Plenty of hypopneas. New to CPAP with a couple questions

[tingull]

Hey all!

Thanks for having this board for folks like myself to explore, I really appreciate having this resource.

Little background: At 37 years old, I've been feeling extremely fatigued (sleepy) for a few years since being diagnosed with Lyme disease in January of 2015. I'd tried all sorts of medical therapies, hormone replacement stuff, etc. It was only recently when I decided "let's figure out how to sleep better instead of staying awake longer". I had a PSG done and it was interesting... I had an AHI of 14.3 but more interestingly I spend 92% of my sleep in N3 and REM sleep. My latency to REM is less than 4 minutes and sleep onset is is less than 5 minutes. So, extremely fragmented sleep. OVer half of my time-in-bed at O2 levels between 90-95%, which doesn't seem too bad, but maybe it is? It says I had a total of 110 desats during the night.

My issues aren't so much with apneas as they seem to be with hypopneas.

I downloaded the SleepyHead app but don't have a card reader for my Macbook so can only go on my app for the Dreamstation (DreamMapper). My AHI will bounce between 5.1 and 9.4 (an improvement), and my apneas are almost always 7 or less, but hypopneas are typically in the mid-20's to mid-30's.

For example: last night I had 7:14 of usage time, AHI of 5.7, 5 clear airway apneas and 5 obstructive apneas, and 31 hypopneas.

My pressure starts at 7 and will go up to 10.

My main question is this: Does increasing pressure really help with the shallow breathing? It's hard to wrap my mind around it, I guess. And will CPAP help at all with that type of fragmented sleep?

Thank you all SO much, again, for this resource.

[Julie]

Do you sleep on your back? That can provoke many more events, but you're going to have to sort out what's Lyme and what's anything else (like apnea)

[Pugsy]

Welcome to the forum.

My pressure starts at 7 and will go up to 10.

Which model machine are you using? The DreamStation Pro (shown in your equipment profile) doesn't do the 7 to 10 range unless you are in the auto trial mode and that's only for short term.

Look on the bottom of the blower for a model number that begins with DSX...tell us the numbers and/or letters after DSX.

Hyponeas are much more than shallow breathing. Think of them as OAs that haven't grown up to be big/bad enough to earn the OA flag.
Watch this video
https://www.youtube.com/watch?v=-gie2dh ... e=youtu.be
They are bad dudes for sure and that's why the machine reports them and will try to kill them if it can.

An OA is when the air flow reduces due to soft tissues blocking the airway...of 80 to 100% that lasts at least 10 seconds.
A hyponea is when the air flow reduces due to soft tissues blocking the airway of 40/50% (depends on brand criteria) to 79% that lasts at least 10 seconds. It is NOT just a shallow breath that some people seem to think of it as. While technically probably "shallow" it's the reason behind the shallow that is the problem.
Think about it...is 70 % reduction really all that much different from 81% reduction? And what you can't see on the DreamMapper app is how long that reduction lasts....how much of a problem do you think a hyponea might cause if it is 75% reduction that lasts for 60 seconds? What about if you have 10 of them within 15 minutes?

If you are seeing a lot of hyponeas then that is usually and indication that the pressure is sub optimal.
When you get the software up and running you might see them in clusters so that would means the pressure is working fine for some parts of the night and not so great other parts of the night. This is quite common...sleeping supine can cause OSA to worsen and need more pressure...REM stage sleep can cause the OSA to worsen and need more pressure.

[tingull]

Thanks! It says DSX400H11C and says DreamStnCPAPPro on it. The sleep doctor said it's set to have the pressure setting they put in +/- 3 depending on how the machine determines I need it.

I do sleep on my back as when I sleep on my side, the mask seems to leak a little bit when I breathe in and the pressure rises.

I have a followup appointment in a couple of weeks and we'll see what they're thinking, too. They say I have idiopathic hypersomnia and likely narcolepsy, but need to have the MSLT for a formal diagnosis.

For now... at least I have a fancy looking machine and get to play out my childhood fantasies of being an astronaut! whatever helps get me through the night, I suppose.

I'll see about getting a card reader and upload that info.

Thanks again

[Julie]

Leaking a little is better than back sleeping that actually creates more apneas/hypopneas - at least try it out and see what results you get.

[Muse-Inc]

I'm in the severe category. During my sleep study, I only had hypops and I desaturated to 83% -- yikes . After getting my therapy optimized, thanks to everyone here, my annual AHI is 0.1 since 2009.

