Large number of hypopneas in the early morning

[n3kf]

Did you miss the bit about breathing out hard when it ramps up unwanted? It works with the resmed, it may work with the philips.
are you awake, when the H cluster is happening? You don't count anything when you are awake.

We all adjust our machines. Have you got the clinical manual for your machine, it's available from apneaboard. A good idea is not to adjust anything you aren't sure of, till you have read up on it. I would go back to the original settings as per the doctor/lab. The auto breath rate, would be what I would choose over a fixed rate, when you''re not sure what the rate should be.

do you have the UA apnea turned off? There may be some that you need to see, as well as the H. the sleepyhead instructions should tell you all you need to know to set up your chart.

No, I suspect that I am in REM sleep when the HCluster happens. Definitely not awake. When I wake up I usually have been having vivid dreams I remember. On top of it, when I get a night when the Hcluster happens (which is frequent), I feel like crap. Except for the move to EPAP min at 5, I am exactly what my prescription is.

I can try the puffing back, but the problem is that just as I probably fall into stage 1, it starts puffing and it wakes me up. This can go on for a long period of time some nights. I don't have a ramp, but maybe I need to put a long ramp in so that I get through that unstable part. My doc has explained that breathing becomes very unstable at the first stage of sleep. I asked if we could do something about the puffing at that point and he basically shrugged.

I'll have to look for the UA that you reference. I'm very new to the sleepyhead software. My goal is to let me get to sleep without that puffing constantly waking me up at first and to get rid of the hclusters. If I get rid of the hclusters my nighthly AHI would be fantastic. And during the hclusters is that patient initiated breaths getting low a problem (although no hclusters and its moot)?

But please bear with me. I will learn with the guidance of the group. Thank you again.

Sent from my Nexus 7 using Tapatalk

[Pugsy]

I'll have to look for the UA that you reference.

Don't bother. You don't have a UA event flag choice on your machine...ResMed ASV machines do but not Respironics. Ajack uses a ResMed machine and that's why he sees it on his SleepyHead reports.

[ajack]

Yes, the UA are resmed, by the look of it. You may not be getting any oa, that makes life easier.

Your minute vent and tidal volume charts are saying you are getting plenty of air over the period of the H cluster.
The H are having some 70% patient triggered breaths, so the machine is doing 30% during the H period.

If it's rem going nuts with periodic breathing, a collar won't fix it.
If the DME has a loaner resmed asv either the s9 or 10, It would be interesting to see what it does with them.

[n3kf]

Yes, the UA are resmed, by the look of it. You may not be getting any oa, that makes life easier.

Your minute vent and tidal volume charts are saying you are getting plenty of air over the period of the H cluster.
The H are having some 70% patient triggered breaths, so the machine is doing 30% during the H period.

If it's rem going nuts with periodic breathing, a collar won't fix it.
If the DME has a loaner resmed asv either the s9 or 10, It would be interesting to see what it does with them.

My system gets replaced next year, so this system is close to five years old. The DME is relatively useless other then selling supplies. I'll probably look at changing DMEs with the next system.

So reading up on hypopneas, I am thinking the hclusters I am getting are probably centrals and not obstructive. I definitely get centrals. I have not had a full blown sleep study for a while. We did a daytime study and discovered the Centrals. I stop breathing a couple times a day while awake. It's bizarre, but doc says it's idiopathic. So it's a bit worrisome to me that I may be getting massive clusters of them. I guess if this is bothersome I will have to talk with my sleep doc about it.

Did you say there are people over on Apnea Board that have more experience with the ASV machine? I am a member there also, so I could raise a post about it if that is the case. By the way, the machine does not think it's periodic breathing. It has never indicated that. But I also realize software is not perfect. I do rem sleep earlier and the hclusters do not happen except around that time of the morning. Quite weird.

I guess I'll see what tonight brings. Again I really do appreciate the input.

Sent from my Nexus 7 using Tapatalk

[ajack]

respironics had an upgrade on their a-sv, you may have the older one. The resmed targets the previous minute vent, the respironics targets the peak flow. I haven't used a respironics, but there is a thread on the other board of those that have. The consensus seems to be that the resmed is the preferred machine.

I would put up a thread, you can't have too much input. It generally gets sorted in the end, the hard ones can go for many pages.

[TedVPAP]

Yes, the UA are resmed, by the look of it. You may not be getting any oa, that makes life easier.

Your minute vent and tidal volume charts are saying you are getting plenty of air over the period of the H cluster.
The H are having some 70% patient triggered breaths, so the machine is doing 30% during the H period.

If it's rem going nuts with periodic breathing, a collar won't fix it.
If the DME has a loaner resmed asv either the s9 or 10, It would be interesting to see what it does with them.

