Severe mixed apnea at the age of 35

[Rubicon]

But let's see what you think-

I think it's a good thing we're not using The Number cause your AHI is back to < 1.0 and that would be your new home.

Sleep continuity remains poor.

Some periodicity continues. ASV will probably kill it but IMO won't solve everything.

Did you ever get a good ENT eval? I forgot and today's another travel day so don't have time to look. There's a little inspiratory and expiratory stuff that might be something but given your history of central stuff absolutely don't want to be dial wingin".

[Herbert]

don't worry. the low ahi won't be consistent, as its going up and down just as it wants. so there's no danger of ending up on the couch for eternity would be low even if ahi would be the key figure

ENT is ear nose throat? I've just recently been at an ent specialist. He used his flashlight and looked into my throat and nose and said that everything looks normal, no narrowings or stuff like that. What I never did, but I know that it's a thing is them putting me to sleep and shoving a camera down my throat. it think that's the only evaluation not done yet.

it's funny that you mention inspiration and expiration stuff going on. yesterday I had a nap in the afternoon without cpap for a long time lying on a reclined chair on my back. and actually I woke up with a short snore which I'm convinced I seldomly do at all. But I also gained some 10kg of weight since this stuff happened due to the stress it put on me. so that maybe just an additional osa component coming into the picture now.

For the asv: I'm still convinced I would really struggle to adapt to it. As soon as I focus on my breath, I'm getting trouble. even without xpap in my face. and with asv I would surely focus on it. also the pushes when having centrals would probably wake me everytime. So what would I win? at some point I guess I will have to try it, but first I'd like to check all other possibilities...

Sleep continuity is the key I guess. Even years before the diagnosis I was wondering if waking up so often per night is normal. It feels like I have to turn every from one side to the other very often and the next morning I remember lots of those turns even though I fall to sleep again very fast. When you're reading about this topic you will find that it's considered normal to wake up between sleep cycles and fall to sleep again. but how often is normal and waking up how much? and even what can be done about it. it's not like anything hurts and I have to turn because of this,, but just my body want to switch sides to feel comfortable again.

It's like you said. Henn or egg... who knows what is causing what for me. and also what part plays this periodic breathing stuff.

[Herbert]

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[Herbert]

New night on the couch. According to my watch I woke up a lot in the first half of the night. AHI is even lower than yesterday. Feeling is: slept longer than usual but I'm still not very refreshed this morning.
Meanwhile I think my AHI is getting lower if I sleep bad and wake up a lot. But this doesn't fit to the theory, that it's the SWJ that is causing the CA clusters. Also in the morning I wasn't waking up a lot and still had no clusters.... so there's still no pattern visible for me.

Flow limitations seem quite high this night as well. https://sleephq.com/public/15332ad3-426 ... 9d1e2e862c

[Rubicon]

When you're reading about this topic you will find that it's considered normal to wake up between sleep cycles ...

Who said that?

I never did.

I would say "At the end of a REM period there is a period of enlightenment". That might be Wake, or just as easily N! or N2 (except for Final REM where you go to Wake and start the day).

I think 5 Awakenings would be considered normal, but you may not recall any of them.

There's a lot of just plain ol' mess, but a lot of periodic stuff (even tho you turned the pressure down):



Go borrow an ASV somewhere.

[Rubicon]

ENT is ear nose throat? I've just recently been at an ent specialist. He used his flashlight and looked into my throat and nose and said that everything looks normal, no narrowings or stuff like that. What I never did, but I know that it's a thing is them putting me to sleep and shoving a camera down my throat. it think that's the only evaluation not done yet.

Right, a "DISE".

Cause in the aforementioned stuff:



#1 looks like some palatal interference
#2 looks like a FL
#3 looks like CBA (cardioballistic artifact and normal and leave it alone)
#4 s another FL
#5 is a FL that leads to an arousal #6

You can look at FLs



and see where they lead to (probable) arousals.

Normally one would crank up pressure or apply some EPR to attack those, but given your tendency for periodic breathing getting rid of FL might (will?) increase PB.

[Herbert]

ok two question to what you just said:

1. Do you suspect some special underlying condition that might be diagnosed and treated by an ent? If you gave me a hint I could follow up on it.

2. ASV seems to be the only solution that might work for all that's going on with me right?

Good thing in Germany: It not such a hustle as in the US being prescribed asv, meaning you don't have to fail all other methods to finally get it. Bad thing is, due to missing the appointment in June the next time ill be in the sleep lab is only in November... so a long time to live with the current situation.

[Rubicon]

1. Do you suspect some special underlying condition that might be diagnosed and treated by an ent? If you gave me hint I could follow up on it.

Nothing special. Simply, the cause of the FLs/OAs (since you wouldn't be on CPAP) would be seen. If the problem was something that could be addressed surgically (like a big palate) then you'd have a viable option.

2. ASV seems to be the only solution that might work for all that's going on with me right?

If you could tell me "all that's going on" then I would be happy to answer that. If your sleep is inherently bad then it will help your response to bad sleep, and not necessarily the bad sleep itself.

That said, it's what I suggested in my very first post.

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Bad thing is, due to missing the appointment in June the next time ill be in the sleep lab is only in November... so a long time to live with the current situation.

You could try some dial wingin'. Do you have any data where you used EPR?

[Herbert]

"all that's going on" means central, periodic as well as flow limitations. As I understood asv is gold standard for mixed apnea.

So you'd suggest to have the DISE evaluation. right? Are OSA problems capable to cause all this periodic and central stuff? since I already had many central and some periodicity already in my diagnosis night in the lab. So it's not just treatment emergent.

Nope I never tried EPR. This is some sort of soft bipap as I understood. Do you think with less resistance during exhaling the periodicity might decrease?

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"all that's going on" means central, periodic as well as flow limitations.

IMO 75% of your issue is Bad Sleep. To which I already said

TTBOMK, there is no xPAP machine out there that has a button that says "Good Sleep".

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Do you think with less resistance during exhaling the periodicity might decrease?

Au contraire, it will probably increase.

However, the hope (and it's a "hope", not a "plan") would be to prevent more FLs that cause arousals than the amount of PB (or even CAs) that adding EPR will generate.

CPAP 10 cmH2O EPR 3.0.

Cause at 9.0 you're still having FLs:

[Herbert]

I have an understanding issue here: I thought EPR is only a comfort feature, but has no positive effect on preventing FLs. Am I right here? Because then I don't completely understand what EPR would add to the equation that 10cmh2o would not do alone.

[Rubicon]

I have an understanding issue here: I thought EPR is only a comfort feature

I thought you thought

This is some sort of soft bipap as I understood.

in which case you'd be correct.

[Herbert]

So is it? Then I don't get why I should turn it on knowingly it will only worsen periodics but not help with FL

And about the bad sleep thing: Might be true but I don't understand what could be the root cause. Neither do I have bad habits besides phone time before sleeping. No caffeine after 3pm, no alcohol, no nicotine, no stress (at least only a bit on weekends), no heavy meals etc.... Nor do I have external disturbances. Last two nights I slept alone in a dark room with earplugs. So there was no movement disturbing me, no lights and also no sounds. I can't even make up anything else that might lead to my bad sleep. Also as you already pointed out when looking on the data of my vacation I can reproduce those results of 'bad sleep' in any environment. So I assume it's nothing external. Is it possible that I'm just retarded when it comes to sleep??? Really sad thought tough...