Hey guys

[Juggsy75]

Those clear airway apnea events you see noted on your reports....those are central apneas.
It's normal to have a few here and there...no big deal and unless someone sees a lot of centrals (like 5 per hour every night average) they don't mean that people get a diagnosis of central apnea along with their obstructive apnea diagnosis.
We all have a few centrals here and there....entirely normal and no big deal and no cause for worry.
Your Central numbers are a long way from worrying about central apnea.

Going through my data alit seems to be hypopneas rather than obstructive, do you think my deviated septum and congestion adds to my issues, the ENT consultant refused it point blank when we spoke

[Pugsy]

Hyponeas are obstructives that just haven't quite made the criteria for a full grown OA.

Obstructive apnea criteria.....80 to 100% flow reduction that lasts for at least 10 seconds

Hyponea criteria....40 to 79% flow reduction that lasts for at least 10 seconds....once it hits 80% it grows up to earn the OA label.

Obstructive sleep apnea pertains to the flow reduction in the airway down below the nasal cavity from saggy airway tissues blocking the airway...more in the area of the airway that is behind the tongue (and slightly above and below)....OSA doesn't originate in the nasal area at all.

Nasal issues can make fixing OSA issues harder to get done but they are NOT the cause of the OSA.

[Juggsy75]

Hyponeas are obstructives that just haven't quite made the criteria for a full grown OA.

Obstructive apnea criteria.....80 to 100% flow reduction that lasts for at least 10 seconds

Hyponea criteria....40 to 79% flow reduction that lasts for at least 10 seconds....once it hits 80% it grows up to earn the OA label.

Obstructive sleep apnea pertains to the flow reduction in the airway down below the nasal cavity from saggy airway tissues blocking the airway...more in the area of the airway that is behind the tongue (and slightly above and below)....OSA doesn't originate in the nasal area at all.

Nasal issues can make fixing OSA issues harder to get done but they are NOT the cause of the OSA.

Once again many thanks for your replies, although I’ve been diagnosed since 2016 I’ve no clue about it as my clinic checks my machine once a year and sends me on my way, m hoping to consistently try to get as low ahi as I can

[palerider]

Hyponeas are obstructives that just haven't quite made the criteria for a full grown OA.

Obstructive apnea criteria.....80 to 100% flow reduction that lasts for at least 10 seconds

Hyponea criteria....40 to 79% flow reduction that lasts for at least 10 seconds....once it hits 80% it grows up to earn the OA label.

Obstructive sleep apnea pertains to the flow reduction in the airway down below the nasal cavity from saggy airway tissues blocking the airway...more in the area of the airway that is behind the tongue (and slightly above and below)....OSA doesn't originate in the nasal area at all.

Nasal issues can make fixing OSA issues harder to get done but they are NOT the cause of the OSA.

Once again many thanks for your replies, although I’ve been diagnosed since 2016 I’ve no clue about it as my clinic checks my machine once a year and sends me on my way, m hoping to consistently try to get as low ahi as I can

Under 1.5 is really good enough for most people, it's a case of diminishing returns after that. Or, lower numbers are harder to get, and there's less and less benefit the closer you get to zero.

[Juggsy75]

Hyponeas are obstructives that just haven't quite made the criteria for a full grown OA.

Obstructive apnea criteria.....80 to 100% flow reduction that lasts for at least 10 seconds

Hyponea criteria....40 to 79% flow reduction that lasts for at least 10 seconds....once it hits 80% it grows up to earn the OA label.

Obstructive sleep apnea pertains to the flow reduction in the airway down below the nasal cavity from saggy airway tissues blocking the airway...more in the area of the airway that is behind the tongue (and slightly above and below)....OSA doesn't originate in the nasal area at all.

Nasal issues can make fixing OSA issues harder to get done but they are NOT the cause of the OSA.

Once again many thanks for your replies, although I’ve been diagnosed since 2016 I’ve no clue about it as my clinic checks my machine once a year and sends me on my way, m hoping to consistently try to get as low ahi as I can

Under 1.5 is really good enough for most people, it's a case of diminishing returns after that. Or, lower numbers are harder to get, and there's less and less benefit the closer you get to zero.

