What do clumps of A & H events mean?

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 5:50 pm

I notice that I usually have large clumps of both apneas and hypopneas in my charts. My leak rates are decent and do not increase around the times of the clumping. I obviously, can't tell my sleeping position at the time. Can this be addressed at all by me to change this?

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 6:22 pm

I have several examples of just what you describe. I know from my sleep study that I had mild number of events during non REM stage sleep but in REM I documented 53 per hour. So...when I look at my reports I often see groupings in what could be the time frame related to REM sleep stages. I also seem to be worse on my back. This I get from my husband more than anything. All my sleep study results were on my back.

I have been making a supreme effort through various methods of staying on my side. It has helped reduce the number of cluster of events. Obviously I want my REM sleep so I am trying to take the other factor out of the equation. Hurts nothing to try. BTW when I have the clusters (get them even using the auto cpap with no maxium) I can count on the morning headache even if those are the only events that get scored.

So a variable that you might try is staying on your side as much as possible and see if it helps. Easier said than done in my case. Also I have to find just the minimum pressure that deals with the majority of my "normal" events and still have the machine be able to respond quickly enough to take care of the "clusters". This is a work in progress. If I stay on my side, don't need much. If I let myself end up on my back the machine gets a real work out.

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 7:08 pm

Thanks Pugsy, I've been trying as hard as possible to sleep on my side(s). Often I have headaches.

I spent 2 weeks at 12cm pressure, 1 week at 13cm and now 2 nights at 14cm. My AHI is still pretty consistent at around 11 (too high I know) with an AI still around 3+.

Even if the clumps happen in REM do you think it could be fixed???

Julie · Post by **Julie** » Sat Jul 25, 2009 7:18 pm

Have you looked into getting a full face mask? You may well be losing all the Cpap air out your mouth if it's open while you're asleep (you can't control it, after all) and it's pretty common for a lot of us.

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 7:24 pm

Julie, my leak rate is often less than 2.0 (95th percentile). Other than 1 night in the last 3 weeks my leak has been < 6.0. Wouldn't that say I keep my mouth closed?

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 7:41 pm

RMinOntario wrote:Julie, my leak rate is often less than 2.0 (95th percentile). Other than 1 night in the last 3 weeks my leak has been < 6.0. Wouldn't that say I keep my mouth closed?

Please confirm your stated leak rate and decimal position.
.20 L/sec would be acceptable (barely)
2.0 L/sec would be showing excessive leaking

obviously 6.0 or even .60 is way too much.

With ResMed machine reporting you want as near zero as possible.

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 7:51 pm

My leak is 'l/min' not 'per second' so it is good.

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 7:57 pm

You have the software. Could you post one of your better graph reports?

If your event clusters are related to REM sleep it must be addressed with pressure, if related to position (i.e. supine) then maybe staying on your side will help.

Post a graph so maybe we can see if they appear to be in a REM stage pattern relating to sleeping times.

2 or 6 L/min leak isn't bad at all. I thought you were getting numbers off the LCD screen instead of the software and giving me L/sec.

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 8:04 pm

Could you please tell me how to get a graph in a reply.

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 8:13 pm

You have to upload the image to a hosting site. I use Photobucket. Then we use the IMG button on the editor to insert the image location.
Sounds harder than it is. I will send you my private email address, send me one of your graphs as an attachment and I will post it for you if you cannot figure it out easily and quickly.

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 8:21 pm

Do have access to your sleep study reports? I was told about my REM activity. Being worse in REM is common, being worse in the supine position is also common. I suspect it is also common for a combination of REM and supine position to also be worse.

I have an auto cpap machine which increases my pressure needs to address (or try to) my clusters. To me that is much better than having a high pressure all the time to catch the sporadic cluster.

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 8:32 pm

From my sleep study, it showed the majority of apneas & hypopneas happened at a pressure of 7cm. Only 1 or 2 of each occurred at 5, 8 & 9cm and none at 10cm. Even with this they started my pressure at 12cm. I never did understand this but didn't know to question it at the time. Now they've said to work from 12cm to 15cm looking for the best pressure. So far I'm at 14 & it's still not good. I was only in REM from 7, 8 & 9cm pressure. Hope this tells you something.

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 8:45 pm

RMinOntario wrote:From my sleep study, it showed the majority of apneas & hypopneas happened at a pressure of 7cm. Only 1 or 2 of each occurred at 5, 8 & 9cm and none at 10cm. Even with this they started my pressure at 12cm. I never did understand this but didn't know to question it at the time. Now they've said to work from 12cm to 15cm looking for the best pressure. So far I'm at 14 & it's still not good. I was only in REM from 7, 8 & 9cm pressure. Hope this tells you something.

I am a newbie and even I know this makes no sense to start pressure at 12 if they seemed to have been handled adequately at 10 cm. Obviously something is going on. I see you are in Canada where it takes an act of God to get an APAP. I don't remember all your history. Did you happen to have a trial with an APAP? Did anyone ever mention central apneas in any of your results? Wonder if the increase in pressures are causing central apneas? Just thinking out loud.

RMinOntario · Post by **RMinOntario** » Sat Jul 25, 2009 8:58 pm

Pugsy wrote:
RMinOntario wrote:From my sleep study, it showed the majority of apneas & hypopneas happened at a pressure of 7cm. Only 1 or 2 of each occurred at 5, 8 & 9cm and none at 10cm. Even with this they started my pressure at 12cm. I never did understand this but didn't know to question it at the time. Now they've said to work from 12cm to 15cm looking for the best pressure. So far I'm at 14 & it's still not good. I was only in REM from 7, 8 & 9cm pressure. Hope this tells you something.
I am a newbie and even I know this makes no sense to start pressure at 12 if they seemed to have been handled adequately at 10 cm. Obviously something is going on. I see you are in Canada where it takes an act of God to get an APAP. I don't remember all your history. Did you happen to have a trial with an APAP? Did anyone ever mention central apneas in any of your results? Wonder if the increase in pressures are causing central apneas? Just thinking out loud.

I did go on an APAP for 2 weeks in June. It was an F&P machine. The 3 trial masks I was given had horrible leaks - 88l/min with 15% excessive leak. Based on that test they put me at 15cm of pressure & I had awful head-aches. I think the test was useless with such high leaks. Their explanation for the high leaks was that the masks are used for about a year before being replaced & that was why I had such high leaks.

During my PSG I had Central apnea index of 1.1. During the titration I showed no centrals.

Pugsy · Post by **Pugsy** » Sat Jul 25, 2009 9:01 pm

Let's see if this works. These are from the OP in this thread who is having trouble figuring out how to post images.

What do clumps of A & H events mean?

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