Not Complaining, But Why Did My AHI Drop from 9 to 3?

[gbvol54]

I've been doing the CPAP thing for just under two weeks with underwhelming results. Prior to last night my AHI was ranging from 6.66 (partial night) to 14 with little response to a gradual increase of min pressure from 4 to 9. Then last night my AHI dropped to 3.36 with the only change in settings being a decrease in Max from 20 to 12. The pressure never bumped up against the 12 limit (maxing at under 11), so I don't see that as a cause. Sleepyhead charts from the last three nights are attached below, all with a min pressure of 9 and AHIs of 7.2, 9.08 and 3.36.

My question is what could have caused such a dramatic drop? The only thing I can think of is that I made a concerted effort to try not to take a deep breath. For years I've had the intermittent feeling, both awake and asleep (waking up with the feeling numerous times a night) that I couldn't get a full breath. I mentioned this to my MD and he gave me a max breath test (Tidal Volume?) that came out normal. In the last couple of days I've been googling the issue and came up with the self diagnosis of Hyper Ventilation Syndrome. After reading how the desire for a deep breath can actually be caused by a lack of CO2, and that repeated deep breaths can in fact worsen the issue I decided to try and fight the urge and instead force myself to take smaller shorter breaths with full exhales. For the most part I was able to do so though i had to get up and walk around a bit a couple of times. I realize this seems like a bunch of hog wash, and perhaps it is, but I can't see anything else to explain the drop in AHI. Could it really be that simple? If the results continue consistent beyond a one day event the next step would seem be to teach myself to avoid the urge even in sleep perhaps though breath exercises like the Buteyko Method. It too seems too good to be true, but I guess there's no harm in trying.

Sorry for the long post but I'm pretty darn confused (but also happy with my first ever sub 5 AHI) and would appreciate any and all thoughts and opinions.

Thanks

http://imgur.com/a/7fkEI

PR Dreamstation APAP Auto w/Humidifier and Heated Hose
ResMed Swift FX Nasal Pillows

[Julie]

Lose Buteyko... fast!

Otherwise, you may be aware of taking (or not taking) deep breaths when awake, but what happens when you're asleep (and when SH tracks validly) can't be known and you have no way of controlling it. Your body may just finally be benefitting from Cpap and you could be relaxing more (even in sleep).

But it's not smart to try and breathe any differently than your body wants to... can only lead to trouble in fact, being hyper aware of it and then not being able to become unaware even if you want to - like a neurotic tic but worse. Your body knows what it needs and how to get it providing obstacles (obstructive apnea) are dealt with, so don't try to outsmart it.

[chunkyfrog]

SELF DIAGNOSIS?
BAD IDEA.
Buteyko--also a bad idea, very bad.
Your doctor did his job. Now let your body and your cpap do theirs.
Just mask up, lie down, and LET IT BE.

[Cardsfan]

The item that changed so much is you CA events. Could be you are just sleeping better.

[wm_hess]

Hi

I was looking at your two charts you provided and noticed that your name is clearly present at the top of both of the charts. You may want to redo the images, but eliminate your name at the top (Profile: XX XX). You don't neccessarily want your identifiable medical information posted forever on the internet.

As far as your question....got me. Sorry but I was hoping to learn how to interpret them better when I was looking at yours.

-Bill

[rick blaine]

Hi, gbvol54,

The first thing I have to say to you is: do not mix up daytime breathing disorders (or the possibility of them) with sleep apnea. They are actually two quite different conditions.

Second, if your understanding of daytime breathing disorders is based on the exotic Buteyko method, you need to know that not every doctor who specialises in chest medicine agrees with its more extreme proposals - including the Australian doctor who came up with the term 'hyper-ventilation syndrome' several years before the Buteyko method was brought to the west - and which Australian doctor I knew and interviewed when I worked as a medical journalist.

Third, in HVS, it's not just the depth or shallowness of the breaths which is important, it's the number of resps per minute. And in fact, resps pm can outway tidal volume as a causitive factor if that number is high enough. For example, In the case of young adult females using only upper-chest breathing and reaching 30 resps per minute.

Fourth, in HVS, it's the pattern sustained over time which brings about symptoms, as well as the number of symptoms. If you're going to be officially diagnosed as having hyper-ventilation syndrome, you're going to have to score 16 or more on the 24-point scale that two Dutch researchers came up with in the 80s.

I'm saying all this because I want to echo what others have said - most patients who diagnose themselves have an amateur for 'the doctor' and a fool for 'the patient'.

Now, it may be that your daytime breathing is unusual, and it may be that you could benefit from some adjustments. However, I suggest you do not futz around with your breathing on your own, and without getting proper supervision.

You need, if you don't mind me saying so, to find a good and experienced respiratory therapist or physiologist.

Now ... wrt to your sleep apnea, maybe no one's explained it to you, but the software on the Philips Respironics machines and the ResMed machines gets freaked out by any kind of deliberate, voluntary, controlled breathing - deep or otherwise. That's just the way that software is written.