My system gets replaced next year, so this system is close to five years old. The DME is relatively useless other then selling supplies. I'll probably look at changing DMEs with the next system.

So reading up on hypopneas, I am thinking the hclusters I am getting are probably centrals and not obstructive. I definitely get centrals. I have not had a full blown sleep study for a while. We did a daytime study and discovered the Centrals. I stop breathing a couple times a day while awake. It's bizarre, but doc says it's idiopathic. So it's a bit worrisome to me that I may be getting massive clusters of them. I guess if this is bothersome I will have to talk with my sleep doc about it.

Did you say there are people over on Apnea Board that have more experience with the ASV machine? I am a member there also, so I could raise a post about it if that is the case. By the way, the machine does not think it's periodic breathing. It has never indicated that. But I also realize software is not perfect. I do rem sleep earlier and the hclusters do not happen except around that time of the morning. Quite weird.

I guess I'll see what tonight brings. Again I really do appreciate the input.

Sent from my Nexus 7 using Tapatalk

This makes no sense to me. It is possible that they are SWJ but certainly not central.

[n3kf]

This makes no sense to me. It is possible that they are SWJ but certainly not central.

Hypopneas can be central or obstructive. Not sure what SWJ is, but why would you say can't be central? Like to understand.

Sent from my Nexus 7 using Tapatalk

[Pugsy]

He may be thinking about hyponeas usually being obstructive but you are correct...they can be both and they can sometimes confuse the Respironics ASV machines in terms of what to call things.

I have seen the Respironics machine call truckloads of centrals with the OA and hyponea name...and it was really obvious they were centrals and full grown CSR to boot complete with the green coloring. It can happen sometimes.

How are things now that you have gone back to a fixed back up rate instead of the auto backup rate?

[TedVPAP]

This makes no sense to me. It is possible that they are SWJ but certainly not central.

Hypopneas can be central or obstructive. Not sure what SWJ is, but why would you say can't be central? Like to understand.

Sent from my Nexus 7 using Tapatalk

I am not familiar with your machine so maybe there are some difference in definition. I guess I need to read up on central hypopneas.
My understanding is the the distinction between OSA and central is based on the response to pulsing. If your machine sensed obstruction, then I trust that there is obstruction.

[n3kf]

He may be thinking about hyponeas usually being obstructive but you are correct...they can be both and they can sometimes confuse the Respironics ASV machines in terms of what to call things.

I have seen the Respironics machine call truckloads of centrals with the OA and hyponea name...and it was really obvious they were centrals and full grown CSR to boot complete with the green coloring. It can happen sometimes.

How are things now that you have gone back to a fixed back up rate instead of the auto backup rate?

AHI was 4.9 last night. Will look at the SD card later today and report back, although being a holiday don't expect many views!! Happy holidays.

Sent from my Nexus 7 using Tapatalk

[Pugsy]

I am not familiar with your machine so maybe there are some difference in definition. I guess I need to read up on central hypopneas.
My understanding is the the distinction between OSA and central is based on the response to pulsing. If your machine sensed obstruction, then I trust that there is obstruction.

It's not so much the definitions or criteria or the pressure pulses used to help distinguish the event category is that it is simply the machine not able to be totally accurate in some rare situations. It can be fooled in some situations where centrals are involved.
Not to mention that fact that there are mixed apneas out there that might start out as central and end up as obstructive or the other way around.
They can morph which is going to confuse the machine.

The example below...clearly shows OAs flagged and CSR and upon further deep inspection (and follow up sleep study) these were centrals.

Simply put....the machine may not always be totally accurate in some situations in the name calling department.

[Pugsy]

AHI was 4.9 last night. Will look at the SD card later today and report back, although being a holiday don't expect many views!! Happy holidays.

Will be interesting to see if you have any clustering happening again with the back up rate set to fixed.

I don't know if those hyponeas are central or obstructive...while not impossible for them to be central in nature....it's surely not very common and if it were me I would probably want to treat them as obstructive at least for a short term experiment to see if I could break up the ugly clustering with traditional methods.
The machine will breathe for you if you don't breathe especially with fixed rate so that the auto back up rate thing is removed.

[TedVPAP]

I certainly appreciate how events can be confused. When I review my own data I try not overanalyze every event, and instead look for trends. Some are scored as hypopneas that look trivial, while others can go unnoticed. But in general, the scoring provides a reasonable assessment of sleeping disturbances.
The algorithms are certainly not perfect - nor can they be since the definitions of event are merely attempts to isolate responses in hopes of better identifying their cause.

