Severe mixed apnea at the age of 35

[Herbert]

Hmmm. I can't find erwachen.

it means waking up or awakening to be more precise

Yes I know. There should be a category for that.

ah okay. Got it. about the AD thing, what did you mean?

[palerider]

I would be glad if it was only trivialities. as mentioned I don't feel well rested in the mornings. so I guess there has to be room for improvement. if you have other suggestions on how to improve my sleep, I'm very eager to know.

It's not a little variable breathing that's keeping you from 'feeling rested'.

[palerider]

probably not good for my mental health).

Since when did you have mental health?

[Herbert]

I would be glad if it was only trivialities. as mentioned I don't feel well rested in the mornings. so I guess there has to be room for improvement. if you have other suggestions on how to improve my sleep, I'm very eager to know.

It's not a little variable breathing that's keeping you from 'feeling rested'.

So what is it?

[palerider]

I would be glad if it was only trivialities. as mentioned I don't feel well rested in the mornings. so I guess there has to be room for improvement. if you have other suggestions on how to improve my sleep, I'm very eager to know.

It's not a little variable breathing that's keeping you from 'feeling rested'.

So what is it?

That's being worked on, but I think part of it is your obsession with finding every single little thing that might not be perfect.

[Herbert]

@Palerider: I don't quite get what your recommendation is. Just accepting how things are?! Also not sure who you think is working on finding things out. my doctors are not doing anything from now. basically they told me I'm fine and only supposed to have the yearly check at my pneuologist. no need to come to a sleep study or similar anymore. so I don't have the feeling anybody besides me (with the help of this forum obviously) is working on improving the status quo. and that's really unsatisfying.

[palerider]

@Palerider: I don't quite get what your recommendation is. Just accepting how things are?! Also not sure who you think is working on finding things out. my doctors are not doing anything from now. basically they told me I'm fine and only supposed to have the yearly check at my pneuologist. no need to come to a sleep study or similar anymore. so I don't have the feeling anybody besides me is working on improving the status quo. and that's really unsatisfying.

You're coming across as somewhat obsessive to find anything that's not perfect in your breathing. My recommendation is to chill out and stop obsessing.

Can your treatment be improved? probably, will being anxious about it help? no. Will pouring over every breath looking for imperfections help? no.

Will following the recommendations of Rubicon to gather more data by changing your pressures help? *VERY LIKELY*.

I haven't seen a single case where anxiety and obsession has ever helped to improve someone's CPAP experience, usually quite the opposite.

[Herbert]

I wouldn't say I'm anxious. at least not in an irrational way. obsessed... might seem like it. my interpretation is rather that I want to suck up every bit of information I can get, as long as the sources are flowing since it seems they are very limited. eg the doctors are very tight lipped (don't know if this expression is correct in english) at best. in a perfect scenario this will help me to understand the topic to that extend, that it gets clearer what I causing my total condition and how to improve it - also avoid it to get more serious...

honestly it feels like if I'm not pushing here and keeping the discussion flowing, at some point I will be alone again with those problems. and alone i wont achieve anything as im no expert. it's really sad, that those who should intentionally be the ones to help (doctors) either don't want or can't care enough - or both. So my experience over the last months is, that you really have to fight for every step along the way...

[palerider]

honestly it feels like if I'm not pushing here and keeping the discussion flowing, at some point I will be alone again with those problems.

Well, this forum's been here since (iirc) 2006, and we're still going strong.

Do what Rubicon recommended, and report back, post your overall screenshot as specified in the first post in the forum, or the wiki post that I linked.

[Rubicon]

honestly it feels like if I'm not pushing here and keeping the discussion flowing...

A brief editorial.

So I just looked at the data from 1.27.2023 (or 27.1.2023) there are about 7200 breaths. I look at a screen of about 20 breaths to try to look for sleep continuity (which technically can't be done cause read my initial point about there's only 2 channels to work with). In SleepHq you can't page through the windows you have to scroll 10 seconds at a time. Further, you have to momentarily pause to wait for the breaths to appear clearly because it's coming off a server. After that you look at 15 minute windows to look for periodicity and events. Arousals, or arousal zones where stage stages might occur, need to be manually tabulated. If someone has stable sleep it goes very quickly. If someone has TWA and a problem that nobody can find it's a quest. If you put up 8 downloads, we're talking insurmountable.

