Please help w/ panic over increase in numbers

[kaiasgram]

Just when I thought burps in the night were my biggest issue. Pugsy and Robysue and any veteran pappers, please let me know what you make of this: So, last night I fell asleep sitting up on the couch and didn't get on the machine until I woke up around 7 a.m. this morning and got into bed. This is the data from the five hours I spent in bed on the machine, 5 hours from 7 a.m. until noon. I'm shocked and scared -- granted this was one odd night but I would like to have some understanding of what was going on, if you can help. (And thanks for your help about the burps too). In that five hour period:

AHI 6.08
Clear Airway 27 events (longest was 30 secs, most around 17-20)
Hypopnea 3 events
Obstructive 1 event (10 secs)

My leak line doesn't look as bad as it has on past nights, yet the pressure was up most of that time. Is the higher pressure causing the clear airway events? Any thoughts? I'm still overwhelmed with all of this. Thanks so much, please hang in there with me!

[Pugsy]

Aliens.

It is highly unlikely that your pressure is causing centrals. It barely got above 8 cm..never made it to 9 cm and you haven't had centrals like this before.

My first suspect after alien fluke whacko night excuse (and we all have them) is that likely your time "asleep" very likely wasn't completely a deep sleep and you had some frequent minor arousals and probably a bit of tossing and turning and holding your breath "centrals" maybe with some sleep transition centrals mixed in. Maybe sleep slightly fragmented due to household stuff going on while you were in bed?
This is sort of like a nap...and naps are notorious for giving us odd data because we don't sleep so soundly in naps.

[kaiasgram]

Ken the sleep tech, I just saw your post to the gentleman with the unsupportive partner and wonder if you'd also chime in about my post. I was evaluated initially with a wrist-PAP 200, never had a full attended sleep study, then titration at home for a week (not at all a week of typical sleep). So far on apap my numbers have looked under control until this five hour stretch this morning. Of course our machines don't give us EEG or BPM info, so it's hard to know what's going on. I can tell you that on the report from my titration study, when I was using an oximeter, my low heart rate every night was 43 (doesn't seem to concern the sleep doctor), and highs were usually in the 80's, except for the first night on titration when something caused my heart rate to go to 155 at some point.

I started looking at cost of pulse oximeters yesterday and they're very expensive and I've already had to pay for *everything* out of pocket. I also noticed that some oximeters have an alarm if your BPM goes below 50 -- in my case with my bpm the alarm would be sounding continuously!

How in the world can I get an accurate handle on my sleep issues? I saw a sleep doc for the first time this week at Kaiser but because of the way Kaiser diagnoses and titrates I'm not convinced she has all the relevant info either. She saw my AHI numbers from the past two weeks since I started APAP and because they were all under 5, she doesn't feel there's anything to worry (or pursue more info) about.

Thanks for any help/insight you may have to offer -- I may end up sending you a pm for info about good sleep centers near where I live. I kind of wonder if the first several hours of sleep while I was sitting up on the couch without cpap were better for me (in terms of desats) than the five hours I spent after that on cpap with 27 CA events.

[MaxDarkside]

Pugsy is probably right. Note that when your respiration rate was the most tranquil, your "centrals" disappeared. The other times when your respiration rate was higher variability, it had numerous spikes in it, probably evidence of moving/turning/etc.

[kaiasgram]

Pugsy, you're always there -- bless you. Seriously. As for the pressure, it was riding at the max I have it set at, 8.6. I know leaks drive pressure up. Are you saying that restless sleep and awakenings also cause pressure to go up?

[avi123]

kaias, I don't see anything unusual in your situation. The Watch PAT 200 is a great home tester. During the home test you're also tested for Oxygen desaturation. If there was something wrong you would be prescribed to be given Oxygen. But apparently you don't need any. To get an idea of your CA events you need to look at a month or two of data.

[Janknitz]

Take a deep breath and repeat after me: ONE NIGHT DOES NOT A TREND MAKE.

Especially an unusual night when your circadian rhythm is messed up.

[kaiasgram]

Don't know what I'd do without y'all. Max, I hadn't noticed that "tranquil" phase, this is the kind of thing I want to learn to attend to so that eventually I won't be sending out APBs every day to all of you! I have a cause and effect question about what you observed -- which generally comes first, the tranquil breathing or the cessation of CA events? I ask because I've read that our bodies react and respond to apneas and desats; I think Ken the tech was just saying on another thread that desats give rise to EEG and heart rate changes, so it makes me wonder about the causal relationship between apneas and respiratory changes.

