APNEA -v- HYPOPNEA

[GoofyUT]

Snoredog, thanks!

I'm pretty sure that the S8 doesn't score during Settling, and that my numbers came down by invoking Settling since it eliminated wakeful artifacts in the scoring algorithm.I'm loathe to raise my floor since I've tried that with adverse effects. And, I don't believe that reducing my max is necessary since the plots show that I'm reaching only barely over my 10 cm during the night (my max is 14).

But, I think that I will try a CPAP trial. I'll start at my titrated 10, and maybe reduce it to 9 (my 95%) pressure. BTW, I can only now fully appreciate the full benefit of having a good AUTO.

Linda-Its the FRIENDS here that make ANY of this tolerable. My gratitude to you.

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, auto

[bbeck4x4]

I felt very similar to what you are reporting, I felt better because of the cpap but worse than before(pre-cpap) until I had gotten near 800-900 hours on the machine, My AHI was less than 5 so my complaints to the sleep doc went down in his book as my needing anti-depression meds(not) now I am at 1100 hours of time on the machine and am feeling better(functional again), it has been a very slow curve for me, One change that I made early on was to switch to a autopap becouse in my sleep study I only slept for the two hours the ambian was in my system. So no titration study. and the Dr guessed at a pressure of 7.

most nights I stay at a pressure of 9 with small bumps in pressure up to 10 and sometimes 11 for about 15-20 minutes at a time, my AHI now is averaging .2 - .7 per hour
it has been dropping very slowly over the last 6 months.

Hang in there and know that this sometimes takes much longer than we would like it to.

My Father in law is at 1 1/2 years on cpap(something that I didn't know until I was on one) and is doing things that I used to be able to do 5 years ago. there is at least a 15 year difference in our ages.

Brian

[Guest]

For anyone who's curious to learn more about CDSB, here's a link to a post by frequenseeker from the TAS forum. He supplies the article: Recognition and Management of Complex Sleep-Disordered Breathing by Geoffrey S Gilmartin; Robert W Daly; Robert J Thomas.

http://www.talkaboutsleep.com/message-b ... hp?p=89686

[DME_Guy]

It sounds like you're doing fine with everything the way it is. You're feeling better and that's the main indication it's working. I think you'd wake up with the mask on your face even at a pressure of zero. There's just no way around it. I rarely make it through the night without waking up from the mask but I do feel much better the next day.

My advice, is listen to your body. If it's telling you the therapy is working, then it very likely is.

[GoofyUT]

Well, I tried CPAP last night with the pressure set to 9.0 cmH2O and the EPR set to 3. My AHI went up to 7.8, but my AI stayed below 1. I'm still convinced that my S8 is scoring lots of artifactual wakeful hypops though. I was able to tolerate CPAP fine and it actually felt pretty comfortable. I'm gonna stay on a CPAP trial for at least two weeks. I'm trying to discipline myself to be more attentive to symptoms and less to numbers, so we'll see how I FEEL today.

I'm still curious about my actual need for treatment given that almost everything the damn thing is scoring are hypops, not apneas, and I don't know if they have any clinical implications whatsoever. But, we'll see how I feel.

Thanks for all the wisdom and support. This is an AMAZING group of folks!

Chuck

[Snoozin' Bluezzz]

I'm still curious about my actual need for treatment given that almost everything the damn thing is scoring are hypops, not apneas, and I don't know if they have any clinical implications whatsoever. But, we'll see how I feel.

The effect of Hypopneas, as I understand it, are that they do result in arousals but not awakenings and that they result in oxygen desaturations which, depending on magnitude and frequency, can result in a long term deleterious effect on your health. Hypopneas were why I was originally prescribed. As I got older, and put on weight, my apneas increased but they are still low. My circumstances are much like yours and I clearly feel better on on the machine.

David

[GoofyUT]

Thanks for your words of wisdom David. its always nice to know that you're not alone and that others have walke down the same path.

I read the article on CSDB and found it FASCINATING. it suggests that for some of us, the sleep disorder may be mediated more by carbon dioxide levels and the instability of those levels rather than oxygen levels (as in sats) and physiologic obstructions. Apparently, gizmos that will manipulate CO2 levels on expiration are what await us (so start looking into buying the stock NOW; We ALL know that OSA is the DISEASE DU JOUR!!! This could be your chance to get into the next ResMed or Respironics, when they are still CHEAP!)

