Someone please help this Newbie!

[Lizistired]

Lizistired, I'm confused by what you said. I thought an apnea was the cessation of breathing for 10 seconds or more. Where am I going wrong here? A hypopnea is reduction in airflow of 50 % for greater than 10 seconds. Thanks.

That's the official definition. It could have been 5 secs, 8 secs, or whatever. The general consensus is that 10 seconds was chosen as that is the threshold that clinical data shows to be the point where there is a measurable or significant adverse effect on the body. The generic definition of apnea is a cessation of breathing, but what is cessation? The time span of one normal breath, or two breaths, or ..... You get the point I'm sure.

So he could stop breathing for 9 seconds, take a breath, stop breathing for 9 seconds, take a breath.... there would be no apneas flagged.
Just like if I have an AI of 4.0 in 10 hours of sleep. That's acceptable. But I know from my sleep studies that all of my apneas were in REM. So if I had 40 apneas for the night and they were all in two 20 minute fragmented segments of REM, an AI of 4.0 doesn't sound so good to me anymore.
The AI also doesn't tell me the duration of the apneas. They could be 10 second apneas, or 47 second apneas like Alex had.
He must feel 1000% better than before. I just want to point out some things he might want to consider when looking at his data.
(I relinked the image here since the other one is gone.)

[SleepyT]

Well, AJ...well done! It seems as though you have "arrived" as the others have stated. I know you are relieved. Having your OSA under control is a life changer. I believe (as others do) you will become one of the experts here in no time...helping other newbies manage this disorder.

Remember to come back to this forum whenever you experience difficulties. Everyone is here to help! Continued good luck....

T.

[AJimen05]

Alex that's great to hear, I think you may actually now have therapy that works for you.

When you get a chance I do suggest you take a close look at your detailed data across several nights, especially the flow data when zoomed in on a 1 minute or 5 minute time scale and compare how things look on average as compared to when you are having an apnea even as well as when hypopneas have been flagged. Knowing how your breathing looks will help you to better understand things as time goes on and will help you determine if anything has changed significantly. It would be good to look at some of the data from before you got treatment straightened out as comparing this with your newer data may give you more insight as well.

I find that keeping a log of how you feel when you wake up helps when fine tuning things as well, but be cautious about jumping to any conclusion on just a single night's information. I am sure you will soon realize that the index numbers only tell part of the story, how you actually feel is much more important. You certainly have made significant improvements in your therapy with only a small adjustment in pressure and are well on your way to improving now that treatment is more effective. I do hope you start to feel it working soon as well.

I was told to expect the metabolism to start to settle to something more normal in the first month or so with heart and brain issues mostly repaired in 3 to 6 months. I know I have certainly seen significant changes in my energy level and overall mood in the past couple of months and now eagerly await things to improve further. Now that I actually have energy I am planning to return to exercising very soon and try to tackle the weight gain, which resulted largely (pun intended) from the untreated OSA.

Thanks so much. Yes, I've been really curious now to check on a daily basis the correlation of how I feel when I wake up with what I see on the data. That's an excellent way to understand how they interact with each other since you're not able to see yourself as you sleep.

For the longest time, I thought I was doing something wrong as far as my weight because I just felt getting more and more bloated and heavy. I always thought it had to do with the sleep disorder.

[AJimen05]

Can you explain a bit more about flow limitation? I'm not to knowledgeable about that. What does it mean and what am I looking for?

Good question. We've discussed it here before and essentially concluded it's a slippery indicator, hard to define clearly, and does not have a meaningful numerical value. In other words, we really don't know much about it, other than it is a measure of sorts of how much the upper airway passage is blocked. Here's a quote from a medical paper I just came across. "Flow limitation is a dynamic obstruction event characterized by the fact that inspiratory flow remains constant regardless of the increase in the pressure applied by the patient’s inspiratory muscles [10,11]." From what I find even the professionals in the business have difficulty characterizing it.

Of all the data on your Resscan screen, this is one you would be better off to ignore for the time being. After you've been in this game for 6 months to a year and have a more complete understanding of all the various aspects of your therapy, then come back and cogitate on it. Not to be flip, but by then you'll have learned enough that it makes some sense, or learned enough to know not to care about it! Or better yet, that graph may diminish to only a few short spikes.

But hey, the fact you care enough and are aware enough to ask about it is commendable!

Lol, good...now I don't feel so bad. All the other graphs I think I got the hang of except that one.

[AJimen05]

Lizistired, I'm confused by what you said. I thought an apnea was the cessation of breathing for 10 seconds or more. Where am I going wrong here? A hypopnea is reduction in airflow of 50 % for greater than 10 seconds. Thanks.

That's the official definition. It could have been 5 secs, 8 secs, or whatever. The general consensus is that 10 seconds was chosen as that is the threshold that clinical data shows to be the point where there is a measurable or significant adverse effect on the body. The generic definition of apnea is a cessation of breathing, but what is cessation? The time span of one normal breath, or two breaths, or ..... You get the point I'm sure.