[ChicagoGranny]

Leaking a little is better than back sleeping that actually creates more apneas/hypopneas - at least try it out and see what results you get.

You do a lot of newbies a disservice by regularly posting this. A properly set and properly operating CPAP system will allow normal breathing when sleeping on the back.

A lot of our newbies are elderly and have significant pain problems if they try to switch from their usual sleeping position(s).

[tingull]

I'm in the severe category. During my sleep study, I only had hypops and I desaturated to 83% -- yikes . After getting my therapy optimized, thanks to everyone here, my annual AHI is 0.1 since 2009.

My lowest desat was down to 82% but it didn’t last super long thankfully.

I appreciate the comments and once I’m not working a closing shift, I’ll get a card reader and put that info up here.

[zoocrewphoto]

Leaking a little is better than back sleeping that actually creates more apneas/hypopneas - at least try it out and see what results you get.

You do a lot of newbies a disservice by regularly posting this. A properly set and properly operating CPAP system will allow normal breathing when sleeping on the back.

A lot of our newbies are elderly and have significant pain problems if they try to switch from their usual sleeping position(s).

Good point. A machine set to the right pressure settings for the person should be able to handle any sleeping position. Yes, some people can have a lower pressure by sleeping on their side, and that may be a big deal for them. But people should try to get the machine set to handle how they sleep normally, rather than changing their sleep to something less than ideal. People who are told never to sleep on their back may spend months trying to make their sleep uncomfortable on their back, actually damaging their sleep more. Or they may just give up, thinking it is impossible to change. Any they may just need a higher minimum, and no change in position at all.

I am worse on my back. I spend most of my night between 11 and 13. If I roll onto my back, it spikes up. As it does that, I roll back onto my side. So, that pressure spike actually helps me back onto my side, without waking me up. If my back is sore, I will sleep on my back most of the night. My pressure runs higher, but my ahi does not. The machine takes care of me, and I don't have to stress about it.

[Julie]

While I agree that side sleeping isn't always possible for some people, it is also tempting to advise those who back sleep AND who have very low AHI's on testing to try not to back sleep as some people who do that no longer need Cpap once they succeed.

[Snoregone Conclusion]

If they have low AHIs while treated while sleeping on their backs, that does NOT mean that they don't need it while sleeping on their sides: that's a load of hogwash.

Someone will inevitably correct me if my understanding is wrong, but this is something that progresses over time as tissues loosen up from vibratory snores, thus it gets worse over time, regardless of what your AHIs are to start with: unless, of course, you somehow believe your body was always at a steady state in regards to SDB instead of progressing to its current state (that's remained stable: I'm not ready to believe bodies are that stable, they degrade over time, I can feel it! Unless everyone else is immortal...) before diagnosis. There's one thing living things are notorious for, other than eventually dying: they're NOT steady state things whatsoever, because then they'd not be alive.

If your misguided thoughts that someone sleeping on their sides instead meant they didn't need PAP therapy, I wouldn't be here in the first place, because except for the sleep test sessions, I can't remember intentionally sleeping on my back for any meaningful amount of time: I've felt like I was suffocating when doing that, and asleep or not, resist doing that, even now, with a machine that I can reason will keep me from suffocating.

From the data I've gathered off the machine, I don't know what it will take, exactly, but it appears this machine may not have the capacity to keep a high enough pressure to keep things sufficiently open that I can sleep on my back: since things haven't always been that bad, that means things degraded over time despite almost always sleeping on my side. Oh, and BTW, I've had shoulder issues for decades, and even with PT in the last couple of years, things are imperfect there, so I'm fighting to balance problems to get better sleep.

[Julie]

I referred to test results being e.g. below 15 or even 10... and you might want to check out this (older) link from a no longer active member - it's long, but interesting (and just ignore the 'personal' stuff in places).

viewtopic/t70205/-Mars-Given-OK-On-Posi ... Positional

[ChicagoGranny]

While I agree that side sleeping isn't always possible for some people, it is also tempting to advise those who back sleep AND who have very low AHI's on testing to try not to back sleep as some people who do that no longer need Cpap once they succeed.

You're a grown woman. Try to restrain yourself from misleading people who have a deadly condition.

[zoocrewphoto]

While I agree that side sleeping isn't always possible for some people, it is also tempting to advise those who back sleep AND who have very low AHI's on testing to try not to back sleep as some people who do that no longer need Cpap once they succeed.

To me, this is still dangerous device.

