Post-sigh apneas

[sunnyU]

I'm seeing quite a few apneas preceded by a sigh. Sometimes up to 4 per hour during the night. Is it normal to sigh so much? Can this be an indication of some underlying problem? Flow limitations may be?
The sighs were present before the PAP too.

[chunkyfrog]

Can you please post some data?

[sunnyU]

Can you please post some data?

#1

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#2

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#3

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[sunnyU]

#4

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Also some weird ones

#5

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#6

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[Pugsy]

Those are all central apneas. The airway is open but there is no effort to breathe.
A big gulp of air followed by holding of the breath for a short period of time.
Maybe a turn over in bed or similar arousal related central apnea.

It is not related to flow limitations which are obstructive in nature.

The "weird" ones...definitely arousal related. Not asleep.

[sunnyU]

Those are all central apneas. The airway is open but there is no effort to breathe.
A big gulp of air followed by holding of the breath for a short period of time.
Maybe a turn over in bed or similar arousal related central apnea.

It is not related to flow limitations which are obstructive in nature.

The "weird" ones...definitely arousal related. Not asleep.

The majority of those are just sighs, without turning or anything (its from my son's data and I often watch him do this in his sleep).
I understand that some sighing is normal, but 2-4/h seems excessive. Or not?

[Dog Slobber]

I'm seeing quite a few apneas preceded by a sigh. Sometimes up to 4 per hour during the night. Is it normal to sigh so much? Can this be an indication of some underlying problem? Flow limitations may be?
The sighs were present before the PAP too.

Sigh, sigh, everywhere a sigh
Blockin' out the scenery, breakin' my mind
Do this, don't do that, can't you read the sigh?

[Miss Emerita]

I sigh a lot in my sleep too. Hard to be sure, but I think some of my sighs mark transitions from one sleep stage to another. If that's true, it might be idiosyncratic.

Anyhow! Your #5 and #6 look to me like arousal breathing followed by a CA; the others not so much, just sleep, a sigh, a CA, and sleep. I'm not myself seeing signs of flow limitation as a trigger. For whatever reason they occur, the sighs are probably reducing the amount of CO2 that tells the brain to breathe; hence the subsequent CAs.

Your son's AHI is pretty good but could perhaps be better. He might try reducing the EPR from 3 to 2 to see whether that makes a dent in the CAs while keeping him comfortable.

But to tell the truth, if most of the CAs aren't coming after an arousal, and don't seem to be disrupting sleep, it is probably not worth worrying too much.

[Pugsy]

Sorry, I have no experience at all with the normalcy of sighing or anything to do with it.
That's a question to ask a doctor.

Lots of things are considered "normal" for kids that isn't "normal" for adults and vice verse.

You see what it looks like on a flow rate graph. I assume he doesn't appear to be under distress when it occurs and we can hold our breath (creating a central apnea) easily for 10 or 15 seconds many, many times an hour and it not mean distress.

Pediatric sleep apnea.....whole different animal sometimes. The threshold for earning a cpap is lower to start with.
You have a lot of questions that are best answered by someone whose specialty is pediatric issues.

[zonker]

I'm seeing quite a few apneas preceded by a sigh. Sometimes up to 4 per hour during the night. Is it normal to sigh so much? Can this be an indication of some underlying problem? Flow limitations may be?
The sighs were present before the PAP too.

Sigh, sigh, everywhere a sigh
Blockin' out the scenery, breakin' my mind
Do this, don't do that, can't you read the sigh?

internetslap.gif

[sunnyU]

What do you make of this one? No sigh, but some uneven breathing preceding it.

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For whatever reason they occur, the sighs are probably reducing the amount of CO2 that tells the brain to breathe; hence the subsequent CAs.

Your son's AHI is pretty good but could perhaps be better. He might try reducing the EPR from 3 to 2 to see whether that makes a dent in the CAs while keeping him comfortable.

