High Respiration Rate -- Still feeling bad with Low AHI?

[satsumass]

Hi,

I just started using sleepyhead with my system one pr1 APAP. I'm doing a lot better compared to when I started 18 months ago, but each night is still "an adventure" and I never quite know what i'm in for the next day.

I recently noticed the graphs now available showing RERA (respiration rate) and stuff like tidal volume, etc.

I was quite surprised when I noticed the respiration rate. It seemed very high. I've looked at it a few days, when my AHI has ranged around the 2s and 3s, and my average RERA each night is around 15-20 up to 20-25 some nights. That seems like really fast breathing -- and thats the average, not the peak. My daytime breathing is standard, 6-10 breaths per minute. In fact I do HRV training with heartmath so I have practice at 6 breaths per minute!

What if anythign can one make out from the RERA, especially when it is high. I have looked around and can't find much good information, other than it gets higher during REM sleep. I use a nasal pillow (tap pap) and regular nasal mask, with teh regular its maybe 5 breaths/minute lower on average, but still high.

I will note I have read some of the buteyko stuff, due to the fact that I am still feeling pretty bad, can't sleep more than 5-6 hours per night, and have a very short control pause breath-hold index (15 seconds, per buteyko). But I haven't been convinced buteyko is legit or even applicable for sleep apnea. Nevertheless, it would seem as though I am hyperventilating at night.

What affects ventilation rate, pressures? Congestion? What is my body attempting to do, and should I be concerned?

See graphs below.

[Pugsy]

RERA is NOT the same thing as Respiration Rate.
RERA is Respiratory Event Related Arousals and you only see them flagged on the event graph on top.

Respiration rate graph is on the lower graphs and respiration rate varies a lot...so that isn't unusual.
I wouldn't worry about it if it were me...we see a normal up and down for the respiration rate..it's not like the RR goes up and stays up all night.

[Julie]

Don't waste your time and energy on Buteyko of all things - there are too many very legit and worthwhile others out there. Lots.

[satsumass]

Pugsy: thank you, that's what I meant. I'm tired

Julie: Can you provide a bit more detail about this opinion? The problem is I have a lot of symptoms that are supposedly correlated to low control-pause, especially thinking and blood flow/oxygenation issues in prefrontal cortex....

[satsumass]

Pugsy I guess what i'm trying to undersatnd is the normal "range" of RR. WHen I see 20-25 I think, wow, i'm breathing faster than once every 3 seconds. That's pretty much in hyperventiolation mode (at least daytime) in my book. If i'm doing that 6 hours a night, what does that mean? Does anything correlate to high vs low RR?

[Rick007]

My daytime breathing is standard, 6-10 breaths per minute.

After beginning CPAP therapy the SleepyHead charts show my average to be about 13, and my maximums are around 32, so pretty close to your own numbers, even higher at times.

I then started to monitor my daytime rates and I was very concerned when I discovered my daytime breathing at 5-7 breaths per minute. According to Wikipedia if my rate falls below the normal level of 13, then I have a condition called Bradypenia. After making this discovery I asked my doctor about it, and he says not to be concerned if I don't have any other symptoms. http://en.wikipedia.org/wiki/Bradypnea

I guess you and I should be more worried about our daytime breathing than our nightime rates.

[satsumass]

wow, well looks like one of the other symptoms of bradypnea is sleep apnea and high blood pressure so seems like he was just blowing you off with the 'dont worry about it!". very interesting though.

[Pugsy]

I don't know if there is any correlation to anything that might explain the times where RR is a bit higher.
You didn't include the top part of the report that shows the events graph or flow rate. Is there anything exciting going on in regards to the various flags you might see on the event graphs during the times where the RR is a bit higher?

I occasionally see spikes to 30 myself and on the low end frequently down around 5 or so. Pretty much every report I have ever seen from anyone always shows a wide range in the RR....just like yours.

When you say "AHI is low but still feeling bad"....what do you mean?
Feeling bad covers a lot of territory.

