CPAP for Hypopnea

[Noddinggal]

I am beside myself as I write this so please forgive me if this question has been answered already. I tried to find a previous post that might answer this but have not had luck. I am wondering if CPAP is a treatment for strictly hypopnea problems. I also have hypopneas when I'm awake so I don't see how treating the sleep portion is the answer. I will explain.

I have been on CPAP for over 3 months now and I actually feel worse. I am being treated or OSA with an air pressure of 10. Now I am looking at my printed report and I am wondering if I am crazy or if the doctors are. I'm mainly wondering if I am even going to benefit from CPAP. I have my doubts right now. As I said, I feel less rested now. I get more headaches and feel more tired and I never remember dreaming anymore. Hurricane Sandy left me without electricity for one night a couple of weeks ago and I couldn't use the CPAP that night and the next day I felt so much better.

Anyway, I'm looking at my report and it says at the bottom that the diagnosis is mild OSA. However in the body of the report is says I had 0 Obstructive apneas, 0 mixed apneas and 0 central apneas. It says I had 30 hypopneas and 82 flow limitation events (RERA) Positional influence was contributing factor; the patient was supine for 212.5 min with supine AHI of 7.9 and a supine RDI of 27.4. non-supine for 96.0 min with a non-supine AHI of 1.3 and a non-supine RDI of 9.4. Now I never sleep in the supine position at home and the only reason I was in that position that night was because of all of the wires I had on me for the study.

Anyway, the report also said the overall apnea/hypopnea index is 5.8 and overall respiratory disturbance index is 21.8, a NREM AHI of 6.0 and REM AHI of 4.4, a NREM RDI of 23.4 and REM RDI of 4.4. Says snoring was rare, heart rate ranged from 49-94 bpm with average heart rate of 64 bpm. ECG displayed NSR.

Mild oxygen desaturations with sleep nadir attained being 87%. The oxygen saturation mean value during sleep was 94%.

I know this is asking a lot but I would really appreciate it if someone could give me an opinion on these numbers. Or at least tell me what they mean. I have no clue and I am brought to tears over this at this point. I am wondering if I even need to use the CPAP or if it is going to do anything. I felt better without it. Now all I do is walk around with stuffy sinus and headache and feel like I never sleep. I don't feel like I'm waking up at night but then again, I didn't before all of this either. I do have asthma and I am overweight and suffer from anxiety. My BMI is 32.8 and I'm 51 years old. Recovered from Ovarian Cancer and have a couple of auto-immune diseases that I am dealing with. But with all of that, this CPAP making me feel worse bothers me more. I don't see the sleep doctor until next month again and I've already explained that I don't feel any improvement but he doesn't say anything about it. Just says it takes time.

I don't know which way to turn anymore. Please can someone help me out here with an opinion.

Thank you.

Karen


Sleep fragmentation was seen with 38.1 brief arousals per sleep hour and due primarily to respiratory arousals. Sleep architecture showed 17.7% state N1, 62.2% stage N2, 11.3% stage N3 and 8.8% stage REM.

[Julie]

Hi, I think some more knowledgable people will give you advice as well, but a couple of things struck me... the first being that I think you're using the humidifier at a high setting if you're congested, but if so, try it on a low setting or even not use it at all unless you feel the need - it's a comfort thing, not mandatory therapy.

The second was that if you have access to an overnight pulse oximeter, use it while sleeping anyhow but on your back... because I think that at worst you may have a little positional apnea/hypopnea, the kind that disappears if you're not on your back... it's a legit thing. As far as RERA's go, I'll let someone else come in because I really don't know anything much about them.

[Noddinggal]

Thank you Julie. I really like the idea of the Pulse Oximeter. Also, I will try the CPAP without the humidifier. I had no idea that the humidifier could actually be causing the stuffiness. I thought it would do the opposite. See how much I know? It's actually set at 76 which was what the medical supply place said was standard. It also has a heated hose. Maybe I can try without it and use the regular hose and see how I feel. I will certainly try the pulse ox also if I can get my hands on one. If they aren't too costly, I'll simply purchase one. With asthma it might not be a bad idea to have one anyway. Thank you.

[Pugsy]

Yes, they use cpap for people who have only Hyponeas. While initially the definition of a reduced flow or partial collapse of the airway may not seem all that much of a big deal on the surface...if you have enough of them the end result is the same...arousals and drops in oxygen levels...stress on the body...poor quality sleep...feel crappy.
You might want to google UARS Upper Airway Respiratory Syndrome...not saying that you might have this but with mainly hyponeas and RERAs it is something to consider. Treatment is still CPAP but seems like results are harder to gauge.

Is your machine the S9 Escape which shows in your profile? If so you have zero way to even know if the therapy is optimal or not. No way to see if leaks are under control. No way to evaluate the therapy at least on paper with reports.
Using nasal pillow mask....any chance you are mouth breathing enough to impact therapy? No way to know if anything needs to be improved on.

