AHI, PB, and 90% p

[sierragail]

Hi to all and a big thank you for being out there. I am new, started on my cpap 18 days ago. My initial sleep test showed AHI of 40. Other than the AHI info, I don't have any more information about my initial sleep test. I plan to get copies of the report when I go in for a checkup. The pressure on my machine is set to fluctuate between 9 and 11.

After 18 days:
AHI is 4.9
Periodic Breathing is 1%
90% pressure is 10.8

In your opinion, how does this look?

The first few days of treatment were like heaven~~~I woke up feeling fantastic. But now, after returning home to 8,000 feet, I feel like each night's sleep is steadily going downhill, or is this all part of the learning curve and has nothing to do with altitude? The machine is self-adjusting for altitude, so I should assume that's not an issue.

I'm getting quite a bit of "raining" on my face, which of course wakes me up. The air temp is nippy at night (no heating systems here), so maybe this is why it "rains" so much? I have tried turning the humidifier down to zero. When I do this, I don't get rained on, but then the dryness of my nasal passages wakes me! I don't have a hose cover but I'm going to make one today. Will this help the "rain?" What type material do you recommend? Terry cloth, fleece, thick knit?

Thanks to all for input!

[tillymarigold]

I live in the high desert also, and I use fleece for my hose cover. That helps with rainout. You're right that it's due to cool air temps at night. In the meantime, if your mask makes it possible, keep the hose under the blankets with you instead of outside.

Are you sure your machine can compensate for altitude that high? I think some machines aren't meant to be used above 7500 feet. I'm at 5200 feet myself.

Your numbers look really good, but the important question is "how do you feel?" Although you won't have a real answer to that for 3-6 months, when you've caught up on sleep completely ("repaid your sleep debt").

If I were you I would want a wider range on the APAP, maybe 9-12 or 9-13. The top pressure should be at least 1-2 cm above your 90% pressure. My 90% pressure on my sleep study was 8.5 and the range my APAP was programmed to was 7-11. If your 90% pressure is 10.8, that suggests to me that there's a significant proportion of time you need a pressure that's higher than the max your machine is set to.

[Pugsy]

There is more to feeling rested when we wake besides getting good "numbers". If you wake for any reason several times during the night it messes with how we might feel. If the numbers of hours asleep is not enough it will also mess with how we might feel. Even though AHI numbers of less than 5 are considered "sufficiently treated", many people notice that they may need an AHI of less than 3 to see much of an improvement.. I don't notice any huge improvement until I have AHI of 1 or less. Those nights have been rare. But I continue to try to strive for it.

Work on leaks if you are having any. Work on the rain out because if you wake up for any reason it disrupts the sleep cycles needed for the body to recuperate. I used some old "tube" socks that my husband had to give me a little extra insulation. Just cut the toes out enough to slide over the hose. It will help with the rain out until you can get something fancier.

Consider increasing the maximum pressure just a little bit to see if the AHI responds or if it affects your sleep.
Sometimes pressure changes can disrupt sleep. If that happens consider a trial with the machine in CPAP mode.

[timbalionguy]

Its interesting that you mentioned a number for 'periodic breathing'. This is something that is generally treated with the more advanced BiPAP machines. What machine/mask, etc. do you have? (Fill out your equipment profile under 'User Control Panel'. Use equipment descriptions rather then pictures for more clarity.)

8,000 feet is pushing the altitude compensation feature of many xPAP machines to its limits. Check the specifications on your machine to make sure it can be used there.

In any case, I am sure with the proper adjustments, your therapy will work for you.

Cool! living at 8,000 feet. We have quite a few areas here above 8,000 feet, but the climate makes them inhospitable places to live.

[sierragail]

Thanks so much for everyone's valuable input. I had been thinking that maybe my range (currently set at 9 to 11) should allow for a higher number, since I'm 90% at 10.8, so I was glad to see the comments and advice on that subject. I'm going to change it to 13 for tonight. The tube socks idea is a really great tip for a hose cover, also the tip to put the hose under the covers with me.

I set my equipment info set to text. I use the PR One System Respironics REMstar Auto (with the attached humidifier) and the Opus 360 nasal pillows, alternating with the Zest Nasal Mask. I think I'm beginning to like the Zest better. They told me this machine could handle 8,000 feet, but then again, who really knows.

I don't really know much about what a Periodic Breathing of 1% means, does anyone out there? And, I wonder if it is due to the altitude? I've heard that PB can occur at really high elevations, but I thought it had to be higher than 8,000 feet. Does anyone else have PB? The sleep center test was more or less at sea level, so maybe that's why it didn't show up down there?

[cinco777]

Here is what Respironics says about "Periodic Breathing"



Here is what Wikipedia says about "Cheyne-Stokes Respiration" (Please note that it is associated with sleeping at High Altitudes)

http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration

Cheyne-Stokes respiration
From Wikipedia, the free encyclopedia

Cheyne-Stokes respiration, also known as periodic breathing, is an abnormal pattern of breathing characterized by oscillation of ventilation between apnea and tachypnea with a crescendo-decrescendo pattern in the depth of respirations, to compensate for changing serum partial pressures of oxygen and carbon dioxide.

