Respiratory rate

[Fenelon]

Thank you Pugsy - I'll definitely ask about the bi-level as an option. I suppose I will have more information to share tomorrow, for now I best pack my bags and hope for the best!

Thank you so much for your help and Gute Nacht!

[Fenelon]

Another day another nightmare I'm afraid.

The sleep lab was not very comfortable and I only slept about four hours, which was split in half almost exactly on the lab report. The first half at a pressure of 5-12 was bad, the second half was at a pressure of 7-16 and was 'good'. I don't have a breakdown of each half exactly, just the overall total. A couple of centrals and hypos but 83 OA (AHI 22.6). The doctor said that the second half of the night was a success and on the (not very clear) graphs there is a distinct difference between the two halves of the night, the second half would have had about 8 events he said, which looks about right with the graph. The problem I have is that he said this difference occurred when they changed the pressure but the pressure graph appears to suggest no change, and the long run of apnea events in the first half didn't seem to respond to the higher pressure setting at all. I'm very confused and disheartened, though it would of course seem odd that such an improvement happened by chance. Again my SpO2 went into the 80s but the doctor said it wasn't for long enough to be a worry and it didn't drop much in the second half of the night. Then he said if I was still tired I should have a blood test, thyroid etc. like I haven't had a multitude of tests already.

So, now I'll need to spend more money and go private for a second opinion - but I'll have to wait three weeks for an appointment. Messing with the settings on my ResMed has proved to be of no benefit to me but I am obviously much worse without the machine, so I guess I soldier on being tired and once more putting my life on hold until I see what the private doctor says.

I wish I had better news. Thank you very much to everyone who has contributed to this thread, your support, advice and suggestions have been both invaluable and appreciated.

[Fenelon]

My last three nights have been significantly better. Last night there were quite a few centrals, but I think this is very likely SWJ - I've now had four different sleep lab studies, with no doctor mentioning centrals, and they only seem to appear when I have a restless night and have switched the machine off/on a number of times. And this seems to be my problem now - adjusting to the new sleep regime. But now that my AHI is coming down, and more importantly I feel much better (very tired still but of clear mind and a lot calmer), I think I will manage a period of transition.

I was quite down after the last night in the sleep lab that I decided to focus on things I could change, no matter how difficult for me. Sleeping position seemed to play a major part in the results from the sleep lab (though no doctor talked to me about this), so I took Pugsy's advice and built a wall (otherwise known as some pillows and weights). The adjustment has not been perfect, I wake up a lot, but I really think it will just take a little time.

I feel like I have turned a corner and I am once again thinking positively. I will, of course, still visit and talk with the private doctor for a second opinion but in the meantime I have ordered various devices/items that supposedly help you to sleep on your side, I am willing to invest to find the most comfortable solution.

My last four nights (the first was in the sleep lab, the last three after I adjusted my position at home):

http://imgur.com/a/Ntfnj
http://imgur.com/a/IgR3D
http://imgur.com/a/kno31
http://imgur.com/a/Z0UnH

Thank you very much to everyone for their help and their time!

[Pugsy]

Your pressure needs have come down significantly with the wall and so has your AHI.
Still a little bit of clustering but not nearly as much as before. Maybe you did have a combination of supine sleeping a some REM stuff mixed in.

Glad you are feeling better too. It's not perfect but it a heck of lot better than it was.

I always say that life doesn't always give us perfect....and that goes for me right now...nearly 2 AM here and I am up because of a dog...3 hours past my usual bed time. I won't sleep late to make up for it either. The other dogs won't let me.
I foresee a rather crappy butt dragging day for me today.

[Fenelon]

Thank you Pugsy, it's definitely a lot better than it was and right now I am happy with that!

I'm very sorry you are not having a good night's sleep - I wish you the best and hope the day and the dogs go easy on you!

[Pugsy]

Thanks. I ended up getting about 6 hours of decent (for me anyway) sleep and while I am not going out to run a marathon it isn't horrible.
At least the other dogs didn't wake me up at 6 like they usually do.

This sleep stuff is a never ending challenge..if it isn't the sleep apnea stuff it's something else.
For me the sleep apnea stuff has been the easiest to fix. I know you aren't so lucky but at least God let me handle the sleep apnea and mask stuff without too many challenges. Now the other stuff...he says I make my own bed and have to lay in it.
I choose to have the dogs and cats and a really old dog that has a weak bladder and toenails that scrape the wood floor to keep me awake...it's my choice since I am always in saviour mode when it comes to my furry friends.

[Fenelon]

I fully understand your love of animals, Pugsy! I've given a house to some rescue dogs here, though I'm currently dog-less!

