Is it normal to have 30 second apneas on PAP?

[Laurie1041]

My data reveals roughly 40 apnea events every night and they all are from 20 to 30 seconds in length.

I am not an expert, but this sounds very wrong to me. It's no wonder I wake up exhausted. These events are the same events that were recorded during my sleep study with the exception that the my AHI has gone from 43.9 to 1.3.

My settings are 7 cms to 12 cms and my median pressure is close to 9 cms with a high of 11 cms.

Any ideas?

Bye for now, Laurie

[Goofproof]

if you are mouthbreathing, and not getting effective treatment from it, yes. Jim

[jonquiljo]

My data reveals roughly 40 apnea events every night and they all are from 20 to 30 seconds in length.

Well, if you slept roughly 8 hours and had 40 apnea events that would be 5 events per hour or an AHI=5.0. If your S9 is telling you that you have an AHI of 1.3 isn't that a little bit off? What formula does the S9 use to compute AHI? I can see why you are tired alright! What I cannot see is why your S9 would come up with an AHI of 1.3. I assume that you counted these events manually from the data.

Maybe your S9 thinks that if it tells you that you only have an AHI of 1.3 you will think you feel better??!! That's why I wanted Encore Pro for my System One to see if it was telling me the truth - I can scan the breath by breath reports and see for myself what it is calling an apnea and how many of them there are. I don't have very many events so I can't see much wrong.

[greg-g]

I would download your data and expand the time scale out to 5 minutes.
Have a look at the data and see if there are any relationships between pressure and your apneas.
Are the apneas recorded as central, or obstructive?
Do they occur only at your minimum pressure or at all pressures?
Is there a corresponding problem with leaks?
You could possibly try adjusting your minimum pressure, either down to 6, or up to your median pressure and see what the effect is.
If your pressure is hitting the maximum you could increase your maximum pressure. I personally leave my maximum set to 20 even though the actual pressure has never gone above 14, and often stays below 10.
If the apneas are central, changing the pressure probably won't have any effect, or for some higher pressures may make them worse.
From my observation I don't think the S9 always gets its typing of the apneas correct.
How long have you been using the PAP, it took me well over a month before I became accustom to the machine and really started having a really good nights sleep even though the machine instantly fixed my apneas, but yes I still do have a few 20 - 30 second apneas. Its nothing compared to my pre APAP days, and I'm much healthier thanks to my S9.

[ozij]

I would download your data and expand the time scale out to 5 minutes.
Have a look at the data and see if there are any relationships between pressure and your apneas.
Are the apneas recorded as central, or obstructive?
Do they occur only at your minimum pressure or at all pressures?
Is there a corresponding problem with leaks?

All very important questions.
Something else watch for: when in your sleep cycle do the apneas happen?
One of the reasons I use ramp is that my breathing is really chaotic when I fall asleep -- and ResMed doesn't report apneas for ramp time -- by setting a 10 minute ramp I avoid recording of the first 10 minutes before I fall asleep.

You could possibly try adjusting your minimum pressure, either down to 6, or up to your median pressure and see what the effect is.
If your pressure is hitting the maximum you could increase your maximum pressure. I personally leave my maximum set to 20 even though the actual pressure has never gone above 14, and often stays below 10.
If the apneas are central, changing the pressure probably won't have any effect, or for some higher pressures may make them worse.

Good things to try.

[robysue]

My data reveals roughly 40 apnea events every night and they all are from 20 to 30 seconds in length.

Well, if you slept roughly 8 hours and had 40 apnea events that would be 5 events per hour or an AHI=5.0. If your S9 is telling you that you have an AHI of 1.3 isn't that a little bit off? What formula does the S9 use to compute AHI? I can see why you are tired alright! What I cannot see is why your S9 would come up with an AHI of 1.3. I assume that you counted these events manually from the data.

For the overnight AHI, the S9 simply divides the total number of detected events by the time the machine was running (in a noon to noon window) and truncates the answer at one decimal place. So for example, if the S9 detected 38 events with S9 running 8 hours in a noon to noon window, the S9's LCD would show an AHI = 4.7 because 38/8 = 4.75 and the S9 truncates (rather than rounds) that number at one decimal place.

Something's not right with the OP's arithmetic or maybe there's a real problem with OP's S9.

To the OP, is it possible that the period for the Sleep Quality is set to one month or longer and that AHI = 1.3 is an average of some very, very good nights a long time ago and more current AHI numbers that are closer to 5.0? How long have you been using CPAP? And have you contacted your doctor's office to report the facts that (1) you are (still or now) feeling exhausted and (2) you think you're having 40 events of lenth 30+ seconds each night?

