Just feel like whining....

[jamieay]

I'm 6 weeks in and getting a little frustrated - last night was the first time I really had to talk myself out of taking the damn mask off and going without it. My first 4 weeks were pretty good, but in the last 2 weeks I've regressed, almost to pre-BiPAP levels. Lots of central apneas. None were seen at the sleep center when they titrated me for the BiPAP - why would I have no centrals at the sleep center but have them at home? AHI is back in the double digits. I've tried sleeping on my side, sleeping on my back, taking a decongestant before bed, lots of things and nothing has any clear repeatable effect. Bah.

I see a neurologist / sleep specialist next Monday. I called to see if there were any cancellations so I could move my appt up, but no such luck.

J.

[jnk]

That's constructive whining. It is allowed, even encouraged.

If you had no central apneas during your sleep test where they can definitively discern the ones that matter, I would not assume that the apneas labeled as centrals by your home machine are actually significant central apneas. They may be harmless pauses in breathing or they may be obstructive and mislabeled central by your home machine. There is no way to know.

All you can do is the practical stuff to hold the course for the first few months, when things are going rough that way. The main thing is to get used to PAP therapy at the first. Making your therapy as effective as possible is a long range goal that you don't have to meet overnight. Keep chipping away.

First, get a comfortable mask that allows your leak rate to be reasonably good and constant. You may discover, along with your medical team, that you need a higher pressure or a lower pressure to get home-machine-estimated AHI as low as possible. But you figure that out once you are settled into the routine of therapy.

Try not eating anything within three or four hours of bed. That doesn't do anything at all for some people. But for others, it really makes a difference with how the therapy goes. Have you tried nasal irrigation instead of a decongestant? Drugs can affect therapy too. Nasal irrigation (sinus rinse) is like taking an all-natural swim in the ocean while in your shower or standing over your sink. The videos at Neilmed.com helped to convince me.

Hang in there. I hope you get plenty of suggestions in this thread.

[jamieay]

As for whether or not the centrals are "real" or simply mis-labeled, I bought one of those little oximeters (CMS-50D+) and used it overnight. Things were nice and steady most of the night, but there was one drop in oxygen levels down to 88%. I'm pretty confident that was a real event as the oxygen level tapered down over several measurements (unlike the occaisional glitches I also saw). How bad is 88%?

And in looking at the waveforms there are definately "flatlines" from time to time where it looks like I'm not even trying to breathe.

Thanks!

Jamie

[jnk]

As for whether or not the centrals are "real" or simply mis-labeled, I bought one of those little oximeters (CMS-50D+) and used it overnight. Things were nice and steady most of the night, but there was one drop in oxygen levels down to 88%. I'm pretty confident that was a real event as the oxygen level tapered down over several measurements (unlike the occaisional glitches I also saw). How bad is 88%?

And in looking at the waveforms there are definately "flatlines" from time to time where it looks like I'm not even trying to breathe.

Thanks!

Jamie

No documented drop below 90% should be ingored as completely insignificant, I don't think, from what little I know. And I don't doubt the reality of the apnea, either. I am only saying that (1) occasional pauses in breathing can occur at changes of sleep stages, and those "centrals" may not be scored as significant during a sleep study, as I understand it, from what I've read by the experts here and elsewhere. I am also saying that (2) the apnea that gets labeled a "central" by a home machine may, in fact, be an obstructive event in some cases. I say that because I, personally, doubt how well the home machines do at discerning the difference between obstructive and central.

In other words, if my study (especially a titration study) showed no significant centrals, then I would tend to question whether I was having any during treatment even if my home machine thought I was. I would tend to think there was at least some likelihood that those "centrals" might actually be obstructive or might be harmless, natural breathing pauses. But hey, that's just me. What I am saying is merely an assumption about a probability. Nothing more.

[jamieay]

Thanks for the insight jnk! I do wonder if those centrals are really centrals or are obstructive. Here's another data point - From my first sleep study -

"The patient had no obstructive apneas and 92 hypopneas, resulting in AHI of 19.6 / hr."

then later

"Impression - Moderate obstructive Sleep Apnea worse during REM sleep and in supine position"

How can I has "no obstructive apneas" AND "moderate obstructive sleep apnea"? Doesn't make sense to me.

Argh. I want a freaking nap.