[Pugsy]

Your leaks are NOT driving your pressure up. Other than that short spike around 7:10 to 7:20...your leaks were minimal to non existent. Unless any of those little tiny spikes is happening to disturb your sleep (and yes, it is possible) they are NOT of any significance at all. I haven't looked at my report from last night but I bet you a whole bunch of money that my leaks were a lot more significant than yours. They always are...I will go check in a bit.

Let me show you leaks maybe driving pressure up...go take a look here and the last half of the night.
Please bear in mind that this particular report is from Encore Pro and I have the leak set for unintentional leak...just like your ResMed machine. For those Respironics users....this is Encore Pro..only available in Encore Pro and believe me..not worth the headaches of Pro.

viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376

You seem to be terrified about the centrals but even if these were the real worrysome kind...the doctor probably wouldn't do anything without a lot more evidence of them being consistently present and causing problems.

What caused the pressure increases that you see? I am thinking probably nothing more than the normal flow limitations and other obstructive event precursors. Just the machine doing its job. It won't respond to centrals.
If you could handle it....use straight cpap at 4 cm one night..see what happens when the machine can't do its job.
Just an idea....not normally something that I would recommend but I think it might ease your mind considerably if you could see what the machine is preventing.. or find out that you need very minimal pressure...

[ChicagoGranny]

I know leaks drive pressure up.

Events "drive" pressure up.

Leaks "drive" flow up.

[kaiasgram]

ChicagoGranny, can you explain to this newbie what you mean by "Leaks drive flow up" ? I'm not sure I've got the concept of "flow" down yet. Thanks. I think I have a flow graph but it's jut not checked in my SleepHead software. I can check and display it if it would help you guys tell me more about what's going on with my leaks and pressures and flows... oh my!

[Pugsy]

Okay, here is an example of my night before last.
Note the cluster of obstructive events prior to 1:40 AM and the marked increase in pressure at same time...leak didn't come until after the events came and went and the pressure started going down....pressure continued down even when leak was pretty big and was present for a few minutes.
Note the last smaller leak (3AM)...pressure did nothing in fact continued on downward. Right click mouse over image...choose view image to see the 3 AM cluster if you can't see it. Image is large and may be off viewing screen.

[DoriC]

Pugsy is probably right. Note that when your respiration rate was the most tranquil, your "centrals" disappeared. The other times when your respiration rate was higher variability, it had numerous spikes in it, probably evidence of moving/turning/etc.

@Max, Thank you! Now I have some useful information to analyze when I see CA's. Even though I can sometimes hear Mike tossing and turning(he can't sleep on his "bad" hip too long) and I even note the time, it still shocks me to see those CA's. I'm learning with Pugsy's help to take a deep breath when I see them and subtract that # from total AHI, but I'm not quite there yet!

@Kaia, I'm certainly no expert but it is reasonable to assume "Aliens"! You slept on the couch all night without pap, got into bed at 7AM,etc,etc! My respiration rate is going up just thinking about your night...and day! Toss last night out! Easy for me to say.

[DoriC]

I know leaks drive pressure up.

Events "drive" pressure up.

Leaks "drive" flow up.

ChicagoGranny, can you explain to this newbie what you mean by "Leaks drive flow up" ? I'm not sure I've got the concept of "flow" down yet. Thanks. I think I have a flow graph but it's jut not checked in my SleepHead software. I can check and display it if it would help you guys tell me more about what's going on with my leaks and pressures and flows... oh my!

I think I'm a little confused too?

[kaiasgram]

You seem to be terrified about the centrals

Ya think? How can you tell?

Just to be clear, this whole thing terrifies me! But I think the centrals terrify me more because there's NOTHING you can do about 'em. I figure with obstructives there are things you can do even in addition to using your machine, like finding best sleeping position. At least your body is TRYING to breathe! You know, I feel a little less nausea today than I have in a long time, and I can't help but wonder if those several hours on the couch (almost upright) while far from an optimal way to sleep, got me more oxygen overall than laying down with cpap. It would be interesting to get an oximeter and do that again and see if/how much desatting occurs in a good recliner. And as you can probably guess, no way am I ready to be a maveric like you and "experiment" with a max pressure of 4, "just to see"! AAAAAAAAHHHHHH !!!!!!!!!!