One, it gives people the idea that they are mild and don't need to use cpap. They may not think it is a big deal, or they may make an effort for a short time to sleep on thier side and then go back to their old way of sleeping.

Two, people do tend to get worse over time. I did not have sleep apnea as a child or teenager. Not sure when it started. At age 39, I was 79 ahi in the first 2 1/2 hours with no REM sleep and very little back sleeping. I suspect a full night without cpap would produce a much higher ahi. I did not get worse in just a year or two. It was over time. And somebody who is mild now and dismisses it may wait a decade or more before considering it again. I wish I had started back when I was mild. It would have changed my life. I would be healthier in terms of weight, blood pressure, etc. More active and able to go biking, rollerblading, hiking, etc. I probably would have been my active in my hobby business. Who knows how much more successful I could be if I had more time and energy devoted to it 15 years ago, eve 10 years ago.

Three, low ahi is subjective and more complex than often mentioned. For example, doctors usually say anything under 5 is good, but a lot of people still feel bad at 3 or 4 and really need to be under 2. Also, An ahi of 3 is classified as mild, but what if the person is having clusters of longer events like my mom was doing. She would have 8 events longer than 30 seconds (one longer than a minute) in less than 10 minutes. Her oxygen was dropping big time, but the ahi of 3.4 sounded mild and no big deal.

I would not want to assume that somebody is mild just because their ahi is low. And I would not want to give somebody the impression that their sleep apnea isn't worth treating, or that simply sleeping on their side would stop it. I hope that my advice never discourages somebody from getting better treatment.

[Pugsy]

To CG and Zoocrew and any others uncomfortable with Julie's tendency to offer advice that might lead someone with mild apnea to ditch the cpap machine if they stayed on their sides and avoided supine sleeping totally....

Mars (the forum member who Julie seems to be thinking about with her "stay off your back" advice) was an outlier who did a lot of experimenting and figured out that he really didn't need cpap if he could stay off his back.
LOTS of experimenting and finally confirmed with real sleep studies done in a lab....Plus he figured out how to for sure stay off his back all time.

Mild AHI diagnosis doesn't mean squat because we don't know the O2 levels involved and all that involves.
Not everyone will have their OSA be markedly worse when supine...yes, some will but not all...some might be like me and have it worse in REM and not much we can do about REM.

People come here for help who have had a recent OSA diagnosis and their doctor suggested cpap....the doctor didn't suggest staying off their back. For that reason I prefer to offer advice about cpap usage and how to make it work. Save the "maybe lose cpap by side sleeping" advice for later IMHO. Maybe later once more information can be gleaned from sleep study reports and the person's own experience with cpap. My overall AHI from my sleep study was 12...rather mild if going by just the numbers for the entire night but what you don't see in that 12 is that in REM sleep my AHI was 53.
What you don't see is that even in non REM sleep my oxygen levels went down to 73%. Had some pretty long events...so duration is important and something we don't see when someone comes here and just says..."my OSA is mild".
What you don't see is that I never got much REM sleep because once I hit REM and those events started coming fast and furious I would wake up. No wonder I didn't get much REM.

So if I had come here and said my AHI from my sleep study was 12...and that's all that was said...to tell me that side sleeping might let me lose the cpap would have been dangerous advice. Side sleeping wouldn't help me at all.
But if I had been one of those people up the DeNile river I might have jumped on it because I really wasn't too keen on wearing the mask and using the machine even though I hadn't even tried it yet.

I think that the "maybe lose cpap if you side sleep" is best saved for later on in the discussion once more information is gleaned and once it is determined if a person is actually having a problem with cpap use or not.
Mars was an outlier...but he still did the needed experiments to confirm his suspicions and he had his doctor involved the whole time.
That's a whole different thing from telling a newbie that they could avoid cpap by staying off their backs and that is the impression that Julie gives with that advice. The people up the DeNile River are going to jump on that impression real fast. It's potentially dangerous to give that impression without gleaning a lot more information.

But this forum doesn't censor information like that because she is technically correct....just poor timing IMHO for offering that advice.
There are some people who can avoid cpap use by staying off their backs. Probably not many but there are some.
What she says falls more in line with what I call "incomplete" information instead of "incorrect" information. Sometimes there is a fine line there and someone has to come along and offer more complete information.

I prefer the KISS principle with newbies because they are already probably in a state of shock over all this new stuff.
Save all the maybes for later once it is determined if the maybes are even needed or not.