Chuck

[-SWS]

Well, I tried CPAP last night with the pressure set to 9.0 cmH2O and the EPR set to 3. My AHI went up to 7.8, but my AI stayed below 1. I'm still convinced that my S8 is scoring lots of artifactual wakeful hypops though. I was able to tolerate CPAP fine and it actually felt pretty comfortable.

I agree with the possibility of artifacts, Chuck. Especially if those increased hypopnea artifacts were primarily concentrated during that period of time just prior to sleep onset. In other words a higher HI concentrated only during preliminary wakefulness can skew an entire night's HI. And those artifact hypopneas could have been related to a higher floor pressure that was just uncomfortable enough (compared to your lower floor pressure) to cause anxiety-related breathing control before autonomic breathing is underway. This is a scenario where proper settling time can really help. However, this hypothetical scenario might be validated by normalizing your own data: experimentally discard the first hour of sleep and see how your HI fares during what should be primarily autonomic sleep.

You had mentioned that you don't sleep as well on xPAP as you had prior to xPAP therapy. The fact is that not only can SDB be highly complex, but so can sleep itself. And my understanding is that stepping through the complex possibilities of bad sleep can be even more complex than all the underlying contributing factors (more complex since the underlying possibilities far outweigh the underlying contributors). As an example, some concomitant non-SDB sleep disorders may only come to light once SDB is successfully treated. Some patients with untreated apnea never progress far enough into the deeper stages of sleep long enough to manifest their concomitant sleep disorders---until xPAP therapy effectively removes the very SDB that had been eclipsing their non-SDB sleep disorder symptoms.

Another possibility for poorer sleep on xPAP that comes to mind is my own observation and not published medical fact. I honestly feel that some people are more inclined toward sensory-based cortical arousals than others. After all, what physiological traits is science aware of that do not manifest with a fair degree of diversity across humanity? I'm personally not aware of any. However, my point is that I honestly think the mask interface itself and even positive pressure can cause an unacceptable level of cortical arousals in some patients. If so this might be one reason why someone might sleep more poorly on xPAP than prior to xPAP.

Another possibility for perceiving that you slept better prior to xPAP therapy might be your prior level of sleep debt related to sleep deprivation from untreated apnea. With heightened sleep deprivation and sleep debt comes a concept known as heightened "sleep pressure". You may very well now sleep with reduced "sleep pressure" because your apnea is now treated for the first time. With that reduced sleep pressure you might be waking up about as often as you would have had you never even suffered sleep apnea in the first place. I mentioned earlier that xPAP therapy can unmask additional non-SDB sleep disorders simply by allowing the deeper stages of sleep to occur. I also suspect xPAP therapy can similarly unmask additional sleep disorders simply by reducing sleep pressure and thereby increasing the likelihood for sensory-based cortical arousals.

Lastly, fixed pressure experiments alone are not enough to exonerate CSDB. Especially fixed pressure experiments that do not run the full course of achieving an adequate titration value. That is because some CSDB related breathing events are purely machine induced (and related to the CO2 respiratory trigger) while the other CSDB breathing events are primary. Those primary CSDB events (mostly obstructive SDB events) were the reason positive pressure had been deemed applicable in the first place. Now, with the application of positive pressure therapy, the CO2 respiratory trigger begins to generate machine-induced central events in a few patients. So here you have two sets of SDB events, simultaneously occurring, via two distinctly separate physiologic mechanisms. The unstable tight rope balancing act I referred to earlier: enough pressure to adequately address the primary obstructive components may also be enough pressure to induce the central components without adequate CO2 regulation; and a low enough pressure to stave off the machine induced central components may not be a high enough pressure to address those primary obstructive components. A theoretical tight rope balancing act in my own view.

The mechanisms involved for machine-induced CSDB central SDB components are not yet fully understood. Because these CSDB patients tend not to fare well with APAP's ever changing pressures, we can only speculate at this point about some of the possibilities. To what extent does an APAP's positive pressure slope or rate of change exacerbate CSDB? To what extent does pressure's amplitude or magnitude alone trigger CSDB manifestations in some patients? How many patients manifest only slight xPAP-induced CSDB breathing patterns with neither significant cortical arousals nor accompanying desats? Patients falling in this latter category, if any, would certainly be those for whom xPAP therapy introduces a beneficial trade off: trading a slight albeit inconsequential CSDB effect for much worse obstructive sleep disordered breathing obstructions. And so the speculation goes on...

