Erratic tidal volume and clustered events: Is this normal?

[rebeccamakesthings]

Hi there. I've been doing CPAP for moderate sleep apnea for a couple months, and for the most part, I think I feel better. I'm not as sleepy, for sure, and I've stopped nodding off in inappropriate situations. I still get days where I'll sleep for 12 or 14 hours though.

I'm using a Resmed Autoset 10 with nasal pillows, with pressure at 7 and pressure relief down to 4.

During my sleep study, I didn't actually have any obstructive apneas, just hypopneas and a few isolated central apneas with an AHI of 20.5. During the titration, almost all the hypopneas were eliminated, but I still experienced about 20ish arousals per hour. I definitely got better sleep though. Initial study, I had 2% deep sleep; during the titration, I managed to get 20%.

Anyway, now that I've been looking at my data regularly and stuff, I'm noticing some things that are probably normal, but that still leave me wondering what's going on.

Basically, sometimes my flow charts get a little weird and stop looking like any regular breathing pattern. During that time, there's no leaking or flow limitation showing up either. My tidal volume goes a little nuts too. Here's some screen grabs of what I'm talking about. Both are from the same 12ish-minute window last night.






Also -- and I did ask about this once before but didn't get much in the way of a response -- a few times a week, I'll get clusters of central apneas. It's generally anywhere from three to ten, in a 15-20 minute window. Here's an example from a couple nights ago:




Basically, I'm just wondering if any of these look like things I need to follow up about with my doc, or is this just normal-ish kind of Sleepyhead white noise?

[Jay Aitchsee]

I wouldn't worry about them. Recording a few events is normal. In a lab, many of the events a home machine records would not be counted. The first group around 01:18 is probably a brief arousal, perhaps as you are transitioning between sleep stages.
The later group around 07:10 looks like what is often called SWJ (sleep wake junk) recorded as you transition in and out of sleep as often seen in the early hours before fully awakening. Completely normal. Again, in a lab, they probably wouldn't be counted. As you transition to wake, your breathing becomes more irregular, but your machine at home doesn't have any way to determine your sleep stage so events are reported which might not be counted in a lab.