I’m not getting 1.5 though, I’m consistently in the 3’s and 4’s

[palerider]

Under 1.5 is really good enough for most people, it's a case of diminishing returns after that. Or, lower numbers are harder to get, and there's less and less benefit the closer you get to zero.

I’m not getting 1.5 though, I’m consistently in the 3’s and 4’s

Well, that one needs work. 4's mean your sleep is being interrupted, on average, more frequent that every 15 minutes all night long.

[Pugsy]

If I was consistently getting reports like yours with hyponeas mainly and AHI in the 3 to 4 range I would increase the pressure 0.5 cm to 1.0 cm and see what happens with those numbers.
From my past experience with a Respironics machine and hyponeas....they are usually fairly easy to kill with just a little bit more pressure.

[Juggsy75]

If I was consistently getting reports like yours with hyponeas mainly and AHI in the 3 to 4 range I would increase the pressure 0.5 cm to 1.0 cm and see what happens with those numbers.
From my past experience with a Respironics machine and hyponeas....they are usually fairly easy to kill with just a little bit more pressure.

I upped the pressure to 7 last week, honestly didn’t really see much difference in the numbers, or did I maybe not give it enough time??

[Pugsy]

If I was consistently getting reports like yours with hyponeas mainly and AHI in the 3 to 4 range I would increase the pressure 0.5 cm to 1.0 cm and see what happens with those numbers.
From my past experience with a Respironics machine and hyponeas....they are usually fairly easy to kill with just a little bit more pressure.

I upped the pressure to 7 last week, honestly didn’t really see much difference in the numbers, or did I maybe not give it enough time??

I always give pressure changes at least a week (preferably 2 or 3) to watch for trends and patterns along with judging how I might feel before I give up on or adopt the change.
We simply don't sleep the same each night and we are going to see a lot of AHI variations even without any changes in anything.

I once did an experiment where I made a change and kept that change for 6 weeks....at the end of the 6 weeks my AHI was averaging half of what it was doing at the beginning. We have to give the body time to adjust to any changes.

The only time I don't give a change a lot of time is if the change obviously causes a significant problem...like aerophagia or something.

You probably also should learn how to identify awake vs arousal flagged events.
Watch all the videos here
http://freecpapadvice.com/sleepyhead-free-software
while it mainly talks about central/ClearAirway apneas....it isn't limited to just centrals that can be false positive flagged events.
Some of your hyponeas might not be even asleep events and if you aren't asleep they just don't count for anything.

A couple of weeks ago I had a really bad AHI night...9.4 I think it was which is highly unusual for me. So I took the time to examine each flagged event to see if I was really asleep or not. It was a nice mix of mostly OAs and hyponeas with a few centrals thrown in.
90 % of the flagged events occurred when I was obviously awake. It just happened to be a night when I slept poorly due to worse back pain than usual. Ugly night for sure but it wasn't related to sleep apnea...it was related to pain issues.

[Juggsy75]

hi all, so its been week or 2 now that ive increased my pressure by 1 to 7, had one night of an ahi of 1.8 other than that they seem to be getting worse not better, below are last two nights graphs both over 5 which is concerning really as it seems even though im being treated im still experiencing sleep apnea,

i rung my nurse at hospital today as my machine is due its yearly check up, and expressed my concern as i have atrial fibrilation so like to keep my SA in check due to the links between the two, first question he asked was have i gained weight, which i have, so he just put it down to that, however i explained that i was this weight when i started my treatment and wasnt getting these numbers then, to which he replied, your older now........

so long story short i cannot go to get machine checked or pressure altered due to covid, he did mention changing some setting to semi auto so that the pressure would go up to 9 if needed , i asked if he told me how to do it over phone could i do it......a very stern ...no was the reply....your not to alter the machine in any way.....best not tell him about oscar then.

any help greatly appreciated as ive noticed an increase in some palpitations last few weeks not sure if theyre related to my worsening numbers

[Pugsy]

Did you do the homework and learn if the events flagged are awake/arousal related or were asleep related?

