Can higher than needed pressure cause Hypopnea Apena

[fdw]

Theoretically, yes.
If turning off EPR doesn't fix it, bumping up one (or more) centimeter(s) might be in order.

Den

Great....I think I'll try it for a few night just to see how i feel.

I've been using straight 12 and 13 for the last couple of years with no exhale relief. I used a C-Flex setting of "2" for years and then turned it off after a few nap "trials" and found out I didn't really need it.......and wondered why I waited so long to turn it off.

Good luck with your experiment.

Den

Den, So you change your pressure from 12 to 13 (back and forth), how do you know when it's time to change?

Last night. Not what I was hoping to see on my report this morning. Looks like the Hypopnea's nearly doubled with the longest at 44 seconds and shortest 18 seconds. Flow Limitations also doubled from previous nights. And finally Time in Apnea was nearly 4 minutes. I feel fine, but will see as the day goes on.

Den, You think I Should wait a few more days before increasing the pressure?

Looks really good to me. I'd let it ride for awhile. You're very close to "perfection". The numbers and types of events can vary from night to night and you can choose to watch those for any trends........and then you can decide whether to tweak them or not. I know, for me, at this time of the year my AHI numbers can be just a bit higher for some reason.

This is a little complicated, but........ With regard to my pressures, I typically use a setting of 12 cm. and have since late 2012. However, in early 2011, I acquired two "cheap" ( $15.00 each ) machines from a source who used to sell on the CPAPAuction.com site. Later in 2011, I acquired a gauge manometer from CPAP.COM to check all my machines. I discovered that one of those "cheapies" was putting out 13 cm. at a setting of 12 cm., and the original Auto I bought (second-hand) in 2006 was putting out nearly 15 cm. at a setting of 12 cm. Well, that "cheapie" I use for naps (it lost its data-recording capabilities before I got it and that's probably why it was so cheap), but, it does blow air and that's why I use it for naps and don't have to download the nap data. With the Auto, I decided to use it this year (except for a few years, I've rotated my machines in some manner.....yearly, monthly, etc.) and in order to get close to 12 cm., using my manometer, I set it to 10 cm., which essentially gives me straight 13 cm. So, this will be the first YEAR I've used straight 13 cm., so I'll see how that works. In the past years when I used that Auto, I had it set to straight 12 and it was actually delivering about 15, so I was actually using a higher pressure than I thought I was using. I actually contemplated sending that Auto machine to one of the places that does repairs and have them recalibrate it, but decided it would be cheaper if I just set the pressure according to the manometer.......which was the way they set the machines years ago. Anyway, so far, so good.

As far as changing MY settings (or machines or whatever), over the years it's become longer and longer trial periods. What used to be "a week or more", became "a month or more" and is now "a year or more". I find it interesting to watch the trends throughout a year or even years. And, that's another reason I use straight pressure. It's a "constant" and other things/factors become the "variables".......instead of the pressure.


Den

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I probably need to have my machine checked, even though the machine is only 6 months old. I remember back in the day (1995, 96,97,98) I had my machine checked on a yearly basis to insure the pressure was at my prescribed pressure limit (straight CPAP). That was when there were no such thing as a data machines (as far as I knew),and the machines were the size of small toaster ovens.....and OSA was a FAD....at least that's what the insurance companies thought. Actually thats why MY insurance does not cover any OSA, sleep studies, equipment etc since the late 90's to this day.

I've always used straight CPAP until this past year (9/2014) when I purchased the S9 AutoSet from CPAP.com and started messing with the automatic settings and joined this forum for help.

Thanks to you Den.....your the reason I went back to straight CPAP.

BTW, I didn't have any issues at all with the 0 EPR setting change.

[Wulfman...]

Well, it's always nice to have more variables or possibilities to explore with the variety of settings with the Autos, but the user needs to be aware of both the positive and (potential) negative things that can happen with any of them. In my mind, having and using an Auto in a range of pressures makes using software MANDATORY for evaluating the data.

Glad to see you're doing so well.