Your doctors have all the tools and data. We got the equivalent of a sledge hammer to fix a Swiss watch.

Keep things in perspective.

[palerider]

We got the equivalent of a sledge hammer to fix a Swiss watch.

But you're very good with that sledgehammer.

[robysue1]

Ok, I've now read the whole thread and I'm (sorta) through the get ready for the semester stuff.

So I want to ask a question about something Rubicon is saying, just to make sure I'm following what's being said:

they said explicitly only the Arousal Index was not checked. rest was checked.

I'll bet they didn't do that either (for instance, the Desaturation Module is pretty accurate, so most, or a lot anyway, of people don't check it). But I think the lies aren't limited.

I don't know what software that is, but computerized arousal scoring isn't accurate to begin with, and using it at all raises questions.

So you should take it other way. Your NPSGs show basic TWA and your downloads look to show a lot of arousals. IMO the arousal count is actually accurate or even under-reported.

Regardless, if they said it's wrong have them rescore the report and send you the amended copy.

Rubicon, you're saying that there's good reason to believe that the large number of arousals on all the NPSG are good lower bounds on the actual number of arousals that occurred on those three nights of sleep. That correct?

Next question: And all or most of those numerous arousals listed used to compute the Arousalindex appear to be spontaneous arousals? Or are they respiratory related arousals? Or is that something that can't be determined?

And previously you said:

He's like underlying CompSAS, poke it with a stick and it triggers a chain.

Are the arousals the stick being used to poke the underlying CompSAS?

Or are they part of the trigger that results from poking the CompSAS?

Or am I missing something critical?

And finally: Herbert writes:

and one more thing: as I'm in the office at work today I will only be able to upload the data of my machine and o2 ring tonight. hope you can have a look on it. you probably find some details which proof or deny my theory about obstructions. BTW this is such a big thing to me, as my fear was, that every was central

You'd REALLY be much better off if you'd quit obsessing about trivialities.

I would be glad if it was only trivialities. as mentioned I don't feel well rested in the mornings. so I guess there has to be room for improvement. if you have other suggestions on how to improve my sleep, I'm very eager to know.

Instead of worrying about your theory about obstructions versus what's causing your central sleep apnea, perhaps you need to be thinking about what's causing all the spontaneous arousals. Because the number of arousals you seem to be experiencing may be enough to explain why you're not feeling well rested in the morning, and it's quite possible that either central sleep apnea or obstructive sleep apnea is the sole cause of those arousals, particularly since it does look like your sleep apnea---regardless of whether it's OSA or CSA or CompSA---seems to be well managed by your current CPAP settings.

[Herbert]

@Robysue1: good questions. in the part about my many arousal I guess you wanted to say that my apnea is possibly NOT (the main?) the reason for the many arousals, as it is good managed right now. correct? Might be true, but I wouldn't know what could be the reason instead. Our bedroom is dark, chilly, quiet. Okay my wife is pregnant and snores from time to time, but that doesn't explain all the other nights last year.

Today I'm in home office so I have some time to post the results/reports of my last nights. Working on that currently and will post soon.

[Herbert]

Ok here comes the reports:

1. Sleep HQ Link for 30.01.2023: https://sleephq.com/public/acdbaa1b-7ab ... 2de3149aa0
2. Sleep HQ Link for 31.01.2023: https://sleephq.com/public/eaf0056e-91c ... a0a4cc024f

3. Screenshot of Oscar 30.01.2023:


4. Screenshot of Oscar 31.01.2023:


5. O2 of 30.01.2023: Average of 96%, lowest sat 92%, lots of desats to the lower 90s, average HR 55.
6. O2 of 31.01.2023: Average of 96%, lowest sat 90%, even more "deep" desats to the lower 90s, average HR 60


So whats interesting: The pressure decrease to 6 did not really affect the my AHI which is still quite good during those 2 nights. But what it clearly affected is my O2 and Heart rate and I don't understand why. When I was on 7 my sats were exactly 97% and lowest desat 94%. Now as you can see in the screenshot under #6 it's dropping frequently to the lower 90s. Still not really worrying but a clear difference. Do you have any Idea why? Attached a pic of my O2 while on pressure 7. I could reproduce this result a dozen times as it looked like that for the 2 weeks I was wearing the Pulsoxymeter before turning down the pressure.

[Rubicon]

Ok here comes the reports:

They're on 6.0 cmH2O.