Sleep onset Sp02 Drops

[scott3026]

Hello Members, I am looking for some advice about these episodes I have been having as I begin to transition to a sleep state. I have a Resmed Airsence 10 and am using sleepyhead software and a Contec CMS50F pulse oximeter. The episodes are being picked up my my machine as Central Apneas and the correlate with Sp02 drops. As I begin to fall asleep my breathing gets shallow and as soon as I drift off to asleep I wake up and take a deep breath of air. The Sp02 drops only occur when trying to get to sleep. Once I have fallen asleep my O2 levels stay level at about 95-97%. I am a lifetime athlete who is in good shape with a low resting HR and am not over weight. I have had a full workup and my heart is fine. I mentioned these episodes to my Dr. and he wants to titrate the pressure up, however I already feel like I am taking in large volumes of air. Thank you for your help!
.
My questions are:

What could be causing these apneas when trying to fall asleep? Could it be the CPAP settings?

How long does your oxygen need to be saturated for it to be considered significant?

For those of you who experience something similar to this, what have you found helps?

Could this be cause by stress or something else?

[Pugsy]

Welcome to the forum.

Could you redo your image so that we can get an overall picture of the entire night?
In this format explained here
viewtopic/t158560/How-to-post-images-for-review.html

Go here and watch the videos
http://freecpapadvice.com/sleepyhead-free-software

[scott3026]

This image is from a few nights back when I used the cpap the whole night

[scott3026]

This image is from last night where I decided to take the mask off. As you cane see from the graph once I got to sleep the O2 stabilized.

[Pugsy]

Are you using EPR? I can't see the settings because of the calendar and pie chart.
If you are using EPR...turn it off.

You may be having some sleep onset centrals which are actually normal and usually not a problem except when they are present in large numbers, keep bouncing you out of sleep so that you repeatedly go back to sleep to have another one, or cause desats.
Obviously if that is what is going on with you there's a lot more than a random sleep onset central and they are probably causing problems.

When is your follow up visit scheduled with your doctor? Do you have one?

Can you zoom in on the first cluster of CAs/centrals...about a 5 minute segment with the first couple of CAs on the right side of the graph and regular breathing preceding the flagged events.
I want to see not only the flagged events but the breathing preceding those events with no flags present.

[scott3026]

Here are the machines settings. EPR is turned on.

[scott3026]

Here is a close up.

[scott3026]

My appointment is not for another month.

I am a retired Air Force Vet and was recently diagnosed with an anxiety disorder. I began to have trouble falling asleep, which lead me to get a sleep test. I was on paxil for 3 years and decided to withdraw from the medication right around the same time I did my sleep study. When I was initially diagnosed with sleep apnea I was told it was a mild form mostly mostly with CA's when I try to drift off to sleep. I have been off the paxil since May which is when I had the sleep study done. My biggest concerns are these episodes I have when I am trying to fall asleep. I rarely have obstructive apneas and only have a few CA's while I am in sleep. I agreed to go on the CPAP because I was told it would help these occasional PVC's I get at random but it has not and my sleep is still hit or miss.

My sleep begins with feeling relaxed and my breath feeling calm, slow, and relaxed. Then I begin to feel less of a need to breath and as I begin to drift off, I wake up feeling disoriented. If this happens enough times and I look at the pulse oximeter I see that is dips to ranges of 92-87.

Could the pressure be too high or could the EPR setting have something to do with this? I live a healthy life. Do not smoke or drink. I do not want to take meds. I would just like to know what is causing this and what can I do to fix it. My Va Dr. seems to have a cookie cutter approach to my treatment and is not taking in to consideration my chief complaints. Thank you for your help and time.

[palerider]

First thing I would do is turn off EPR.

[Pugsy]

Turn off EPR for tonight.

Share tonight's report tomorrow.

These graphs on the right along with the usual stuff on the left.
Events
Flow rate
Pressure
Leak
Flow Limitation
Snore if it has much on it...if it's blank or doesn't have much...omit it.

Omit the tidal volume and resp rate graphs.

Include the SP02 graph if you want to wear the device tonight.

Turn off the pie chart....Preferences/Appearance tab...remove check mark for "show pie chart".

[Ric]

Your SPO2 drops appear to correlate with drops in tidal volume and breathing rate (not a surprise). It's possible that you are experiencing central apneas associated with the complex process of "falling asleep". (Or it could still be obstructive (?). One possible solution would be to experiment with a bipap if that were available; that would likely correct for any apneas of central origin. Or (as suggested earlier) turn off the EPR, which might somewhat correct for protracted exhalation intervals, sometimes that happens. A bipap would be more definitive.

[palerider]

Your SPO2 drops appear to correlate with drops in tidal volume and breathing rate (not a surprise). It's possible that you are experiencing central apneas associated with the complex process of "falling asleep". (Or it could still be obstructive (?). One possible solution would be to experiment with a bipap if that were available; that would likely correct for any apneas of central origin. Or (as suggested earlier) turn off the EHR, which might somewhat correct for protracted exhalation intervals, sometimes that happens. A bipap would be more definitive.

Or.. not.

[Ric]

Disabling the EPR will only increase the pressure on exhalation, which may or may not influence the breathing rate. Whereas a bipap will fully correct for a depressed breathing rate, which appears to be a factor in the above conversation. With EPR enabled, an ordinary cpap/apap machine (with EPR capability) still relies on endogenous (physiological) triggers to adjust the pressure and to detect exhalation events. A bipap does not; it syncs to a predetermined interval. It seems to me that would be a worthwhile experiment. Turning the cpap into a simple fish-tank style air compressor might solve his problem. Or not.

[palerider]

Disabling the EPR will only increase the pressure on exhalation, which may or may not influence the breathing rate. Whereas a bipap will fully correct for a depressed breathing rate, which appears to be a factor in the above conversation.

There's lots of different types of bilevel machines. making blanket statements like "a bipap will blah blah blah" is wrong. (as is calling bilevel machines "bipaps", since only Respironics makes "bipap" machines.)

Most bilevel machines will not "fully correct for a depressed breathing rate", or indeed, do anything at all about a breathing rate, since they're all spontaneous and triggered by the patient's breathing.

With EPR enabled, an ordinary cpap/apap machine (with EPR capability) still relies on endogenous (physiological) triggers to adjust the pressure and to detect exhalation events. A bipap does not; it syncs to a predetermined interval. It seems to me that would be a worthwhile experiment.

You've clearly confused ""bipap" with "non-invasive ventilator", which is a *type* of bilevel machine, but not nearly the entire class of them. You'd do well to review machine types and the difference in standard bilevel machines, and bilevel machines with a back-up rate (NIV).

Turning the cpap into a simple fish-tank style air compressor might solve his problem. Or not.

I have no idea what kind of lunacy this is supposed to be.

[scott3026]

@Pugsy

Please let me know your thoughts. Thank you again for your help and concern.