It is caused by damage to respiratory centers,[1] and is also characteristic of newborns with immature respiratory systems. In the second case however it is a symptom of developmental immaturity and not of a damaged or defective cardiopulmonary system.
Contents
* 1 History
* 2 Associated conditions
* 3 Related patterns
* 4 References

History

The condition was named after John Cheyne and William Stokes, the physicians who first described it in the 19th century. [2][3]


Associated conditions

This abnormal pattern of breathing, in which breathing is rapid for a period and then absent for a period, can be seen in patients with heart failure,[4][5] strokes, traumatic brain injuries and brain tumors. In some instances, it can occur in otherwise healthy people during sleep at high altitudes. It can occur in all forms of toxic metabolic encephalopathy.[6] It is a symptom of carbon monoxide poisoning, along with syncope or coma. This type of respiration is also often seen after morphine administration.

Hospice personnel often document the presence of Cheyne-Stokes breathing as a patient nears death, and report that patients able to speak after such episodes do not report any distress associated with the breathing, although it is sometimes disturbing to the family.

Related patterns

Cheyne-Stokes respirations are not the same as Biot's respirations ("cluster breathing"), in which groups of breaths tend to be similar in size.

They differ from Kussmaul respirations in that the Kussmaul pattern is one of consistent very deep breathing at a normal or increased rate.

[sierragail]

Hey Cinco777,
Thanks so much for your feedback on PB. I had a chemical stress test to the heart last month and it was normal. I'm on Atacand for high blood pressure (last 5 years) and recently Metoprolol was added for tachycardia. Maybe the high BP and perhaps even the tachy are the result of having had undiagnosed sleep apnea for a very long time? I've read there are some connections between high BP and sleep apnea. I think the PB is probably is due to the altitude, especially since the cardio stress test was normal, at least I certainly hope so. Do you know what a PB of 1% means? Does that mean that 1% of my apneas are due to PB?

[cinco777]

Do you know what a PB of 1% means? Does that mean that 1% of my apneas are due to PB?

I suspect that your 1% Periodic Breathing (PB) means that you experienced PB for 1% of your total Session time. Total Session time is the time from blower on to blower off. My suspicion is based on how Variable Breathing (VB%), a different measure of breathing, is calculated for my Respironics APAP machine. VB% is calculated as (total time spent in Variable Breathing divided by total Session time) * 100.

Another PR-1 user said that he experienced a few 4% PB Sleep Sessions (nights) during his first week. He reported that his %PB fell to 1% at the start of his second week of use.

[sierragail]

I found this article today concerning PB at high altitudes and thought I would pass it on:
"Temazepam at high altitude reduces periodic breathing without impairing next-day performance: a randomized cross-over double-blind study"
http://www3.interscience.wiley.com/jour ... 1&SRETRY=0

Tonight I'll be taking 1 mg of Ativan (lorazepam, close enough) to see how it goes. Over the past 19 days I had PB of 1%. I have reset my machine read-out so that I can access the data daily, instead of being stuck in the the 7 day/30 day mode. Last night my AHI was 6.8. Thanks to all, and especially SocalMonkey, for posting how to set up this machine to show the daily data. I appreciate it very much.

[shambharwani]

The definition of PB on Medicinenet.com is:

Definition of Periodic breathing

Periodic breathing: Clusters of breaths separated by intervals of apnea (no breathing) or near-apnea. As opposed to normal breathing which is usually regular.

Periodic breathing was originally thought to arise from serious neurologic or cardiovascular disease and therefore to carry a poor outlook. It is now known that periodic breathing tends to occur during sleep, it can occur in healthy persons, and the apnea in periodic breathing is usually central (without respiratory movements) rather than obstructive (caused by upper-airway blockage).

Periodic breathing during sleep occurs typically in patients with congestive heart failure.

http://www.medterms.com/script/main/art ... key=10902#

[sierragail]

Hi Shambarhwani and to all,
Thanks for your input. Everything I read also mentions either congestive heart failure or a serious lung issue. It's all very baffling. I've spent thousands and thousands in the past 5 years on ultrasounds, HRCTs of the lungs and abdomen, liver biopsies, echocardiograms, cardiac stress tests, blood tests, and more, and all it does is alienate me from doctors. Yet I continue to be breathless, tired, dizzy, near-fainting, confused, GI issues, tight feeling in the lungs and chest, at times a burning feeling in the lungs, get swollen ankles, and of course no sleep (which is why I'm here!)