[Laurie1041]

I would download your data and expand the time scale out to 5 minutes.
Have a look at the data and see if there are any relationships between pressure and your apneas.
Are the apneas recorded as central, or obstructive?
Do they occur only at your minimum pressure or at all pressures?
Is there a corresponding problem with leaks?
You could possibly try adjusting your minimum pressure, either down to 6, or up to your median pressure and see what the effect is.
If your pressure is hitting the maximum you could increase your maximum pressure. I personally leave my maximum set to 20 even though the actual pressure has never gone above 14, and often stays below 10.
If the apneas are central, changing the pressure probably won't have any effect, or for some higher pressures may make them worse.
From my observation I don't think the S9 always gets its typing of the apneas correct.
How long have you been using the PAP, it took me well over a month before I became accustom to the machine and really started having a really good nights sleep even though the machine instantly fixed my apneas, but yes I still do have a few 20 - 30 second apneas. Its nothing compared to my pre APAP days, and I'm much healthier thanks to my S9.

[Janknitz]

I think Laurie said something on another thread about sleeping around 11 -12 hours, so length of time may be one factor we are misreading.

When the pressure is wide open (high pressure set to 20), the machines are sometimes slow to respond to apneas because they have a wide range of pressure to work through in handling them. So that can be one explanation for long apnic events--the machine has to "get there" to treat the apnea. But your range of 7 to 12 is pretty narrow.

Conversely, when the pressure is set in a narrow range, it is sometimes insufficient to treat a particular apnea event. On the Respironics graphs, this will appear quite distinctly as a flat line at the top of the pressure range beause the machine "wants" to go higher but can't because of the limit set for the high pressure. Most of your apneas are treated, but some whoppers get through. I don't know what this would look like on a ResMed graph.

You also have to look at the leak chart at the same time. I seem to recall somewhere that if the machine is perceiving a leak, it may actually LOWER the pressure first to give the mask a chance to reseat--and apneas can sneak through in the meantime. With the respironics data, all is presented nicely on a single page, so you can compare pressure, leaks, and events on the same time scale.

[Laurie1041]

I would download your data and expand the time scale out to 5 minutes.
Have a look at the data and see if there are any relationships between pressure and your apneas.
Are the apneas recorded as central, or obstructive?
Do they occur only at your minimum pressure or at all pressures?
Is there a corresponding problem with leaks?
You could possibly try adjusting your minimum pressure, either down to 6, or up to your median pressure and see what the effect is.
If your pressure is hitting the maximum you could increase your maximum pressure. I personally leave my maximum set to 20 even though the actual pressure has never gone above 14, and often stays below 10.
If the apneas are central, changing the pressure probably won't have any effect, or for some higher pressures may make them worse.
From my observation I don't think the S9 always gets its typing of the apneas correct.
How long have you been using the PAP, it took me well over a month before I became accustom to the machine and really started having a really good nights sleep even though the machine instantly fixed my apneas, but yes I still do have a few 20 - 30 second apneas. Its nothing compared to my pre APAP days, and I'm much healthier thanks to my S9.

Day 17
OK, I took a look at last night's data using 5 minute increments - pardon my bad, I am just learning how to utilize ResScan, not to mention getting used to a whole new "night life" with APAP. That's where my error in data interpretation occurred - I was looking at a 12 hour window whereby any and all events appear as clusters. Difficult to count the events with any type of accuracy. It just "looked" like a lot of events, which of course, had this newbie concerned.

But back to last night's data - 10 centrals and 2 obstructives. My AHI was 1.2, Median Leak 0.0, 95th Percentile 3.6, and Maximum was 21.6L/min. My Pressure Median was 7.1, 95th Percentile 8.3 and Maximum was 9.3. Length of sleep 7.49.

I think the patient is going to live. I did wake up to switch out masks - the SoftGel is size small and it is obviously too small - not only does it dig into the bridge of my nose, but I woke up at 5:00 AM feeling air hungry. I switched over to the Swift FX nasal pillows and had immediate relief both to my nose and feeling like I was getting air flow.

I am going to have to get Velcro and put it on the backstrap because it continues to slip. I hope that fixes the problem. Any comments or suggestions most welcome. Thanks to all for responding. Laurie

[Janknitz]

Phew, that sounds better, Laurie!

The velcro REALLY helps with slippage issues with the Swift FX, and the other thing I find helpful is a hose hanger. I find the weight of the slinky hose on the FX is always threatening to pull the nasal pillows away from my nose. By suspending that hose, this is much less of an issue and I can move more freely without always having to "manage" the hose. If you look on my blog, you will see my jury rigged, homemade hose hanging system.

I get the best numbers and the best sleep with the FX.

[greg-g]

My feelings are that your results are good and I wouldn't adjust anything.
Although not everyone agrees, for me it took well over a month to become accustom to APAP and get a good nights sleep. It just slowly improves all the time.
As Janknitz said for good results, and good compliance it's essential to have a comfortable set-up.
Below is a cut and paste from a previous post with links to other posts.
I've now used this set-up for three months and can't think of any other improvements other than making another hose hanger that is collapsible for travel

I initially found the FX to be a disaster, but with a few modifications its brilliant.
The rear band moved all over the place, and movement broke the seal. I had to wake up to move.
Now with velcro on the headband, a hose hanger, forehead mount, and an air diffuser, I can toss and turn and sleep all night.
I also use the largest size pillow.
See
viewtopic/t55230/viewtopic.php?f=1&t=53591 for details of the headband and hose hanger
viewtopic/t55230/viewtopic.php?f=1&t=54 ... t=diffuser for the diffuser.