Jamie

[Emilia]

Hypopneas are apnea wanna-be's.... they are shallow breathing episodes that could eventually morph into apneas as your condition, if left untreated, worsens. There are different types of apneas... obstructive, hypopnic, central, mixed. You are Dx'd as moderate OSA because that is the terminology used regardless of the type. I also have a similar dx -- my sleep study showed 78 events in 5 hrs of sleep; 77 of those were hypopneas and 1 apnea. My Dx was moderate sleep apena because my AHI was 16. At least you had some REM sleep to measure; I only recorded 2% of my time in REM.

Hope that helps.... now go take that nap!

[jnk]

Just as Emilia explained, someone with a lot of hypopneas, which are a kind of event in their own right, gets labeled as having "obstructive sleep apnea" because there is no diagnosis of "obstructive sleep hypopnea." The bottom line is that your breathing was such that someone thought a form of PAP therapy might help you. Getting you that help requires a diagnosis, and that's the name of the diagnosis.

As I understand it, sometimes what gets called a hypopnea in a sleep lab/center can get scored as an apnea by a home machine. I forget exactly why that is, but there are experts here who can explain such things.

Use the machine for the nap, Jamie. But then you know that.

[Mask2sleep]

Mind if I piggy-back on to your wine? Right now I am not sure why I am ng the mask on every night. If the 7 day average is to be believed on my machine then my AHI is about 15. I can't say if that is correct though because under info I keep getting SD Card Error and it won't write to the cards so if that isn't working what else isn't? My nose is sore and red from the pressure of the mask and I somehow got a blister on my forehead from the support piece there. Thursday a tech comes to look at the machine and fit me with a new mask. Hopefully I can do a nasal pillow or the mirage vista and get rid of that forehead strap. I did expect things to be going a bit smoother
The one positive thing I have to say is the last couple nights I am barely noticing the pressure when I wake up. I even put my hand in front of the vent on the mask to make sure it was really on, so that is nifty

[jamieay]

Feel free to join in the whinefest Mask2Sleep - all of my hose-nosed brothers and sisters are welcome! Just a dumb question - have you tried unplugging the unit, ejecting the card, re-inserting the card, then plugging it back in (in that order)? I had that error once and doing that cleared it for me.

When I look at my waveforms (http://www.scribd.com/doc/35981598) it looks like my longest "flatline" is about 10 seconds. I guess that might just be a periodic change in sleeping position, etc. If so, and there aren't any real centrals going on, then maybe all I need is a pressure adjustment. Sounds like that's not all that unusual. I don't want to mess with it myself until the doc looks and tells me if these are real or bogus centrals, but it may end up being a easy fix.

J.

[Janknitz]

Do you have software to check your leaks (the large leaks which are reported on the screen are not particularly useful)?

I'm wondering if that may not be the real issue in your AHI numbers.

[andyw715]

OAs, CA, Hypops....in one way or another they all do the same thing. 02 desaturation.

The OAs and CAs do it faster, since they are either complete blockages or just no airflow. Hypopneas is a 50-80% reduction in airflow.

Its all still OSA.

In business, cash is king. Here; 02 is king. No matter how a desat happens, the goal of PAP is to limit/stop/slow the rate of desturation to levels that your body can handle - the magic 90% or whatever.

OAs are a bit different because you aren't trying to breathe, but chances are if they are sparstly sprinkled (and short lived) amongst CAs and Hypops, then it could be a stray electron or someting that made the PAP mark them down.

Or maybe you had a dream and was told to hold your breath

[jnk]

the goal of PAP is to limit/stop/slow the rate of desturation to levels that your body can handle

That is certainly one of the primary goals, along with preventing disturbances to sleep itself (arousals) that can make sleep less than restorative.

[M.D.Hosehead]

Does one need Encore Pro to look at the waveforms? I have EncoreView and can't seem to find them.

[jamieay]

I'm using EncorePro to view them. Never tried the viewer.

Jamie

[echo]

the goal of PAP is to limit/stop/slow the rate of desturation to levels that your body can handle

That is certainly one of the primary goals, along with preventing disturbances to sleep itself (arousals) that can make sleep less than restorative.

Well said jnk. In my case I had all hypops, never desaturated to any significant levels, yet my sleep stages were like a train wreck with tons of arousals.

Jamie, just curious, what are your bipap settings?