Den

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[Elle]

My AHI went down when I lowered my pressure. Not sure if I was having more leaks with higher pressure.

My sister who recently started was in a panic because her AHI was 3 the other day.

[archangle]

I wonder if there's such a thing as a "central" hypopnea? i.e. you have a reduction in breathing due to reasons other than obstruction, but it's not severe enough to count as an apnea. It seems that there would be, but maybe we don't use the term, because it's hard to measure.

As to the hypopnea, zoom in on the waveform and look at how much your breathing actually reduces for how long. Many of them are a lot less scary if you look at the actual waveforms rather than the numbers. Sometimes, when my machine says "hypopnea," when I look at the actual data, it looks like I was breathing heavily for several breaths before the "hypopnea" and the "hypopnea" was fairly normal breathing.

Given your low AHI, I doubt there's much of problem anyway.

[Wulfman...]

I wonder if there's such a thing as a "central" hypopnea? i.e. you have a reduction in breathing due to reasons other than obstruction, but it's not severe enough to count as an apnea. It seems that there would be, but maybe we don't use the term, because it's hard to measure.

As to the hypopnea, zoom in on the waveform and look at how much your breathing actually reduces for how long. Many of them are a lot less scary if you look at the actual waveforms rather than the numbers. Sometimes, when my machine says "hypopnea," when I look at the actual data, it looks like I was breathing heavily for several breaths before the "hypopnea" and the "hypopnea" was fairly normal breathing.

Given your low AHI, I doubt there's much of problem anyway.

Yes there is. I've seen numerous references to them in my readings. Google it and see.
I have no inklings that it might apply to "fdw", but they are a category of events.


Den

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[fdw]

I wonder if there's such a thing as a "central" hypopnea? i.e. you have a reduction in breathing due to reasons other than obstruction, but it's not severe enough to count as an apnea. It seems that there would be, but maybe we don't use the term, because it's hard to measure.

As to the hypopnea, zoom in on the waveform and look at how much your breathing actually reduces for how long. Many of them are a lot less scary if you look at the actual waveforms rather than the numbers. Sometimes, when my machine says "hypopnea," when I look at the actual data, it looks like I was breathing heavily for several breaths before the "hypopnea" and the "hypopnea" was fairly normal breathing.

Given your low AHI, I doubt there's much of problem anyway.

Here's a close up of one Hypopnea from last night. In my opinion the breath wave length is a little disruptive but not crazy by any means, this one Hypopnena was 50 seconds long however which could be caused be a little higher leak rate. To me its a little odd that by turning off EPR my AHI increased due to increased Hypopnea's.

[archangle]

Here's a close up of one Hypopnea from last night. In my opinion the breath wave length is a little disruptive but not crazy by any means, this one Hypopnena was 50 seconds long however which could be caused be a little higher leak rate. To me its a little odd that by turning off EPR my AHI increased due to increased Hypopnea's.

The square top waveform on inhale makes me think obstructive, but that's not definitive.

I find my hypopnea index goes up without EPR as well, but it's still pretty low.

[fdw]

Here's a close up of one Hypopnea from last night. In my opinion the breath wave length is a little disruptive but not crazy by any means, this one Hypopnena was 50 seconds long however which could be caused be a little higher leak rate. To me its a little odd that by turning off EPR my AHI increased due to increased Hypopnea's.

The square top waveform on inhale makes me think obstructive, but that's not definitive.

I find my hypopnea index goes up without EPR as well, but it's still pretty low.

Looks like my FL's increased since changeing EPR to 0, could be coincidental but that's the highest I've seen them.

I've been at 13.6 (straight CPAP) for 3 weeks now so I believe it's time for a pressure increase as Den suggested in an earlier post.....feeling pretty worn out . Hello 14.0

[Jay Aitchsee]

As to the hypopnea, zoom in on the waveform and look at how much your breathing actually reduces for how long. Many of them are a lot less scary if you look at the actual waveforms rather than the numbers. Sometimes, when my machine says "hypopnea," when I look at the actual data, it looks like I was breathing heavily for several breaths before the "hypopnea" and the "hypopnea" was fairly normal breathing.