My results continue to improve, here's last night's:

http://imgur.com/a/RAGO4

Pugsy (or anyone else who might know), may I ask your opinion on the CA number? At what number should these be looked at more closely? After beginning to sleep on my side the OA have plummeted but the CA have increased, albeit slightly. One night was 3.64 but normally the number is similar to the one above. Last night there were 13 clear airway events. 4 of them can definitely be discounted as SWJ. I'm not sure about the others - though I am waking up a lot as I make the transition from moving about a lot in bed to a fairly rigid sleeping position (I think this is normal and will get better, it's already beginning to improve). My three recent sleep lab reports have recorded CA events as 4,4 and 3. No doctor has even mentioned them to me.

I'm not too worried at the moment and realise I can probably discount most of the CA as being down to broken sleep but assuming I couldn't discount them for sure, what number can I glance at and not really be concerned?

As always thanks for your time!

[Pugsy]

Remember some centrals are normal.
Sleep onset centrals or sleep stage transition centrals. They are real but normal and not a big deal unless present in large numbers and/or causing problems like desats or they keep bouncing a person out of sleep and they can't ever progress into the needed sleep stages.

When a person has insomnia issues and they wake up and go back to sleep and they wake up and go back to sleep over and over again they are going to have a greater chance of having more sleep onset centrals simply because they are having more sleep onsets..that transition to sleep.

If you wake up 4 times during the night...there's 4 times that you have sleep onset again where it's possible to have sleep onset centrals.

Your image won't load for me tonight...my internet speed is down to a slow crawl.

As to how many centrals before we worry...and centrals that we can't explain away as SWJ stuff or restless sleep stuff.
Doctor's probably won't even raise an eyebrow unless you average 5 or more per hour...consistently.
Sleep onset centrals are ignored unless they are causing problems. One or 2 sleep onset centrals with each sleep onset transition probably would also be ignored.

If it bugs you too much though...run it by your doctor and get his input for peace of mind if nothing else.

Me personally....I wouldn't start worrying unless I saw centrals consistently every hour all night long and every night that amounted to 4 or more. I would discount potential sleep onset centrals since those are considered normal and I would of course discount the SWJ centrals. If the remaining was running 4 or higher I would ask my doctor for his thoughts on it.

[Fenelon]

Thank you so much Pugsy! Last night's number of 1.61 is about normal for me, and that's before I have deducted sleep onset etc. I have also just realised that the numbers from the sleep lab are not per hour but per night - 4,4 and 3!

Thank you again for your time, you've been a great help!

[Fenelon]

This post is just to say please do not give up if you are struggling with therapy! It seems I have found the key to my treatment, sleep position. But it has been a tough road to travel to get here. My numbers could be lower, my sleep is not perfect, I'm even tired still - but I feel like a different person. Clearer, calmer and no doubt nicer. I thought I was a side-sleeper - and here's the thing, so did my girlfriend! She has been as surprised as me that I'm not! It seems I start on my side but roll onto my back and spend most of the night in that position. No more!

The image below is from last night. I awoke in the middle of the night thinking I was dreaming I was on my back. I was! I had accidentally knocked down my support! I switched the machine off and fixed the support. Needless to say the cluster of OA was the back sleeping episode! The image after is my last night BEFORE changing my sleeping position. What a difference.

Try everything and don't give up!

http://imgur.com/a/ltVFz
http://imgur.com/a/9u4sv

Thank you to everyone who has contributed to these posts, I have appreciated your help so very much.

[Pugsy]

Good job. Don't be disheartened if your "wall" sometimes moves out from under you and you end up on your back. It just happens sometimes.
While not everyone with OSA will have a significant change in pressure needs when on their backs it is very common and you drew the short straw on that one.

You also drew some other short straws that complicated things...the aerophagia short straw at higher pressures...the fact that on your back your machine can't go high enough to fix the problem even even the aerophagia monster wasn't present. Plus the short straw of living where it isn't so easy to get a bilevel that might keep the aerophagia monster away and go higher with the pressures than your current machine.

You have found a workable solution. With time the body may decide it is okay with staying on your side more and not "fight" it so much. Or again it may not. The body is a funny little dude. My back just kills me when I go on my back...not perfect on my side but on my back it's just awful. So you would think that this funny little dude would want to stay off the back but nooooo....it just wants to mess with me. I woke up early this morning and my back was screaming at me and yep...I was on my back. Ended up I simply couldn't get comfortable in any position so I just got up a bit earlier than I really wanted to.
Fortunately for me at least the back sleeping doesn't change my pressure needs...in my case it is the REM stuff that needs a lot more.

[Fenelon]

Thank you for all your input Pugsy! And I hope your back feels better!