So he could stop breathing for 9 seconds, take a breath, stop breathing for 9 seconds, take a breath.... there would be no apneas flagged.
Just like if I have an AI of 4.0 in 10 hours of sleep. That's acceptable. But I know from my sleep studies that all of my apneas were in REM. So if I had 40 apneas for the night and they were all in two 20 minute fragmented segments of REM, an AI of 4.0 doesn't sound so good to me anymore.
The AI also doesn't tell me the duration of the apneas. They could be 10 second apneas, or 47 second apneas like Alex had.
He must feel 1000% better than before. I just want to point out some things he might want to consider when looking at his data.
(I relinked the image here since the other one is gone.)

I absolutely feel so much better. I still believe I have a bit to go to feel at my optimum but I'm glad to be on a path to getting there. That is something to think about Liz. Being that the technical definition of an Apnea are for events of 10 seconds or more...what's to say that we can have a bunch of these 8 or 9 second events that impair our ability to rest and function as well? I guess with reaching that 'sweet spot' of the right pressure and other variables, will reduce those as much as possible?

[AJimen05]

Well, AJ...well done! It seems as though you have "arrived" as the others have stated. I know you are relieved. Having your OSA under control is a life changer. I believe (as others do) you will become one of the experts here in no time...helping other newbies manage this disorder.

Remember to come back to this forum whenever you experience difficulties. Everyone is here to help! Continued good luck....

T.

Hey T,

I defintely look forward to paying it back with others on here that are much more novice than I am. Thanks for your kind comments!

[DoriC]

Alex, something else to consider. You really need to look at your flow data. You can have back to back apneas under 10 seconds that won't be flagged. If so, you should be able to see them at 5 minutes, and then go to 1 minute to zero in on them.

Hey Liz,

Can you explain a bit more about flow limitation? I'm not to knowledgeable about that. What does it mean and what am I looking for?

I seem to recall someone describing FL as Hypopnea wannabees!

[SleepingUgly]

Yes, the question, I think, is whether FLs cause symptoms in any given individual. If they don't cause arousals or sleep architecture disruptions (do they ever cause the latter?), or increased work of breathing (what else am I missing?), they may not cause EDS, so it may not be necessary to treat them. But I think in the absence of an EEG, it would be impossible to know for sure if they are causing those. One could titrate their pressure upward to eliminate them, and if/once eliminated, see if they feel better.

[Lizistired]

I asked recently "how could I have an obstructive apnea without flow limitation?". I didn't get an adequate answer but it wasn't worth pursuing at the time. I would think it would be a central.
I assume that clusters of flow limitations are REM stage based on my PSG results. Might be wrong. I can't do anything about them anyway. That's the machine's job.

[Pugsy]

I assume that clusters of flow limitations are REM stage based on my PSG results. Might be wrong. I can't do anything about them anyway. That's the machine's job.

Very true. I have had the same clusters and based on PSG studies very likely in REM. Doesn't really matter where they are at. They need to be broken up anyway. But it is sort of interesting to see the pattern....

[SleepingUgly]

I also have much more events in REM than in NREM. In fact, I think my NREM RDI was 4 and my REM RDI was 58. BUT, I had near continuous FLs in NREM. My SaO2 didn't drop below 92%, I believe, which may in part be because I am thin.

Long before I was diagnosed with SDB, I was put on protriptyline for it's activating side effect. It was not a perfect solution to my EDS (and had A LOT of undesirable side effects), but it did help my EDS. In retrospect, I suspect the reason it helped is that it suppressed REM.

I am still curious about the role of medications in suppressing REM in REM-dependent OSA. The little bit I could find on it suggested that, ironically, they tend to improve airway patency in NON-REM. I'm also curious about whether the disrupted REM leads to worse EDS than less REM. There's much discussion of the benefits of REM sleep, but I haven't seen anything to suggest that suppressing it (not eliminating it, mind you) is actually bad for you. I know that nights that I feel like I was dreaming all night are followed by high EDS days, but it's possible I remember all that dreaming because I was waking up more, and the waking is the problem. Who knows.

[Lizistired]

I don't recognize the EDS acronym, but this sounds like it needs it's own thread.

[SleepingUgly]

EDS = Excessive Daytime Sleepiness, and it crops up in nearly every thread!

[Lizistired]

I just thought maybe a thread titled something like "EDS, medications and REM suppression?" might get you more specific feedback and be searchable in the future.

[SleepingUgly]

Oh, thanks, but I think my gluten thread is already pretty far out there! And it's more curiosity at this point, as I'm not ready to consider taking a medication to suppress REM. I'm getting back on nasal steroids after more than half a year of trying to do without them, and once things settle down with my nose, I'll go back on CPAP and try that again.