If you do deep breathing exercises - with perhaps a few "control pauses" thrown in - while you have the mask on, and while the machine is running, it will record them as centrals. (The purple lines on the events chart.) And your AHI will go up - what some people call 'artificially up' - meaning 'it's not sleep apnea which is causing that'.

So ... you ask for thoughts and opinions. Here are mine, and my apologies in advance if I sound a bit brusque, but I'm not wanting to write War and Peace here.

1. Stop doing any kind of special, deliberate breathing while you have the mask on and the machine running. Just stop it.

2. Give up on the idea that you're supposed to have this sleep apnea thing all fixed after two weeks. Two weeks in which, as I understand it, you have changed the settings several times.

I don't know if anyone has told you, but the best protocol for adjusting pressures and sleep habits and so on is: make one small change at a time. Then let that run for at least three or four nights, before evaluating it.

3. Stop 'chasing the dial' - ie, thinking you have to get it down below the magic 5 - or the even more magic 2 - by the end of the month, or by some other target date - or you're toast. This isn't a competition.

4. Another thing I don't know if anybody's told you - irrespective of the deliberate deep-or-shallow breathing effect, you need to give your body-and-mind time to learn how to work with this new system.

You say "just under two weeks"? It took me three months just to start getting below 10 on my 551 seven-day average reading.

5. If you are waking up with the feeling that you can't get a full breath (and it has been ruled out that you have any organic condition) - then know this: at that point, you are no longer sleeping.

Now, there are breathing exercises you can do once fully awake which might help. But first you would have to learn them - to the point where you can easily slip into doing them (and note, with the mask off, and the machine not running).

But to get to that point, you would need, in my opinion, to learn them from a proper, trained professional. And he or she could address any unhelpful daytime breathing patterns as well.

What I'm saying in general is: there may be a way for you, with the help of forum members, to get closer to the optimum treatment. But the way you are currently going about it is not the best way.

[gbvol54]

To all who replied, thank you. No offense taken. But my post may have been misleading. I intended the term 'self diagnosis' mostly in jest/sarcasm. I did research hyperventilation, and I do fit the symptoms, but I'm not ready to run off to some commune and become spiritually enlightened. My poorly made point was that I had a dramatic improvement with the only change being an effort to resist my pattern of falling into periods of fighting for deep breaths. I sleep poorly and wake often for bathroom trips. As I try to go back to sleep I often get the urge/perceived need for a deep breath that I cannot obtain. These periods also wake me during the night. All I did different last night was when those urges occurred, and I was awake, was tried to take normal breaths with a complete exhale. No exercises or anything, just trying not to gasp for a deep breath. After a few minutes the urge subsided and I was able to go back to sleep. I can't see where this could possibly do any harm. Whether this had an effect on the drop in AHI has to be uncertain at best. But if it did, and the for it to improve my sleep, it would it would have to become more of an automatic response to the deep breath urge. This is where breathing exercises could perhaps be beneficial.

So I believe I got my questions answered (despite my poorly worded post) in that I interpret the majority of replies to indicate the following:
1. No one saw anything in the charts that sticks out as a cause of the AHI drop and AHI drops from 9 to 3 are not unusual.
2. Buteyko is a bad idea (or perhaps the root of all evil After all, Buteyko was a Russian...)
3. Patience is a virtue I lack.
4. Don't go messing with breathing exercises until I get some professional guidance (Pulmonologist ?).
5. Don't leave personal information on charts posted on the internet (I'm a dunce).

Thanks again.

[Julie]

I wonder if you tried raising the head of your bed on a couple of bricks... and make an effort to not back-sleep (lots of people have shortness of breath doing that) if you'd have fewer 'episodes'?

[rick blaine]

Given what you now add, gbvol54, you may well have HVS. (But remember, I am not a doctor )

One of the pieces of advice given to patients with HVS is - once in distress, don't keep fighting for that deep breath (that you think or feel is what you need).

So when you say,

"All I did different last night was when those urges occurred, and I was awake, was tried to take normal breaths with a complete exhale. No exercises or anything, just trying not to gasp for a deep breath."

it seems that you inadvertently did the right thing. Those "normal breaths with a complete exhale" sound almost like one of the responses you would be taught by a professional. (Obviously, I can't tell just from what you say. A pro would need to see and hear you demonstrating what you did to best guide you.)

It's the next step which is the key one. It's 'what do you do to prevent getting in that position?'

Finding yourself in that position is like being at sea and just about to hit the rocks. Sure, some nifty seamanship can get you out of that tight spot. But what is needed long-term is lessons in steering well clear of the rocks in the first place.

And the answer is to practice good breathing habits - to the point where they do become automatic. It isn't very dramatic - not like taking a wonder-drug or having a big operation. It's just repetition, with coaching and supervision - to the point where you follow those good habits all the time. And then, no more involuntary deep-breath urges.

For what it's worth, six sessions with a respiratory therapist at roughly two-week intervals is the norm. Just so you have something to compete with.