Do you take any meds at all...even OTC meds?

[satsumass]

Pugsy:

Thank you for your reply. The sleep event graphs were fairly standard, nothing particularly significant in relation to the RR movements I could tell. I was more thinking about in 'real life', what a high nightime RR might correllate to. Like, decreased exercise endurance, or asthma, or nasal congestion, or something.

AHI is low, anwhere from the 1s to the 4s, 7 and 30 day average right now of around 3 but that's a bit high from where its been.

I sleep anwhere from 4.5 hours per night on the low end to 6.5 on the high end, i'd say these are my 10th-90th percentile figures. But its disrupted and choppy especially in latter part of the night.

Still feeling bad means mood and energy and mental performance/attention. I also have bipolar disorder (bad combo with sleep issues, trust me) so take a number of meds for that, as well as OTC supps. A long list . I've brought it in with me to the Stanford sleep center and they sort of brushed it off, saying none of the supplements would have been having much impact. But i don't believe them.

Only occasional use of formal sleep medication, lately it's been 5-10mg of doxepin. For months it was just time release melatonin and 100-300mg of gabapentin as needed. Its never for sleep initiation, always to help keep me asleep and prevent the constant, almost daily 4-5am (or earlier) awakenings.

"natively" or at least a few years ago before the sleep issues got bad, I always said i was one of these 7.5-8hr/night need sleepers.

A few supps I take, my consistent ones:

Magnesium
Zinc
Methylfolate
B12
NAC
EGCG
Ashwaghanda (sometimes)
Taurine (sometimes, for sleep or stress)
Grapeseed Extract
Curcumin
standard vitamins (C, E)
CoQ10
Acetyl-l-carnitine
Tryptophan (sometimes)
Melatonin 3mg time release

probably more i'm forgetting but yeah. I take a lot. Though been on a long term trend to reduce (this is less, if you can believe it, than before).

[Pugsy]

My niece s bipolar...man, the drugs she takes....
Research thoroughly (multiple websites) all the side effects that are possible with all of your meds.
If you see nervousness, agitation...stuff along those lines...they might be a factor in the increased respiration...they might not too.
The mental cognition stuff...depending on what you are taking...yeah, definite possibility.
Also look for anything that might affect sleep quality..insomnia or trouble getting to sleep or staying asleep.
If your meds are anything like what my niece takes...long list of potential side effects that are very ugly.

I have no idea if your increased respiration is a sign of anything more than a dream...since it concerns you....talk to your doctor about your concerns. Just because I don't think it is significant doesn't mean that there isn't a situation where it might be significant.

BTW just because you have a higher rate doesn't automatically mean you are hyperventilating. Perhaps you are just breathing really shallow but rapid. Good dream maybe...or bad dream??

If you have a mind to you could get an overnight pulse oximeter that records overnight so you ca see if anything is going on in terms of oxygen levels.
They can be found for as little as $50 or so on EBay. Just have to make sure you get one that records overnight and has software.
Something similar to these
http://www.pulseoxstore.com/Downloadable-Pulse-Ox.html

[Julie]

Hi again - I suggest you do some Googling regarding Buteyko - a known quackery thing, because it's too much for me to do here. They make it sound great, but apart from a member here (Todzo) anyone who's done some research has discovered that it's just another one of those things (and I'm not anti-alternative med. on principal or anything) that came up many years ago and resurfaces now and then (like Essaic for cancer) but has never ever been scientifically or medically proven to help, certainly not for apnea. Normal people cannot (and probably shouldn't) control their breathing in some abnormal way... not smart.

[kteague]

I'm probably speaking way out of turn here since I know nothing about respiration rates, and it's more of a question than a statement. The respiration rate is an index or an average, right? Wondering if there's a timing pattern to the ups and downs? Reason I'm asking is I've read that the limb movements of PLMD affect heart rate and blood pressure during sleep, so it seems reasonable to think it could affect respiration rate also. Any sleep professionals here that could say what they see regarding respiration rates in patients with limb movements?