I've noticed the same thing. My S9 sometimes scores apneas after a period of increased flow rate amplitude (possibly awake). The scored section (hypopnea) may be reduced from the preceding period, but often it doesn't look to be much less than a normal sleep period level. I think one has to question the validity of any hypopnea scoring because, by definition, the reduction must be accompanied by either a 3% oxygen desaturation and/or an arousal. Since, to the best of my knowledge, ordinary xpap machines can measure neither SPO2 or arousals, events scored as Hypopneas, in my opinion, have to be questionable.

http://www.aasmnet.org/articles.aspx?id=4203
1A. Score a respiratory event as a hypopnea if ALL of the following criteria are met:
a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative hypopnea sensor (diagnostic study).
b. The duration of the ≥30% drop in signal excursion is ≥10 seconds.
c. There is a ≥3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal.

[palerider]

ordinary xpap machines can measure neither SPO2

they should start building spo2 monitors into masks... they've already got wires up the hose to the mask... it wouldn't take that much more ... nobody says you have to measure spo2 in a fingertip

[Wulfman...]

Here's a close up of one Hypopnea from last night. In my opinion the breath wave length is a little disruptive but not crazy by any means, this one Hypopnena was 50 seconds long however which could be caused be a little higher leak rate. To me its a little odd that by turning off EPR my AHI increased due to increased Hypopnea's.

The square top waveform on inhale makes me think obstructive, but that's not definitive.

I find my hypopnea index goes up without EPR as well, but it's still pretty low.

Looks like my FL's increased since changeing EPR to 0, could be coincidental but that's the highest I've seen them.

I've been at 13.6 (straight CPAP) for 3 weeks now so I believe it's time for a pressure increase as Den suggested in an earlier post.....feeling pretty worn out . Hello 14.0

To paraphrase what ol "Snoredog" used to say.......if you change your settings and things get worse, you're going in the wrong direction.

But, that's how you find out what works.


Den

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[fdw]

Here's a close up of one Hypopnea from last night. In my opinion the breath wave length is a little disruptive but not crazy by any means, this one Hypopnena was 50 seconds long however which could be caused be a little higher leak rate. To me its a little odd that by turning off EPR my AHI increased due to increased Hypopnea's.

The square top waveform on inhale makes me think obstructive, but that's not definitive.

I find my hypopnea index goes up without EPR as well, but it's still pretty low.

Looks like my FL's increased since changeing EPR to 0, could be coincidental but that's the highest I've seen them.

I've been at 13.6 (straight CPAP) for 3 weeks now so I believe it's time for a pressure increase as Den suggested in an earlier post.....feeling pretty worn out . Hello 14.0

To paraphrase what ol "Snoredog" used to say.......if you change your settings and things get worse, you're going in the wrong direction.

But, that's how you find out what works.


Den

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Last night went pretty well. The first session was without EPR (FL's 95% 0.17) and the second was with EPR 1 (FL's 95% 0.06)......from the looks of things I get better rest with EPR on.
Take a look at the length of that Hypopnea...65 seconds, don't look like I ever stopped breathing though.

[Wulfman...]

Great!
Glad to hear you're finding your appropriate/effective tweaks.


Den

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[archangle]

Take a look at the length of that Hypopnea...65 seconds, don't look like I ever stopped breathing though.

Minute vent is a useful thing to look at to see how much your breathing decreased at that time.

This is a beautiful example of why everyone needs a fully data capable CPAP with flow rate waveforms.

It's also useful to zoom out a bit, so you can see the breathing levels on either side of the hypopnea. I think one screwy thing about some of the CPAP machines is they tend to count the time interval of a hypopnea and apnea until the breathing returns completely back to "normal."

Also, in a sleep lab, a "hypopnea" requires a drop in blood oxygen before you call it a hypopnea, and the CPAP machine can't see SpO2.

[palerider]

Take a look at the length of that Hypopnea...65 seconds, don't look like I ever stopped breathing though.

well, if you stopped breathing, (for long enough) it'd be an apnea.