If they were asleep related....you do well enough until the middle of the night which makes us wonder what changed to cause the problem because something changed. My first suspect is you were on your back? Do you ever sleep on your back? Sleeping on your back can make OSA worse and you need more pressure. It's fairly common.
Second suspect would be REM worsening the OSA and you need more pressure. We often have more REM in that last half of the night.
Again REM stage sleep impacting OSA and pressure needs is fairly common.

If you weren't asleep....then it's not a pressure or OSA issue...it's a sleep issue and those flagged events aren't real. Not sleeping well is the problem and how to fix that depends on what is causing the poor sleep.

If you were asleep then you need more pressure at some times during the night for either of the 2 reasons offered as most likely causes.
There's no way around it.

Odd that you had 1 night with a nice low AHI....so again...what changed....we know something changed for there to be a big difference.

[Juggsy75]

Did you do the homework and learn if the events flagged are awake/arousal related or were asleep related?

If they were asleep related....you do well enough until the middle of the night which makes us wonder what changed to cause the problem because something changed. My first suspect is you were on your back? Do you ever sleep on your back? Sleeping on your back can make OSA worse and you need more pressure. It's fairly common.
Second suspect would be REM worsening the OSA and you need more pressure. We often have more REM in that last half of the night.
Again REM stage sleep impacting OSA and pressure needs is fairly common.

If you weren't asleep....then it's not a pressure or OSA issue...it's a sleep issue and those flagged events aren't real. Not sleeping well is the problem and how to fix that depends on what is causing the poor sleep.

If you were asleep then you need more pressure at some times during the night for either of the 2 reasons offered as most likely causes.
There's no way around it.

Odd that you had 1 night with a nice low AHI....so again...what changed....we know something changed for there to be a big difference.

I did do my homework but I’m afraid I still don’t understand how to tell what’s what, regarding my back, yes I do tend to move onto my back at night I think, I’ve noticed I’ve had nights lately with very very vivid dreams.... I’ll have to try and see if I can learn about the awake episodes again
Thanks for the reply

[Pugsy]

It can take a lot of looking at the flow rate to spot the minor changes that point to arousals.
Sometimes it's easy and sometimes it's not. I mainly just count the obvious ones.

First you have to recognize your own sleep pattern. The breathing is very predictable and rhythmic.
Awake/arousal breathing is irregular.

Asleep breathing with a couple of probably real asleep apnea events. Note the regular pattern of the breathing before and after the flags.


Asleep breathing


Asleep breathing circled in red. Everything after that is awake/arousal related breathing.

[Juggsy75]

It can take a lot of looking at the flow rate to spot the minor changes that point to arousals.
Sometimes it's easy and sometimes it's not. I mainly just count the obvious ones.

First you have to recognize your own sleep pattern. The breathing is very predictable and rhythmic.
Awake/arousal breathing is irregular.

Asleep breathing with a couple of probably real asleep apnea events. Note the regular pattern of the breathing before and after the flags.


Asleep breathing


Asleep breathing circled in red. Everything after that is awake/arousal related breathing.

i think after watching the video im starting to get it, below ive included a snap of a brief moment of what it says are hypopneas and a central, if im reading it correctly it seems as though i wake as theresalot of high spikes before the events, so am i correct in dicounting these due to that possibly just being an arousel or turning sleeping position?

[Pugsy]

That entire segment you show appears to be arousal related breathing to me. Can't see the breathing pattern immediately prior to that segment but if that were my report I would chalk those flagged events up to arousal related and thus they don't count.

A few weeks ago I had a night with AHI of 9.4. Unusual for me for sure so I looked more closely and I manually counted and looked at each flagged event. 90% of those flagged events were so obviously arousal/awake related that a blind man could see it.
It also happened to be a night where I slept poorly due to back pain. I had done some yard work outside that I paid for in the middle of the night. I over did things. I knew I woke up often because I hurt like hell.

Now sometimes we do have real asleep events that cause the subsequent arousal breathing and flagging. So sometimes a real event ends up causing a lot of false positive events. So if we see that happening a lot then obviously we want to reduce those primary real events and the best way to do that...more baseline pressure or allow the machine to auto adjust if the machine is capable.
My own AHI is very rarely more than 25% real events. The bulk of my AHI is always arousal related and not related to real events causing the arousals so I don't see the need to use more pressure.