled.

Is there some reason why my hypopneas would be so long in duration?
Why do they persist after the apnea events are minimized or even eliminated?
Will a higher pressure control them?
Any thoughts on what is causing them? I have noticed my nasal congestion has increased recently, possibly due to over humidification and/or spring allergens but this is only a guess. As I have no detailed data prior to the most recent week, I don't know if this pattern is new or not.

I visited my sleep doctor yesterday and his position is that my OSA is controlled to well within the normal range with an AHI of 2 or lower and that his job is done till this time next year.

He did authorize an APAP trial though and I borrowed an S8 APAP from my DME for a couple of weeks yesterday. I tried it last night for the first time but the pressure range was set too wide (5-15) and I suffered severe obstructions right after falling asleep so I reverted to my machine for the rest of the night. I intend to set the minimum pressure higher tonight on the APAP and take another run at it. Is it possible that the APAP will respond with higher pressure to the hypopneas and eliminate them?

What pressure range should I set the APAP at? I run my CPAP at 10.8.
What other possible cause could there be for these extended hypopneas? How do I get rid of them?

Thanks for any suggestions. I'm quite anxious at this point to get to the bottom of this so I can get some proper sleep and give my heart a rest.

[dtsm]

I can't address the long hyponeas, etc. I have lots of Hi but my Ai, like yours are relatively low. I get up 1-2 times a night but have no problems getting back to sleep. Hopefully others can be of more help.

Now that you do have a data capable apap unit, suggest the following:

1. If you're cpap pressure is 8.5, I would narrow the range and set the minimum to no lower than 8. The upper range isn't as important, you can set anywhere from 12 to 20. So one range could be 8-12, or 8-13, 8-14, etc.

2. I would try to access the data, see if you can get a ResScan card from DME (it should come with the S8 AutoElite II) to download each week and send/deliver to DME for print-out the reports. Obviously investing in the hardware and software is the best solution (if you do decide to get the card reader or usb adapter, pm back for 'help' with getting the software).

[SleepyBobR]

Thanks.

Actually my S8 Elite II is fully data capable and I have the data card. What I lack is the s/ware and card reader (not sold in Canada for some reason). My
DME also is just learning how to use the Rescan s/ware to produce detail reports. For some reason, they were unable to produce reports for the dates prior to April 6th. They are working on that.

I will move the minimum pressure on my borrowed APAP up to 9 as you suggest.

I'm really interested in understanding the meaning and significance of these extended hypopneas as well as how to manage them as I suspect they may be the reason I can't stay asleep and keep waking up. I should probably also get an pulse/oximeter to monitor my O2 dsat as I suspect it is not good.

With respect to the Rescan s/ware and card reader, I am interested in how to acquire this in Canada. None of the online sellers will ship to Canada. In fact, as far as I can tell, the s/ware is no longer available to anyone.

[dtsm]

With respect to the Rescan s/ware and card reader, I am interested in how to acquire this in Canada. None of the online sellers will ship to Canada. In fact, as far as I can tell, the s/ware is no longer available to anyone.

PM on the way

[OCSleeper]

If your current CPAP was set at 10.8 and the range from the DME for the APAP was 5-15, you could try combining the two: 10-15. This equates to a range of -1 cm to +4 cm relative to your CPAP setting. The lower level is what counts. 15 is a good upper limit if the OA's are already under control. Over 15 cm, you're talking some serious pressure which you probably don't need to explore right now.

Hard to say why the HYP duration is so long. While it takes some minimum pressure to splint the airway open and eliminate the OA's, it takes even more pressure to widen it further to pressure partial closures. Unfortunately, the HYP's cause arousals just as easily as the OA's, so they need to go away as well. If this range doesn't solve the problem after about a week, try raising the min pressure about 1 CM every 3-4 days. If you get to min=15, max=15 and you're still not feeling better after a week, it's time to ask for a bi-level trial I think.

It's sounds like you're in striking range of a good result though, so keep trying. Good luck.

[DaveL]

I'm very interested in this thread.

I live in Ontario too, and have been a hoser for 10 years. Looking for ways to monitor my treatment so that it's more effective.

Interpreting, my sleep specialist feels that a little knowledge is a bad thing; the engine run time monitor is sufficient to prove compliance.

Regards,
Dave

[Ms.Snuffleupagus]

Bob, sent you a pm.

[SleepyBobR]

Got it. Thanks much. I'll be placing my order.