Even people who have optimal therapy, on paper at least, don't always see the improvement that want to have and yes, some of them feel worse. There are some usual suspects...like hours of sleep, fragmented sleep, meds (RX or OTC), other health issues, mask issues, bed comfort and a long list of other possible culprits.

[archangle]

Humidity settings is one of the things that everyone simply has to try various settings and see what happens.

You might also try changing your EPR setting and see if anything improves as you vary it.

[Todzo]

I am beside myself as I write this so please forgive me if this question has been answered already. I tried to find a previous post that might answer this but have not had luck. I am wondering if CPAP is a treatment for strictly hypopnea problems. I also have hypopneas when I'm awake so I don't see how treating the sleep portion is the answer. I will explain.

I have been on CPAP for over 3 months now and I actually feel worse. I am being treated or OSA with an air pressure of 10. Now I am looking at my printed report and I am wondering if I am crazy or if the doctors are. I'm mainly wondering if I am even going to benefit from CPAP. I have my doubts right now. As I said, I feel less rested now. I get more headaches and feel more tired and I never remember dreaming anymore. Hurricane Sandy left me without electricity for one night a couple of weeks ago and I couldn't use the CPAP that night and the next day I felt so much better.

Anyway, I'm looking at my report and it says at the bottom that the diagnosis is mild OSA. However in the body of the report is says I had 0 Obstructive apneas, 0 mixed apneas and 0 central apneas. It says I had 30 hypopneas and 82 flow limitation events (RERA) Positional influence was contributing factor; the patient was supine for 212.5 min with supine AHI of 7.9 and a supine RDI of 27.4. non-supine for 96.0 min with a non-supine AHI of 1.3 and a non-supine RDI of 9.4. Now I never sleep in the supine position at home and the only reason I was in that position that night was because of all of the wires I had on me for the study.

Anyway, the report also said the overall apnea/hypopnea index is 5.8 and overall respiratory disturbance index is 21.8, a NREM AHI of 6.0 and REM AHI of 4.4, a NREM RDI of 23.4 and REM RDI of 4.4. Says snoring was rare, heart rate ranged from 49-94 bpm with average heart rate of 64 bpm. ECG displayed NSR.

Mild oxygen desaturations with sleep nadir attained being 87%. The oxygen saturation mean value during sleep was 94%.

I know this is asking a lot but I would really appreciate it if someone could give me an opinion on these numbers. Or at least tell me what they mean. I have no clue and I am brought to tears over this at this point. I am wondering if I even need to use the CPAP or if it is going to do anything. I felt better without it. Now all I do is walk around with stuffy sinus and headache and feel like I never sleep. I don't feel like I'm waking up at night but then again, I didn't before all of this either. I do have asthma and I am overweight and suffer from anxiety. My BMI is 32.8 and I'm 51 years old. Recovered from Ovarian Cancer and have a couple of auto-immune diseases that I am dealing with. But with all of that, this CPAP making me feel worse bothers me more. I don't see the sleep doctor until next month again and I've already explained that I don't feel any improvement but he doesn't say anything about it. Just says it takes time.

I don't know which way to turn anymore. Please can someone help me out here with an opinion.

Thank you.

Karen


Sleep fragmentation was seen with 38.1 brief arousals per sleep hour and due primarily to respiratory arousals. Sleep architecture showed 17.7% state N1, 62.2% stage N2, 11.3% stage N3 and 8.8% stage REM.

Hi Karen!

First of all, listen to your body!!!

I have been on CPAP for over 3 months now and I actually feel worse.

I feel less rested now.

I get more headaches

I feel more tired

I never remember dreaming anymore.

Hurricane Sandy left me without electricity for one night a couple of weeks ago and I couldn't use the CPAP that night and the next day I felt so much better.

With your Apnea Hypopnea Index (AHI) of 5.8 but your Respiratory Disturbance Index (RDI) of 21.8 Upper Airway Resistance Syndrome (UARS) seems a real possibility. The discoverer of UARS eventually found that CPAP is not a good choice for treatment of UARS.

Understanding of sleep study parameters – well – short road long road -

Short road: http://www.sleepnet.com/definition.html

Long road: http://emedicine.medscape.com/article/1 ... #aw2aab6b6 (note: the link drops you near the end of the article, near the common terms)

Longest road: search it out in PubMed and Google Scholar

I used to be able to recommend Wikipedia but they appear to be under major “dumb down” attack. You might be able to find some old page versions or similar that would be good articles.

I think you are doing very well to educate yourself, get your full sleep study report and find out why the CPAP was scripted. Ask the doctors themselves what their reasoning was. Ask them, after you have educated yourself, if UARS was/is being considered and why or why not.

