Large number of hypopneas in the early morning

[n3kf]

Hello All,
I have a Respironics System one ASV. I have complex sleep apnea and get both obstructive and central apneas. I have noticed that I can get a pretty high AHI some mornings. I started using sleepyhead and see the system seems to take care of the obstructive and central apneas, but I do get hypopneas. On the days the AHI is high, I notice I get a time period where I get a salvo of hypopneas. Last night for example was only a 4 hour sleep night. Everything was really good until 6:30 to 7:15. During that timeframe I had 67 hypopneas. Then from 7:15 to 7:30 things went back to normal. Any ideas what can cause something like that? When I wake up I feel like crap. I took a sleepyhead screenshoot, but cant figure out how to post it. Naturally the ASV function is really cutting in and my patient triggered breaths go down in the 50 - 60% range.

Any ideas how I can improve that? Thank you!

[Julie]

I wonder if you tend to either roll onto your back at those times, increasing the events, and/or end up with your head bent down on your chest (or close to)? If the latter, I would recommend trying a soft cervical collar to keep your head up, airway more open (and jaw, if not lips, closed). If you're on your back, see if you can do something e.g. like wear a backpack with towels in it for a while til you get used to not sleeping that way.

As for SH -

https://sleep.tnet.com/resources/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize

[ChicagoGranny]

I took a sleepyhead screenshoot, but cant figure out how to post it.

Upload it to imgur.com then post the link in this thread.

Everything was really good until 6:30 to 7:15. During that timeframe I had 67 hypopneas

Is it possible you were awake or drifting in and out during that period?

[n3kf]

I took a sleepyhead screenshoot, but cant figure out how to post it.

Upload it to imgur.com then post the link in this thread.

Everything was really good until 6:30 to 7:15. During that timeframe I had 67 hypopneas

Is it possible you were awake or drifting in and out during that period?

Thanks. I'll try and get it uploaded one I am back in the PC.


If I was awake I would know that the ASV is puffing at me to get me breathing. It's pretty obvious if you are awake when it does it!

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[n3kf]

I wonder if you tend to either roll onto your back at those times, increasing the events, and/or end up with your head bent down on your chest (or close to)? If the latter, I would recommend trying a soft cervical collar to keep your head up, airway more open (and jaw, if not lips, closed). If you're on your back, see if you can do something e.g. like wear a backpack with towels in it for a while til you get used to not sleeping that way.

As for SH -

https://sleep.tnet.com/resources/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize

I have a really bad back, so the pain from being in my back would wake me up pretty fast. I just find 67 events in 45 minutes pretty nuts. May have to put a camera on me!!

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[n3kf]

Hello All,
I have a Respironics System one ASV. I have complex sleep apnea and get both obstructive and central apneas. I have noticed that I can get a pretty high AHI some mornings. I started using sleepyhead and see the system seems to take care of the obstructive and central apneas, but I do get hypopneas. On the days the AHI is high, I notice I get a time period where I get a salvo of hypopneas. Last night for example was only a 4 hour sleep night. Everything was really good until 6:30 to 7:15. During that timeframe I had 67 hypopneas. Then from 7:15 to 7:30 things went back to normal. Any ideas what can cause something like that? When I wake up I feel like crap. I took a sleepyhead screenshoot, but cant figure out how to post it. Naturally the ASV function is really cutting in and my patient triggered breaths go down in the 50 - 60% range.

Any ideas how I can improve that? Thank you!

OK, I probably should note that I use a mirage full face mask. Pretty bazaar how this happens. And it certainly is not an isolated occurrence. Any ideas? Thanks.

Sent from my Nexus 7 using Tapatalk

[ajack]

If it were my chart, try a ffm first, I'd also try epap 6- 7, 2 below the epap 95%, min ps 3, (the median PS numbers) that should clear a lot up. Or leave the PS on 0 and increase the epap till it settles. There also could be some positional apnea, that may need looking at later. If chin tucking, a soft foam cervical collar can diagnose it to be the case.

[n3kf]

If it were my chart, try a ffm first, I'd also try epap 6- 7, 2 below the epap 95%, min ps 3, (the median PS numbers) that should clear a lot up. Or leave the PS on 0 and increase the epap till it settles. There also could be some positional apnea, that may need looking at later. If chin tucking, a soft foam cervical collar can diagnose it to be the case.

I got a lot to learn here, so being an engineer I'll ask lots of questions. I thought that having too much EPAP, that it could cause you not to breath and thus cause a central apnea. Although I guess the servo may cause that not to happen. Lots of parameters here.

Another problem I have with the full mask that when it ramps up to 12 or 13 it causes leaks.

Thanks for the feedback. I guess I could always make small adjustments and see it it goes in the right direction.

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[TedVPAP]

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).

[ajack]

The machine has a 'mask fit function' that will blow pressure to help you adjust your mask. Getting the leak fixed is the first step.

With my asv, I set my epap 1cm below my epap 95%, with your chart that would be 7. you could go less and have 6. so 6-7 like I originally said. we are talking very small numbers, most will tell you to use min 6 so you don't feel short of breath. my epap is currently 10.

you have to have enough epap to stop the UA and H on an ASV. The UA/H aren't from CA. you can keep the ps:0 if you want to, it doesn't matter much at the end of the day, keep raising epap till the ua and most of the H without a deep breath in front of them, go away. The cluster of H may be from chin tucking, If it continues, a cheap foam cervical collar for a few nights will tell you if it is. You could also focus on keeping your chin up and head back, then relax, this is the position you want to keep your airway open. If you wake up with your chin buried, you need to do something.

