Low CA at sleep lab, high CA at home

[Papit]

Below are a few new pictures taken of last night’s sleep that appear to confirm that the periodic breathing patterns in Flow graphs of the previous night were not a one-night oddity. The stat numbers look better than the night before.
5/7- CA: 3.5, OA: 0.0, AHI: 3.8, Leak: 20.4, Min.Ox: 83, #<90: 4, T<90: 0.2min
5/6- CA:10.4, OA: 0.7, AHI:12.0, Leak: 22.8, Min.Ox: 75, #<90: 11, T<90: 1.5min
The first two are the Summary Stats and Graphs.
The 3rd (6:56 – 7:10am) shows a period of undisturbed breathing followed by the onset of a disturbed periodic breathing episode at 7:09.
The 4th and 5th (7:08 – 7:22am) show the full range of all Sleepyhead graphs during the disturbed breathing episode.
And the last one (7:52 – 8:06am) shows a final pronounced periodic breathing episode that ended my sleep and fully awakened me.

[avi123]

Again you're starting with 3 and 4 hours long sleep time. In the clinics that I did my sleep studies it was SIX hours!

[Papit]

It appears that I am at least sometimes, perhaps typically, awakened by my weird apneas. Check out the last of the graphs I posted. In the past I referred to my chaotic sleep 'non-schedule' and 'irregular' sleeping as insomnia.

[JohnBFisher]

Greetings! From my layman's perspective, I tend to agree with avi123 .. that you have at least ComplexSA (Complex Sleep Apnea) .. that is, if you don't have it prior to use of xPAP therapy, the addition of the pressure triggers central sleep apneas (and the periodic breathing). The unit you are using does not adequately address the central sleep apnea, nor the periodic breathing.

At this point, it would be best if you saw a neurologist who specializes in sleep medicine. You want one that won't shy away from central sleep apnea.

The chaotic breathing that you mention seems to indicate that during some of these events your body is getting a bit confused about what to do. It makes me think that your issue might be due to complex sleep apnea, not just central sleep apnea.

[avi123]

Papit, I agree with John. Make an appointment with:

http://www.dukehealth.org/physicians/paul_c_peterson

[-SWS]

Papit, I agree with the posters recommending that you see a sleep doctor well-versed in treating central apneas.

I'm just now finishing the review of your data. So I'll try to offer more detailed comments tomorrow. But if I don't go to bed now, I'm going to feel pretty sheepish when I mention skewed circadian rhythm---and sleep drive’s potential for introducing central apneas in those who are so inclined… G'night.

[-SWS]

Still parsing through your data for patterns, Papit. You have a prominent albeit episodic central component in my opinion. If those centrals are post-arousal (pain response, PLM related, etc.) then some doctors will not treat them. The same is true of sleep-onset central apneas. In the former case it makes sense to attempt to treat the root cause---if the central apneas are severe enough. In the latter case it makes sense to attempt to stabilize sleep---using the likes of circadian management techniques, sleep hygiene improvements, medications, even cognitive behavioral therapy. The idea is to not only synchronize sleep/wake so it's the same time each night, but to also maximize sleep pressure and stage-related sleep drive. Easier said than done, especially for patients like us who have chronic pain problems. Essentially stabilizing sleep itself stabilizes central respiration in some cases. At least that's the theory as I understand it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670331/

Then, if secondary CA root causes are addressed and significant central apneas remain, doctors are more inclined to treat the central apneas rather than suspected origins. It sounds as if your original doctor waited and hoped for adaptation to ameliorate the centrals. I personally suspect that's a good strategy for up to three or four months.

I noticed you use a mask with little dead space. I bet it feels unencumbering, and that's good. But as it turns out a little more dead space---and thus a little more CO2 rebreathing---might be beneficial to your pathophysiology. I'd probably even experiment with a wider hose, despite the exhaust vent being upstream of the hose.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014237/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014238/

http://erj.ersjournals.com/content/23/1 ... e90504ad98

[-SWS]

"Papit, are your above graphs of 3 hours a section of longer time? I am wondering what caused the pressure to go up to 10 cm at 4:15 a.m.?"

Thanks for the scrutiny. I got to bed late and had a short night of it. Interesting question you have. Maybe some of our more experienced members can jump in here about that.

Only two of Resmed's three criteria are graphed directly above: obstructive apneas and flow limitations. When you see pressure increases in absence of those two criteria, then by default detected snore should have caused the pressure increase. Above we can't see detected snore or the bottom-most part of the flow-limitation graph.