If I were you and decided to continue the experiment with CPAP I would rig to use the nightly data from the machine to follow what is happening myself. I do this myself and have come to believe that it is essential for anyone who uses CPAP. Even if they hit it right on to start with, the body changes. You must be able to follow that.

Whether you decide to continue the CPAP experiment or not I would pursue anti-inflammatory foods, anti-oxidant foods, aerobics if possible, and some form of eucapnic breathing re-training (I use pulse oximeter guided breathing – halved my need for CPAP pressure in a year!).

Have a great week!

Todzo

[SleepingUgly]

With your Apnea Hypopnea Index (AHI) of 5.8 but your Respiratory Disturbance Index (RDI) of 21.8 Upper Airway Resistance Syndrome (UARS) seems a real possibility. The discoverer of UARS eventually found that CPAP is not a good choice for treatment of UARS.

Please point me to a peer reviewed article that says CPAP is not a good choice for treatment of UARS.

It really makes no difference if you have UARS or OSA, the treatment options are the same.

[Todzo]

With your Apnea Hypopnea Index (AHI) of 5.8 but your Respiratory Disturbance Index (RDI) of 21.8 Upper Airway Resistance Syndrome (UARS) seems a real possibility. The discoverer of UARS eventually found that CPAP is not a good choice for treatment of UARS.

Please point me to a peer reviewed article that says CPAP is not a good choice for treatment of UARS.

It really makes no difference if you have UARS or OSA, the treatment options are the same.

Listen to the man himself:

http://doctorstevenpark.com/expert-inte ... lt-on-uars

Have a great week!

Todzo

[SleepingUgly]

With your Apnea Hypopnea Index (AHI) of 5.8 but your Respiratory Disturbance Index (RDI) of 21.8 Upper Airway Resistance Syndrome (UARS) seems a real possibility. The discoverer of UARS eventually found that CPAP is not a good choice for treatment of UARS.

Please point me to a peer reviewed article that says CPAP is not a good choice for treatment of UARS.

It really makes no difference if you have UARS or OSA, the treatment options are the same.

Listen to the man himself:

http://doctorstevenpark.com/expert-inte ... lt-on-uars

Have a great week!

Todzo

Do you have a transcript of that talk? I think I have listened to that one before, and I don't remember him ever saying that CPAP is not a treatment for UARS, nor can I imagine him ever saying that.

[Noddinggal]

Thank you all for your replies. I have some avenues to explore now. Incidentally, I decided to not use the CPAP last night to see what would happen. After not having any dreams (or least none that I remember) for 3 months, last night I had very vivid dreams. I will mention this to the doctor. In fact, since my appointment isn't until next month I think I am going to call and have the appointment moved up if possible. Oh and I woke up feeling much more rested this morning. And no headache either.

Now I am not going to say that I don't need the CPAP and maybe I slept better because the CPAP adjustments or mask or something else might need adjusting. I'm just saying, I slept better without using the CPAP. And after 3 months of stuffy sinuses, I woke up this morning and everything cleared out. Been clearing out for the past hour and I can finally BREATHE again. Something else I will mention to the doctor.

Thank you all again. I will get to the bottom of this. I have learned in the past that just because a doctor gives you a diagnosis, it doesn't mean it's the whole story. In 2008/2009 I was diagnosed with worsening acid reflux and gastritis. It got worse and worse regardless of how many pills the GI kept adding to my daily regimen. Doctors told me there was nothing more that can be done, just take the antacids. But they weren't working and I was getting worse and worse. So I changed doctors several times that year because I felt like something was just getting missed. Finally found a GI who took it seriously and ordered a CT-Scan. Stomach/intestines all looked fine but what was found was stage 2C Ovarian Cancer that had just started to spread. If I had listened to the GI and just popped 4 Prevacid and 2 Zantacs every day and just suffered with my burning stomach instead of going with my gut (no pun intended), I would not be here having this conversation today because I would have quickly developed stage 4 Cancer with very small chance of survival. It ALWAYS pays to listen to your body and seek to feel better. And since I'm not feeling better and I'm feeling worse instead, I will at least attempt to find out if there is something else that's going on. I do have asthma problems and have had sinus problems and nosebleeds for years. I have Aortic Stenosis which is in the moderate stage and I have Hypothyroidism for years.

Again, I thank you all. This is such a great place. I do continue to try to make using CPAP work for me, I just want to make sure I'm using it correctly and not missing something else that needs attention at the same time. I wish my CPAP model would give me my AHI report but it does not. It only gives me usage reports but no results to monitor improvements. If it did, then at least I could check that.

You all have been most helpful. Thanks!
Karen

[chunkyfrog]

DH is using his Autoset WITHOUT the humidifier,
because of congestion apparently triggered by the humidifier.
Go figure.

