Going after Hypopnea events

[yardbird]

This morning I got up and read my card.

ZERO apnea events! I think that's a first for me.

Using my CL2 mask and the new Intellipap Auto.

AHI for last night is 1.9 .... all from hypopnea events.

I've only got 3 nights data on this machine so far, but it looks pretty convincing that my sleep disruptions are almost entirely from hypopnea rather than apnea events. When I wake up in the night I pop one eye open and look at the time (it's projected on my ceiling so I can see it). For each time I can remember waking, the graph shows hypopnea events.

So I guess I'm looking for ideas on how to try to address the hypopnea.

My titrated pressure is 8cm. I have the machine set to range 7 to 12.

Currently, the machine responds to Apneas and hypopneas like this:

Apnea% = 10% (respiratory flow must fall below 10% to be considered an apnea... combines with Apnea Duration below)
Apnea duration = 10 seconds ( number of seconds that respiratory flow must remain below Apnea% setting to be detected as an apnea)

so... flow falls below 10% of normal and lasts for 10 seconds, this is an apnea

Hypopnea % = 50%
Hypopnea Duration = 10 seconds

so... flow falls below 50% of normal for 10 seconds, this is a hypopnea

My question becomes.... if I change a setting for hypopnea.... let's say... to 5 seconds instead of 10. Will it simply detect more hypopneas because now the citeria is only 5 seconds? Or will it then RESPOND to what it believes to be a hypopnea event SOONER than it did when set at 10 seconds?

Is it possible that I need to simply raise my lower limit? Like maybe a pressure of 7 is not enough to stave off a hypopnea event where a pressure of 8 might eliminate some of these?

If we only look at AHI... 1.9 is not bad... but the hypopneas are apparently waking me up several times a night and that's gotta stop.

thoughts?

[ozij]

Good questions.

Is the machine raising pressure in response to the hyponpnea it records, or is it not?

Are you sure its the hypopnea waking you, and your arousal causing a toss and turn that gets recorded as a hypopnea?

O.

[yardbird]

Good questions.

Is the machine raising pressure in response to the hyponpnea it records, or is it not?

Are you sure its the hypopnea waking you, and your arousal causing a toss and turn that gets recorded as a hypopnea?

O.

I do see increases in pressure correlating to hypopnea event clusters. The larger the cluster of events, the more noticeable the pressure increase.

Am I sure the hypopnea is waking me?
Good question. kind of a "chicken or the egg" scenario, eh?

Let's say that I strongly believe that the hypopneas happen first and the arousal follows as a result.

[Georgio]

On the Intellipap, I've tried 50% then 40% for hypopneas and 40% seemed to make matters worse. Next I'm trying 60%. One of the strengths of the Intellipap is the number of therapy combinations it can provide. Apparently it's an individual thing how everyone reacts to settings. If you haven't already, there is lots of information and discussion on the Intellipap under announcements above; Intellipap vs. M-Series. Good luck with your therapy.

Georgio

[john5757]

Georgio,

I am getting the same results you did I've tried 50% then 40% for hypopneas and 40% seemed to make matters much worse and waking up very tired. I then tried 55% and now 60% and the results appears to be encouraging and I will check for the next few days. The Intellipap is my third auto cap and my pervious auto CPAP is the GoodKnight 420E which is wearing out and I hope to get as good or better results on the intellipap. The Intellipap is certainly responding to Hypopnea events alright.

[rogelah]

Hypopnea is literally under-breathing. There is usually airflow. It is based on your respiration rate (RR). So, if your RR is normally 12 breaths per minute (BPM) then a 50% reduction is 6 BPM or less. My sleep breathing problem is neurological (muscular dystrophy) and my RR is affected by pressure during exhale.

Changing the percentage doesn't reduce the hypopneas; it only changes the reporting of them. I have no idea if 1.9 is good or bad (mine is currently in the high teens even with use of a ResMed S8 AutoSet II in CPAP with EPR turned on).

I would try to understand the cause before masking the problem.

Sorry if I am sounding "preachy". I am struggling to understand how to reduce hypopneas myself.

[LoQ]

Hypopnea is literally under-breathing. There is usually airflow. It is based on your respiration rate (RR). So, if your RR is normally 12 breaths per minute (BPM) then a 50% reduction is 6 BPM or less.

Interesting definition of hypopnea. I may be mistaken, but I think a hypopnea is not about respiration rate, but about how much air is flowing. Thus a 50% reduction would be half as much air per breath, not necessarily fewer breaths per minute. In other words, it's shallow breathing, not infrequent breathing.

[rogelah]

It is defined as overly shallow breathing or abnormal breathing rate. I think it is hard to distinguish which cause is the culprit without some other sensory device such as was used in your PSG.

Shallow breathing is when you inhale using only the intercostal muscles and do not use your diaphragm, assisted by your abdominals, to fully expand your lungs. In my case my intercostals and my abdominals are weak leading to a low breathing rate and/or shallow breathing.

