Severe mixed apnea at the age of 35

[Rubicon]

So HRV unto itself is good. It is the heart responding to something else (at least as it relates to sleep). There are 4 HRV bands, based on frequency. Let's divie them up into "good" and "bad":

• High Frequency (HF) (0.15 to 0.4 Hz) This wave would have a length of 2.5 - 6.7 seconds. In sleep, this activity will often translate into the phenomenon of Respiratory Sinus Arrhythmia (RSA), where the HRV would correlate directly with each respiration.
  
• Low Frequency (LF) (0.04-0.15 Hz) This wave would have a length of 6.7 - 25 seconds. In sleep, this activity will correlate with the respiratory events.
  
• Very Low Frequency (VLF) - 25 seconds - 5 minutes, vasomotor changes and thermoregulation.
• Ultra Low Frequency (ULF) - 5 minutes - 24 hours, circadian stuff.

[Herbert]

Sledgehammer.

I can't work like this.

Seems you got to start a new sleep lab I will request it from my cardiologist.

[Herbert]

So HRV unto itself is good. It is the heart responding to something else (at least as it relates to sleep). There are 4 HRV bands, based on frequency. Let's divie them up into "good" and "bad":

• High Frequency (HF) (0.15 to 0.4 Hz) This wave would have a length of 2.5 - 6.7 seconds. In sleep, this activity will often translate into the phenomenon of Respiratory Sinus Arrhythmia (RSA), where the HRV would correlate directly with each respiration.
  
• Low Frequency (LF) (0.04-0.15 Hz) This wave would have a length of 6.7 - 25 seconds. In sleep, this activity will correlate with the respiratory events.
  
• Very Low Frequency (VLF) - 25 seconds - 5 minutes, vasomotor changes and thermoregulation.
• Ultra Low Frequency (ULF) - 5 minutes - 24 hours, circadian stuff.

I read it, also in the other post of yours, but still I did not understand it. what does it mean "to correlate with respiratory events"?

[Rubicon]

Yeah with rocks and sticks.

And since Wellvue only plots every 4 seconds and you're bradycardic I have NFI if this is even a stone that can be overturned anyway, this is something that just looks funny.

Oh well, can't hurt to see what they got for LF.

[Herbert]

and also important question: how can my cardiologist send my ecg to me? it was for 18 hours, so I guess as pdf this would probably mean 200 pages, or not?

[Herbert]

Yeah with rocks and sticks.

And since Wellvue only plots every 4 seconds and you're bradycardic I have NFI if this is even a stone that can be overturned anyway, this is something that just looks funny.

Oh well, can't hurt to see what they got for LF.

the bradycardia was already in my focus in the past. maybe I should do the afib Ablation solely to increase my rate in rest

[Rubicon]

I read it, also in the other post of yours, but still I did not understand it. what does it mean "to correlate with respiratory events"?

übereinstimmen.

[Herbert]

I read it, also in the other post of yours, but still I did not understand it. what does it mean "to correlate with respiratory events"?

übereinstimmen.

no, the word was clear, but what does it mean in the end that the heart rate in that wave Form correlates with the breath? maybe that my/that special wave length of my heart rate when asleep (maybe also when awake?) influences my breath to be "out of tune", periodic whatever? or do I get it completely wrong?

[Rubicon]

Either:

Circulation is inconsistent and that creates respiratory instability; or

Underlying respiratory instability causes heart rate variability; or

To a degree, both are present.

[Rubicon]

And then xPAP worsens respiratory instability.

Find my Feedback Loop graphic that summarizes this if you're interested.

[Herbert]

Either:

Circulation is inconsistent and that creates respiratory instability; or

Underlying respiratory instability causes heart rate variability; or

To a degree, both are present.

makes total sense. but how can circulation be unstable if there's no heart insufficiency given?

[Herbert]

And then xPAP worsens respiratory instability.

Find my Feedback Loop graphic that summarizes this if you're interested.

might also be true. but how could this go along with my ahi improving from ~60 to merely 2,4 in my 6 month average? and what would it imply? Asv as better solution?

[Herbert]

and also important question: how can my cardiologist send my ecg to me? it was for 18 hours, so I guess as pdf this would probably mean 200 pages, or not?

please give me your feedback to this as well. would like to request it only once at my cardiologist

[Rubicon]

OK so 3 things:

1. The Wellvue download indicates significant HRV (and it's probably bad HRV). However, it generates data at 4 second intervals, and there's probably some signal averaging done so IMO that thing may be VERY inaccurate in bradycardia. All we need from the Holter is confirmation that it's NSR or maybe sinus arrhythmia during sleep and not a lot of LF junk. If your guy or report says it's fine then we should believe him. The problem undoubtedly occurs ONLY during sleep so it should have stuck out like a sore thumb. That said, if he sounds like the guys who interpreted your NPSGs then I'll tell you what to look for in the 200 pages of data.

2. Speaking of NPSGs get the arousal problem resolved. You have either hundreds or dozens, IMO they're still there, and they have to straighten it out.

3. The PB. Yes almost completely resolved, so perhaps it was (is) simply CompSAS/TECSA. Course that doesn't explain all the centrals on diagnostic. THAT would be good data to put under the microscope but I don't feel like it.

[Herbert]

ok some thoughts:

1. I value my cardiologist much higher than the sleep docs. He always seemed to be diligent to me. Nevertheless I will request the 24h ecg today, and we can have a look on it.

2. Escpecially with my result of the last two nights I really question the interpretation of my first NPSG. I don't doubt that I had events, probably even alot. But somehow it feels off/wrong. One important question: In your time as professional did you ever observe that psyhlogical "weight" could create false events, or something that could be falsely interpreted? I'm asking because when I was at the first NPSG this was a time where I was struggling with my afib diagnosis so much, that I randomly scared out of sleep several times per night. I just startle really badly several times per night due to the psychological pressure I felt. It was like that also in the NPSG night and my question is: Could this look like apneas in the recordings? probably not right? Just want to rule this thought out of my mind...

3. I mean this is exactly the crucial point now. I'm glad that the PB seems to be therapy induced, but also somewhat still worried about the CSA - but about the CSA I will shortly after post about this night. I think it's really interesting.