[BlackSpinner]

Thank you all for your replies. I have some avenues to explore now. Incidentally, I decided to not use the CPAP last night to see what would happen. After not having any dreams (or least none that I remember) for 3 months, last night I had very vivid dreams. I will mention this to the doctor.

For what it is worth, the dream memory is because you woke up. If you don't wake up, you won't remember them, so I would NOT consider this a positive sign. REM generates many more events due to the physical changes.

[Noddinggal]

Actually, I woke up because my alarm woke me up. But I felt more rested this morning. I did call my doctor and he said I can come in this afternoon to discuss everything with him. I'm wondering if I might need to try a different size nose pillow or different head gear or something. I'm doing the best I can to make this work if this is what I need to do but don't want to do it if it's not necessary and if there is something else that needs to be addressed. All I can do is try to find the best solution possible.

Thanks for your reply.

Karen

PS - I wanted to add that the only reason I thought it was a good thing that I finally remembered dreaming is because it was my understanding that dreams are more abundant and better remembered during REM and I thought more and/or better REM sleep was what I was aiming for in order to feel rested. I'll have to ask the doctor about that this afternoon. I could have misunderstood something somewhere.

[Todzo]

With your Apnea Hypopnea Index (AHI) of 5.8 but your Respiratory Disturbance Index (RDI) of 21.8 Upper Airway Resistance Syndrome (UARS) seems a real possibility. The discoverer of UARS eventually found that CPAP is not a good choice for treatment of UARS.

Please point me to a peer reviewed article that says CPAP is not a good choice for treatment of UARS.

It really makes no difference if you have UARS or OSA, the treatment options are the same.

Listen to the man himself:

http://doctorstevenpark.com/expert-inte ... lt-on-uars

Have a great week!

Todzo

Do you have a transcript of that talk? I think I have listened to that one before, and I don't remember him ever saying that CPAP is not a treatment for UARS, nor can I imagine him ever saying that.

Hi again SleepingUgly,

You are correct, he does not mention it there.

What I do believe I actually remember is Dr. Park mentioning this change of direction by Dr. Guilleminault. I cannot remember in which interview this occurred nor can Dr. Park.

Perhaps the best question is “are there any studies that show PAP as an effective treatment for UARS”. Since it is currently believed to be rare and a suggested diagnosis I believe it is unlikely we will find studies either way.

In this case Karen does not find it effective.

Since PAP in general is often abandoned over time and since a recent review on UARS [1] specifically mentions “problems with compliance” while attempting to use CPAP for UARS I am not surprised.

Take care,

Todzo

1. Pépin JL, Guillot M, Tamisier R, Lévy P. "The upper airway resistance syndrome." Respiration. 2012;83(6):559-66. doi: 10.1159/000335839. Epub 2012 Mar 1.

[SleepingUgly]

What I do believe I actually remember is Dr. Park mentioning this change of direction by Dr. Guilleminault. I cannot remember in which interview this occurred nor can Dr. Park.

Perhaps you are thinking of this, from Dr. Park's website:

The lead author of this article (Dr. Guilleminault at Standford University) was the first to describe UARS as well. In his original UARS paper, he treated these constantly tired people with CPAP, or continuous positive airway pressure. This is a device that delivers gentle air pressure through the nose, thereby keeping their breathing passageways open. For the most part, they all did well, but in the long term, they could not continue sleeping with masks and hoses attached to their faces. Most UARS patients, due to heightened sensitivities, are unable to tolerate this device.]

I believe Dr. Park states that Dr. Guilleminault has said that patients with UARS are unable to tolerate CPAP; however, even though I have actively searched for it, I have never found where Dr. Guilleminault actually says that. Furthermore, Dr. G treats UARS patients with CPAP.

Perhaps the best question is “are there any studies that show PAP as an effective treatment for UARS”. Since it is currently believed to be rare and a suggested diagnosis I believe it is unlikely we will find studies either way.

Of course there are. Just google Dr. Guilleminault or Dr. Avram Gold for a few of the people who study UARS. I am not sure why you think it's a "rare" diagnosis. Personally, as I've stated elsewhere, I don't put any stock in the categorization of patients as UARS vs. mild OSA. One lab's UARS is another lab's OSA. Fortunately it makes no difference, as the treatment is the same.

In this case Karen does not find it effective.

I won't argue that she doesn't find it effective in treating her subjective symptoms, yet.

Since PAP in general is often abandoned over time and since a recent review on UARS [1] specifically mentions “problems with compliance” while attempting to use CPAP for UARS I am not surprised.

I don't know if compliance is any worse for UARS than for OSA. Again, I'm not terribly impressed with the categorization scheme for SDB in general. Let's agree that compliance is probably poor across the board.

There's certainly no harm in her asking for clarification from her doctor, and leaving no stone unturned.