I guess what is puzzling me is that the OP's charts show all signs of OSA, and nothing that supports Central. That is why I thought is would be useful to review the sleep study. I don't think it Is reasonable to conclude that the OP's treatment is misidentifying all events, or that the treatment is working perfectly for Central, but working poorly for OSA. Maybe I am wrong. Trying to learn.

Make sure you adjust the mask to get a good seal at the pressure of interest.
To address the hypops you need more pressure. If that causes more centrals then the machine will take care of them.
On another note, you may want to post your sleep study results (black out personal info).

[Pugsy]

I guess what is puzzling me is that the OP's charts show all signs of OSA, and nothing that supports Central. That is why I thought is would be useful to review the sleep study. I don't think it Is reasonable to conclude that the OP's treatment is misidentifying all events, or that the treatment is working perfectly for Central, but working poorly for OSA. Maybe I am wrong. Trying to learn.

You don't see obvious signs of centrals because the machine is preventing them by breathing for the person and that's why the patient triggered breaths aren't 100%. If the machine wasn't breathing for him his PTB would be 100% instead of something else.
Example...of PTB is 70% then that means for 30% of the time the machine is doing the breathing.
It doesn't flag a central when it breathes for a person. It would only flag a central if it was prohibited from breathing for the person ...say with too restrictive of a setting that ties it's little hands.

So the PTB numbers being low tells me the machine is doing some breathing for the person and that fact tells me that centrals are being dealt with.
So a back door way of knowing centrals are a factor without ever seeing the actual flags which we don't want to see anyway.

Complex Sleep Apnea..that's when a person has both problems...central and obstructive sleep apnea.
So we have to do 2 things...treat the obstructive stuff in the traditional way and then let the machine treat the centrals assuming we haven't tied it's little hands.
That's why I gave the link to the ASV titration document
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
So it could be read since it explains the need for EPAP minimum doing a good job holding the airway open in the first place (just like when using regular apap). We need to do both things....hold the airway open for the obstructive stuff and treat the centrals at the same time. This is why these ASV machines do both but we have to set the machine so that it can do both and sometimes minimum EPAP of 4 or 5 or 6 or even 7 simply doesn't do a good job just like with APAP machines and minimum of 4 or 5 or 6 or even 7 doesn't do such a good job.
I know one guy using minimum EPAP of 12 with his ASV to deal with the obstructive side of things and may even need a bit more.

I am not so sure that those hyponeas are central in nature...but they could be...and if it were me I would at least try killing them with more EPAP or IPAP but the OP didn't want to do that because he was afraid it would cause centrals...which to me wouldn't matter because he is already on a machine to deal with centrals because we assume he already has a problem with them. But I can't come up with an urgent proven argument to tell him to do that because I can't say with 100% certainty those hyponeas are obstructive in nature since I know that sometimes the machine can make mistakes.
OP seems to prefer to investigate the back up rate thing as maybe being a factor instead of the usual thought "more EPAP minimum"...it's a reasonable thought. Worth seeing if something as simple as putting the machine back to fixed back up rate will prevent ugly hyponea clustering.

So I am not saying that the machine is wrong...just that it could be wrong...and if it were me I would go about things differently but I am not the OP and he wants to go about things a little differently...so I will try to help him in that regard. Maybe later if no joy with other ideas he will want to maybe try more EPAP or maybe just adding a little PS minimum (which would be what I would probably try first....I would try just a little PS minimum to see if those hyponea clusters would get smaller).

[n3kf]

He may be thinking about hyponeas usually being obstructive but you are correct...they can be both and they can sometimes confuse the Respironics ASV machines in terms of what to call things.

I have seen the Respironics machine call truckloads of centrals with the OA and hyponea name...and it was really obvious they were centrals and full grown CSR to boot complete with the green coloring. It can happen sometimes.

How are things now that you have gone back to a fixed back up rate instead of the auto backup rate?

AHI was 4.9 last night. Will look at the SD card later today and report back, although being a holiday don't expect many views!! Happy holidays.

Sent from my Nexus 7 using Tapatalk

OK. Here it is with everything set back to what the doc had ordered. I realize I should give it a couple days. I was going to ask about the patient triggered breaths. I assume that means the system is puffing to make me breath when it detects I am falling below the backup rate? Looking at that chart is freaky, but its obviously the same for the data the doc looked at, so I guess that is expected on an asv. Is that right?

Anyway, there was an hcluster around the same time, but only about 15 minutes this time, so the numbers are better. Maybe I need to wakeup at 5:30 (its an hour off) and read until 6:30 and then go back to sleep. My gut says that since going from automatic which used a lower back up rate, to 14 the hclusters decreased. Maybe I need to go to 15. But that seems fast. Timing my breathing right now, its 12. Looks like automatic was around 10. Confused.

Sent from my Nexus 7 using Tapatalk