I have diagnoses of high blood pressure, diabetes 2, Sjogren's Syndrome, Reynaud's Phenomena, IBS, hiatal hernia, uh, that's enough I guess for now---but none of those account for my breathlessness and perennial fatigue. I guess the worst part right now is being out of breath. Why does this happen? I can't even talk and walk at the same time. Forget about trying to talk while eating (well, that's bad manners anyway.) I am thin, stay fit and active, work like a maniac in the yard, carry heavy loads, walk everyday, never eat out, drink lots of water, but something is just not right with my body, obviously!

I've been to more doctors in the past 5 years than I've been to in my total life, but I'm pretty sure that none of them think there is anything wrong with me. Certainly I don't want there to be anything wrong as well, but my body keeps telling me there is! It's not normal to get completely breathless walking across the town plaza, at a regular normal pace, in regular weather, on flat land, and then have to hold onto the side of a building to keep from falling over! I used to be a long distance hiker on the AT!

But talking to everyone here gives me the conviction to go back to the doctors (one more time) and see what can be done.

[tillymarigold_]

I'm not saying this to be mean, but in all seriousness, have you thought about going to live at a lower elevation? I mean, 8000' is enough to cause a problem for some people ... it would cause a problem for most people at first, but I'd guess some people would just not be able to live at that elevation.

It might be worth trying the absolute most natural way to get more oxygen (living somewhere with more oxygen in the air) since all the expensive, complicated ways aren't working for you.

[cinco777]

Have you had an angiogram to see if you have narrowing of your arteries? If not, please read the following Wikipedia links:

http://en.wikipedia.org/wiki/Angiogram

http://en.wikipedia.org/wiki/Angioplasty

Background
In December 1996, I experienced shortness of breath while out for a morning run (I was on a business trip to a place that was "cold" compared to my home here in the California Bay Area). Fast forward, after many tests, to September 1997, when I received two stents (Cardiologist wanted to do three but technology was not yet available to stent the third much smaller "almost fully closed" artery). In September 1998, technology having caught up to my need, I received my 3rd stent. Since 9/97, I have not experienced any more shortness of breath episodes - I'm still a runner.

Some of the symptoms that you are describing fit my experience. I am also a skier. Prior to 9/97, I often felt fatigued when I was up skiing. We often stayed at places that were at elevations of 6000 - 7000 feet for our ski weeks. At the time, I equated my skiing fatigue to not being acclimatized to the higher elevations. After my 9/97 and 9/98 angioplastys, I didn't feel fatigued any more when up skiing. Just to be clear, I do feel tired after a day on the slopes, but not that drained fatigued feeling that I had experienced before 97-98.

I agree with the previous poster who suggested living at a lower elevation. If you feel better at lower elevations and can not determine how to feel better at your 8000' elevation, a move may be your only choice.

[sierragail]

Hi to both previous posters,
Believe me, moving down to sea level is our top priority right now, and the sooner the better of course. Neither me nor my husband have felt so great up here--yeah the weather is great and the views are lovely and the forests are beautiful, but, well, so what if you feel like you're a hundred years old with one foot in the grave. Things have prevented us from moving, like the economy sucks everywhere and we'd like to sell our house instead of rent it out. But at this point in the game, we will rent it, if selling doesn't happen on time. He's in culinary school and finishes up next August. If I absolutely must, I'll move down before then, if I have to. This place up here at 8,000 ft is just a short side trip in the journey of life, but it sure has been heck on my health, and his too. He had a right partial colectomy last spring (polyps that just kept coming back again and again over the past 10 years, and had finally become pre-cancerous).

Cinco, I had a chemical cardio stress test last month. Everything showed up okay. Would this stress test have revealed a stenosis of the arteries, or would that be found in a separate test? I'll go check out those links you sent. Thanks.
gail

[cinco777]

Cinco, I had a chemical cardio stress test last month. Everything showed up okay. Would this stress test have revealed a stenosis of the arteries, or would that be found in a separate test? I'll go check out those links you sent. Thanks.
gail

The other tests available at that time (1997) - I think that I had them all between 12/96 and 9/97 - will give you a "Maybe Yes / Maybe No" answer. An Angiogram will give the Cardiologist and YOU a highly visible Yes or No answer. Please note that an Angiogram proceeds immediately to an Angioplasty (or leads to a Bypass procedure) if sufficient narrowing/blockage is found. My first procedure with two stents took over 2 hrs (you get to watch it all on large Screen TVs as you are awake the whole time). My second procedure with one stent took less than 2 hours. I enjoyed watching both procedures as you are definitely getting "an up close and personal" experience. I considered my two procedures a real learning experience and was glad that I got to watch them from start to finish. I started taking statins in Fall 97 to lower my cholesterol. I've posted my experiences (side effects, etc.) and experiments with cholesterol lowering drugs on other threads.

Please note that my experiences with Angiograms and Angioplastys was 11 - 12 years ago. There may be some non-invasive tests today, with new technologies, that may equal an Angiogram's diagnostic accuracy. Although I try to keep current on what's new in this area, I may not be fully up-to-date on the latest advances so check it out by doing your own research and talking to a good Cardiologist.