And I repeat, these modern machines will record deliberate breaths as possible centrals. So until this 'thing' is less of a factor, your numbers may not be reliable.

Oh, and btw, the problem some professionals have with Buteyko is that - at least in the sources I've seen - the suggestion is that Buteyko breathing exercises are the sole treatment for sleep apnea, regardless of the severity.

[gbvol54]

Rick,

Thanks for the followup comments and the additional effort to understand what I was trying to communicate. You captured it well and I agree I need professional help for an actual solution rather than a bandaid. I'll get in to see my regular MD and be more persistent about getting evaluated for HVS.

Six sessions over a three month period eh? A small price to pay if it gets me a good nights sleep.

[johnnyp]

Why all the hate for Buteyko?

Just curious why the Buteyko Method was dismissed without any justification. It seems to me that if speed and quantity of air passing through the airway increases the inward pressure on the airway, then by reducing the volume of air (and therefore the speed and quantity) it should reduce the number or severity of the apneic episodes. Obviously you need to consider the size of the airway as well. All Buteyko teaches is a set of exercises to normalize breathing. Saying that a person with sleep apnea shouldn't change the way they are breathing is like saying a fat person shouldn't change the food he is eating. I personally know several people with sleep apnea who have changed the way they breathe using the Buteyko exercises and have had sleep studies show they no longer have sleep apnea. I wouldn't be so dismissive of breathing exercises so quickly. The advice to just wear the CPAP and shut-up seems a little defeatist. Obviously there is a reason you have sleep apnea. It's impossible to breathe properly while sleeping if you are breathing improperly while awake.

[palerider]

It's impossible to breathe properly while sleeping if you are breathing improperly while awake.

it's impossible to win a marathon while sleeping if you are improperly winning marathons while awake.

[ChicagoGranny]

It's hard to say without sitting with your Sleepyhead chart and zooming down to look at a good many of the wave forms before and after events, but I suspect the night you have high AHI includes a lot of "false events" that are recorded while you are awake. I say this because the chart of the night with 9.0 AHI shows a relatively high amount of clear airway events and a relatively low number of obstructive apnea events. You also write:

The only thing I can think of is that I made a concerted effort to try not to take a deep breath. For years I've had the intermittent feeling, both awake and asleep (waking up with the feeling numerous times a night) that I couldn't get a full breath. .... I sleep poorly and wake often for bathroom trips. As I try to go back to sleep I often get the urge/perceived need for a deep breath that I cannot obtain. These periods also wake me during the night. All I did different last night was when those urges occurred, and I was awake, was tried to take normal breaths with a complete exhale. No exercises or anything, just trying not to gasp for a deep breath. After a few minutes the urge subsided and I was able to go back to sleep.

This is an indication that you are under some nervous stress when in the bed, and these as the times when awake breathing becomes irregular, and there is a tendency to reflexively hold one's breath. The machine will report these are clear airway events because it does not have the ability to know that you are awake.

You might want to keep a journal and compare how relaxed you feel with your AHI for the night. I suspect your body knows full well how to breathe properly when you are actually asleep. Your issue may be how to relax at night. This is a very common issue for beginning CPAP users.

Good luck, and if you still have concerns about a breathing abnormality, don't hesitate to see a doctor.

[ChicagoGranny]

Why all the hate for Buteyko?

Because there is no evidence it is effective.

In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; the Buteyko method was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.[1] A Cochrane review had earlier found "no reliable conclusions" could be determined based on the limited available evidence.[8]

Advocates of the Buteyko method report a wide range of other diseases and symptoms (numbering up to 150), including diabetes, reproductive disorders and psychological disorders, which they believe is aggravated by hyperventilation and hypocapnea, and therefore are treated by use of the Buteyko method. However, research into the effectiveness of Buteyko have focused almost exclusively on asthma with a small amount of research on sleep apnea.[4] Members of the medical community have been skeptical of the efficacy of Buteyko due to the often "exaggerated and unsubstantiated claims" earlier made by Buteyko practitioners.[5]

There are few high quality studies such as randomized controlled trials looking at the efficacy of treating asthma with "breathing retraining" methods in general, which include the Buteyko method, yoga training and other relaxation techniques.[8] Many of the studies that have evaluated breathing retraining have significant methodological flaws, including small sample sizes,[9] possible patient selection bias as well as heterogeneity in design that makes coming to a firm conclusion difficult.[10] These studies are also hampered by the difficulty in proper blinding and placebo control which could introduce more bias into these studies.[9]

https://en.wikipedia.org/wiki/Buteyko_m ... ectiveness

It's impossible to breathe properly while sleeping if you are breathing improperly while awake.

And because proponents make up no-basis-in-fact, but catchy, statements like that to promote the method.

[chunkyfrog]

. . . "Hate for Buteyko"?
Not hate, but something more like disgust; maybe hate for the proponents who insist on PUSHING QUACKERY,
because if it were merely a harmless ripoff, the foul is mild--but when it can cause HARM, different story.
Nobody needs this garbage, especially when it supplants or delays REAL MEDICINE.