[Rastaman]

Hmmmm. Lots of good info here. The lowest I've ever been able to get my AHI is 3.7 but that same day I went back to sleep after 2 hours up, and it went up to 5.1 so, really I've never gotten below 5.1

I use the same machine as GoofyUT and some of you here. My ranges are 8 to 17. Lately, with a new mask (Activa instead of Swift) my high point has been 16.2 instead of 17.2 I don't know why. But anyway I feel that the upper part of the range is about correct, although I'm not sure about that 8 #. Previously I was on CPAP at 13 but that wasn't enough on a night where I might have 3 or 4 adult beverages. I needed more pressure on those rare nights. Anyway, when I went to APAP they gave me a broad range.

I tried GoofyUT's suggestion about the settling time at 30 minutes. That's what I have it at right now. Some nights I get 5.2 and other nights like last night it was up to 10. I seem to do something in my throat at night where liquid collects and causes me to cough. So, some of the AHI might not be real obstructions at all, other than the obvious.

I feel pretty good during the day and that's what counts. BUT, I'm feeling fatigued during the day a bit. Not at work usually, although an hour long meeting can start to send me into sleepy-land because I'm not really mentally involved other than just listening. And at night I seem to be getting tired earlier than other days even with caffeine intake. I think my 6 and 6.5 hour sleeping sessions are catching up with me. I really NEED 7.5 to 9 hours a night and seldom if ever get it, even on a day off.

Interesting journey. Atleast I'm not at 124 events per hour anymore and my oxygen is no longer down to 75% My muscles in my back and arms seem to be "re-inflating" with no upper body exercise at all (I do lower body exercise for cardio usually). And that has been an interesting feeling. It's hard to describe but it suddenly like I can flex muscles that I haven't been able to feel in years. They were probably atrophying before and now that they're getting proper oxygen they're coming back to life.

[Rastaman]

WHAT are artifacts?

[Sleepless on LI]

WHAT are artifacts?

I'm going out on a limb here, being probably THE most unscientific person on this site, but I believe artifacts are marks that show up on data that do not indicate what the data is supposed to be indicating, sort of like a false positive caused by other things.

I remember having a CAT scan once and they said there was evidence of a stroke. I freaked out until they finally had it read by the chief radiologist who said it was just an artifact on the scan and there was no stroke.

Hope I'm not that far off with my definition.

[Guest]

I too am feeling so tired during the day and evening. I have my ahi's down to less than 4 every night - and feel really tired after 3 months of cpap along with just now getting my mask at a 'comfortable' level - I wake up due to leaks - but not 76 times per hour like in my sleep study so not sure why I am so tired either - may have to go to sleep doc again to find out - very interesting reading here - that the osa, once treated, unmasks other sleep disorders not known until now - ugh, I just want some sleep for crying out loud!!!

[GoofyUT]

Amen BRO!!! (Or Sis!!)

Chuck

[GoofyUT]

SWS-

I was able to eliminate what I consider to be wakeful hypopnea artifacts by enabling Settling on my S8. I believe that the S8 disables its scoring algorithm during settling. As soon as I did so, my AHI plummeted from around 9 to less than 3, again almost entirely because of the precipitous drop in hypops. That's why I'm confused about the legitimacy of my diagnosis. I had a barely qualifying AHI (23) during my pitiful split night PSG with NO indications of centrals. I find when I acquired a data-capable blower that virtually everything its scoring is hypops, and many of those may be artifacts. I am sleeping poorly, and I believe that your notion of cortically-induced arousals is spot-on. In that sense, my poor sleep may be more related to sensory phenomena rather than ventilatory. And, if I'm experiencing them because of the flood of senses thoughout the night with masks, shifts in masks, hose tugging, noise, wondering about what my numbers are gonna be, etc., etc., what's the point? Am I going though all of this to simply blow air up my upper airway to treat artifactual hypopneas? As you point out, increasing my pressure INCREASED my AHI through hypops,and perhaps that is caused by discomfort from the higher pressure, which caused cortically-mediated flow degradations. CSDB makes sense too however. But I simply don't know how to investigate this absent a research lab such as would be found at Mass General.

What's a boy to do????

Chuck

[Snoozin' Bluezzz]

What's a boy to do????

Chuck

How about taking this data back to the Doc as justificaiton for another sleep study (non-split night) to confirm or discount the diagnosis?

It seems to be either that, or just saying the hell with it until some time passes during which you may, or may not, do more damage to your body and immune system.

David