But to tell the truth, if most of the CAs aren't coming after an arousal, and don't seem to be disrupting sleep, it is probably not worth worrying too much.

Do you think the sighs could be an indication of too much CO2? Wouldn't higher EPR be actually helping with that?

Pediatric sleep apnea.....whole different animal sometimes. The threshold for earning a cpap is lower to start with.
You have a lot of questions that are best answered by someone whose specialty is pediatric issues.

I found so much info on this forum that it feels like members here know everything about sleep:) I can't resist asking

[Pugsy]

I found so much info on this forum that it feels like members here know everything about sleep:) I can't resist asking

While I appreciate your confidence....I will be the first to admit that I know very little about pediatric sleep apnea.
I never really had the opportunity or need to learn much about it.
I understand your desire to help your son in every way possible. I would do the same thing myself if I were in your shoes. That help would involve digging everywhere to find information.
I don't think the sighs mean anything bad or anything you can do about but it's what I think and I have no proof. It may be entirely normal for your son and mean nothing but I just can't say for sure. Heck, it might mean something just as easily but I don't know what it means.

There's something I try to live by that is number one on my list and always has been......first do no harm.
It is even more important when it comes to children.

[Miss Emerita]

I know nothing at all about pediatric apnea, but I do know that no one's breathing is smooth and even all through the night. Your best bet, as others have said, is to discuss your concerns with the doctor. Let us know what you learn, would you? That could be very helpful to the next person with similar questions.

[nee]

No advice to offer here, but I saw in an earlier thread that you are looking into an orthodontist and ENT for your son. I am SO happy you are doing that and setting him up for success in the long run.

If you'd like, send me a PM with your location and I can look into an orthodontist for you that is aware of airway issues. Just a friendly dentist trying to help here

[DreamDiver]

I'm seeing quite a few apneas preceded by a sigh. Sometimes up to 4 per hour during the night. Is it normal to sigh so much? Can this be an indication of some underlying problem? Flow limitations may be?
The sighs were present before the PAP too.

Wow! Another person with Clear Airway* Apneas only! Welcome!

I understand it's a pretty rare thing. And yes, sometimes I sigh and then don't breathe during sleep -- so it registers as a clear airway apnea. What you're showing with the big sigh and then apnea is text-book for what I see in my flow rate graphs. It's only recently that I've also begun seeing some stray hypopneas in my graphs.



Side notes:

• What's interesting to me is that you have almost zero flow limitations. You're probably a lot younger than I.
  EDIT: Just now seeing that this is probably regarding your very young son. Wow! You are the best parent to catch it this early! So... Cool...
• I bet he doesn't snore. I don't. It took forever for me to get a sleep test because I didn't show the usual signs.
• I find myself sighing during the day because I also forget to breathe just sitting there, and my 02 goes down. Then I remember to fill my lungs and within seconds the Sp02 is back to about 95%. They don't call it an apnea if you're not asleep, but it might be interesting to know if there's a term for that. If I'm moving around a lot, I don't get a chance to forget to breathe because the body seems to demand a higher breath rate/volume.

* Unless things have changed in the last few years, there seems to be some nebulous non-clarity as to whether "Clear Airway" apneas are truly Central apneas. Obstructive apnea is supposed to mean there is something (sinuses, throat, whatever) blocking the effort. With Clear Airway apneas, the lack of obstruction is clearly visible in that you can see the heartbeat in the Flow Rate wave form. If there were obstruction, you would see a flat wave form as shown in the image with no heart beat visible in the flow rate. Nothing is obstructing the airway, yet apparently when measured with a chest belt in a lab, we register effort. This seems pretty sketchy to me. My confirmation-biased mind thinks it's Centrals... But they respond to APAP, so because they're relatively well managed, the Sleep Industry simply classify them as "Clear Airway" apneas so we don't get classified for the way-more-expensive Aircurve. (People with more knowledge, please let me know if there are newer studies about this.)

I'd be curious to know just how many people on this venue who use APAP show nothing but CA's on their Oscar data.