Also, I don't know how xPAP machines determine hypopneas.

[bonjour]

I too feel the need to minimize hypopnea events

3 Days of Data, The first is a FFM, the last two are a Aptiva Nasal mask.
I think most of the snoring events are a hacking cough lingering from a very bad chest cold.

Thoughts please.

[john5757]

On my old GoodKnight 420E it will response to flow limitation by increasing pressure depending on the switches you use on the unit and will not increase pressure for central apnea by listening for a heart beat. The GoodNight unit if it can hear a heara heart beat it is usually right that the event is central in nature but can not allways pick out all centrals events My old ResMed auto with the Res link will report minute ventilation as liters per minute
fro example you start out on 15 liters per minute and in deep sleep 8 liters per minute is common for some. But there is no pressure increase until there is a "flattening" of the airwave. All auto CPAP will increase pressure for snores. On the new Intellipap it will response to snores if it finds a 70HZ sound wave. Not sure how reliable it is but it seems to response to snores quite fast as compared to the ResMed and the GoodKnight. I still new with the Intellipap and still trying to get it to work well for my needs.

Hypopnea is literally under-breathing. There is usually airflow. It is based on your respiration rate (RR). So, if your RR is normally 12 breaths per minute (BPM) then a 50% reduction is 6 BPM or less. My sleep breathing problem is neurological (muscular dystrophy) and my RR is affected by pressure during exhale.

Changing the percentage doesn't reduce the hypopneas; it only changes the reporting of them. I have no idea if 1.9 is good or bad (mine is currently in the high teens even with use of a ResMed S8 AutoSet II in CPAP with EPR turned on).

I would try to understand the cause before masking the problem.

Sorry if I am sounding "preachy". I am struggling to understand how to reduce hypopneas myself.

[timbalionguy]

Not trying to hijack this thread, but it looks like several people are trying to pursue different but closely related scenarios here. Here is my scenario.

After a little over a month of therapy, I am finding that the lion's share of my AHI events are hyponeias. My AHI so far has averaged right around 11.... with an AI of typically less than 1, and an HI typically around 10. Pressure range is currently 10-15, and i was originally set up with 10-13. Sleep doctor said I was 'hard to titrate', and told me it might take a while to find the right numbers.

Typically, I will experience a string of hyponeia events, to which my IntelliPAP machine (seems popular on this thread!) responds by raising the pressure. Usually, they stop, but not until I am near the top of the current pressure range. When the hyponeias stop, the machine lowers pressure gradually. Snoring is (usually) infrequent, but when I snore, I will often see AI's, HI's and possibly even a central event (IntelliPAP reports as an 'NRI").

I note my tidal volume is 600-800 mL with 14-15 BPM while falling asleep. Average tidal volume is 450-570 mL with an average BPM of 16 while (supposedly) asleep. There seems to be no correlation with HI rate and sleeping tidal volume that I have yet observed. Quality of sleep varies from night to night, but have not experienced any really bad restless nights.

Is a hyponeia possibly a type of flow limitation, possibly caused by nasal congestion? (I use a Quattro or Hybrid FFM with similar results) Or, is it always a fundamental breathing problem?

Could hyponeia possibly be a result of my body trying to breathe against pressure when I am asleep? I have no problem breathing against any pressure I have tried so far (up to 15) if I am awake to notice it. No other pressure problems (except mask leaks ) noted, such as gastric insufflation, etc.

Since my AI's are very nicely controlled, even at 10, does this mean that maybe my base pressure is too high? Or is peak pressure too low yet? (I am thinking my final range is going to be 11-16 or 12-16, but need a few more nights' data).

Occasionally, I have a much lower Hi rate, and occasionally a much higher Hi rate. No wonder my 'operator' had a hard time titrating me!

[yardbird]

Replying to this a little late maybe. We jsut buried my wife's dad so.... been a long week....

I bought a recording pulse oximeter to see if the hypopneas were causing desats. I never went below 92%. So if I've got no apneas, but I do see hypopneas being reported by my machine, I'm going to relax a little and not get too overly obsessive about chasing the numbers. I would *like* lower hypopnea numbers, but if I'm not desatting I might also want to assume that my machine is preventing the hypops from progressing to apneas. And reporting hypops it might be like a cat bringing home a dead mouse. Saying, "Look what I caught!" ..... good kitty.

[kteague]

Yardbird, my condolences to you, your wife, and the family at this time.
Kathy

[robertmarilyn]

Yardbird, my condolences to you, your wife, and the family at this time.
Kathy

Same here yardbird.

mar (your avatar is funny)

[timbalionguy]

Yardbird, my condolences to you as well. I know what it is like. I lost my mom just before this whole 'adventure' began.

And an update on my long-winded post--

The last three nights, I have had vastly improved hypopnia rates, with no real explanation why. These have also been good sleep quality nights as well. In the interim, I have learned that raising pressure is the best way to clear a 'normal' hypopnia. So, I am thinking even more, as I suspected, that 11 or 12 to 16 is the next thing to try.