If you get rid of the pie chart we can see the full stats, but median MV of 7 with RR of 12, it all looks good with the PS:0 you are now using. it's whether you like the comfort of PS:3 and it is your median PS.
I'm OK either way, it isn't going to affect your treatment to any great extent, as far as I see it.

If you want to minimise the CA, if they are pressure induced, then min PS comes into it, like it does on apap and flex/EPR.. but I don't think you should get o2 destaturations with pressure induced CA. They say it's the body waiting for the co2 to build back up. In any case they are fully treated by the ASV mode. You can pick up a cms50f off of ebay for $50 that will measure your o2 overnight. Your minute vent and tidal volume charts will also tell you if there are issues.

If you puff back, the machine will reset itself a bit and stop the higher pressure. You breathe funny when going to sleep and the machine thinks it's a problem.


There are a few ASV users on apneaboard too.

[Pugsy]

You might want to read this
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

Obviously something changed in those wee hours of the morning....rolling over on your back maybe or maybe some REM stage sleep or maybe a little of both. With either is is common to have our OSA made worse and need more pressure.

You have more than one option to try in an effort to clean up that clustering.
More EPAP is one choice...and actually increasing the PS from minimum of 0 to maybe 3 or 4 might also work.
Long standing general "rule"....EPAP for OAs and IPAP for hyponeas...and changing PS from 0 to 2 or 3 or 4 gives a person more IPAP.

[ajack]

That's true for bpap titration, epap for OA and ipap for H.
The titration for the ASV is epap for both oa and H. The default is ps:3, some go down, thinking it will help CA, you need a reason to go higher than ps:3 I think it would be to support minute vent/tidal volume and respiration rate. if it's a bit off. You can't do much as the most on the s9 is min ps:6

[n3kf]

OK, I really appreciate all the info. I moved the EPAP to 5 last night. Now I also need to come clean (well apparently there is an effect). About a week ago I got tired of the constant puffing going to sleep. My backup rate was set to 14. I had read that if set a bit lower, it may improve that. So I decided to set it to automatic. Can I assume if your respirations drop too low it may cause hypops? Anyway, I had set EPAP to 5. Went to sleep and 4 hours later woke up for a pit stop. Looked at unit and said I was at 13.9 for an AHI. I had not moved from the position I went to sleep in. When I woke up I was dreaming, so assume it may be REM? Anyway, at that point I remembered I had moved the back up rate from 14 to automatic. So I moved it back to 14 and kept EPAP min at 5 ( two changes engineers know not to do that). I slept another 2.5 hours and woke up knowing I was dreaming. AHI was 0 on the machine. Now I realize 2.5 hours does not mean its repeatable.

Just looked at the data. The first sleep session looked just like the night before. Right before I woke I had 45 minutes of tons of hypops. The second session had none of those obviously. This was with backup at 14. Now as I was falling asleep the system was puffing at me pretty constantly. Looking at the data, the patient triggered breaths is significantly lower then the first session. Going from 90 when falling asleep to a low of 32. And probably averaging around 60 during that sleep session.

So is there a correlation to the automatic versus 14 for the backup rate and the hypops? Do I need to be concerned about the lowness of patient triggered breaths if I could continue to get a decent AHI?

I can post whatever is needed, multiple shots if needed. This stuff is very complicated and I won't touch anything without advice from you all again!!! Thank you and thank you!

Sent from my Nexus 7 using Tapatalk

[n3kf]

OK, I really appreciate all the info. I moved the EPAP to 5 last night. Now I also need to come clean (well apparently there is an effect). About a week ago I got tired of the constant puffing going to sleep. My backup rate was set to 14. I had read that if set a bit lower, it may improve that. So I decided to set it to automatic. Can I assume if your respirations drop too low it may cause hypops? Anyway, I had set EPAP to 5. Went to sleep and 4 hours later woke up for a pit stop. Looked at unit and said I was at 13.9 for an AHI. I had not moved from the position I went to sleep in. When I woke up I was dreaming, so assume it may be REM? Anyway, at that point I remembered I had moved the back up rate from 14 to automatic. So I moved it back to 14 and kept EPAP min at 5 ( two changes engineers know not to do that). I slept another 2.5 hours and woke up knowing I was dreaming. AHI was 0 on the machine. Now I realize 2.5 hours does not mean its repeatable.

Just looked at the data. The first sleep session looked just like the night before. Right before I woke I had 45 minutes of tons of hypops. The second session had none of those obviously. This was with backup at 14. Now as I was falling asleep the system was puffing at me pretty constantly. Looking at the data, the patient triggered breaths is significantly lower then the first session. Going from 90 when falling asleep to a low of 32. And probably averaging around 60 during that sleep session.

So is there a correlation to the automatic versus 14 for the backup rate and the hypops? Do I need to be concerned about the lowness of patient triggered breaths if I could continue to get a decent AHI?

I can post whatever is needed, multiple shots if needed. This stuff is very complicated and I won't touch anything without advice from you all again!!! Thank you and thank you!

Sent from my Nexus 7 using Tapatalk

Here is a shot of last night. First with EPAP 5 and back up rate automatic. And the second with EPAP min 5 and back up rate 14.

Sent from my Nexus 7 using Tapatalk

[ajack]

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.