Are these truly obstructive events?

Hey all,

In case you read my history, I've since been officially diagnosed with CPAP and titrated(16AHI supine, 8.6AHI on side--all hypopneas, zero obstructions, sats never below 93%). Moved from a swift nasal pillow to a quattro FFM because my PSG revealed that I am in fact a mouth breather (and leak from my mouth).

So I've been going strong for amount 1 month now between pressures of 8 and 10, currently on 10. When I first started, I was concerned with the numerous centrals that were being recorded, and it was assumed these werent true central apneas (centrals, CA, CAs), but me tossing and turning in bed as evidenced by the single spike in inspiratory flow followed by what was a breath-hold when moving. Overall, I don't feel any better.

Over time, my "CAs" have declined, but I continue to log apnea and hyponea. My AHI ranges from 1.25-3.5, and when I drink alcohol it often drops to below 1 (I drink socially maybe once per week). Before getting the FFM I ranged from 4-6.5 or so. I only use melatonin for sleep.


Looking at my logs, most all of the events deemed apneic have similar characteristics of the "CAs" some users had suggested were really just me moving around. My question: are true apneic events more likely to just pop up in a seemingly "normal" waveform, rather than following these big fluctuations I have in inspiration?

Click on your "events" tab and you will see the length of each event. Remember, the OA is a blockage...an H is a partial blockage...CA generally no blockage.

most of them have some rapid deep breathing before hand, It could be just an excess of o2 and your body waiting for the co2 to catch up.
you could try 11cm and see if there is any change or turn on the auto function

You aren't really zoomed in close enough yet to make any evaluation as to status of those events.
Everything is still too squished together.
Needs to be more along this level of zooming.

Heres some more images with increased zoom.

LSAT wrote:Click on your "events" tab and you will see the length of each event. Remember, the OA is a blockage...an H is a partial blockage...CA generally no blockage.

I'm not entirely sure where you're getting at with this comment with respect to my question. I could have worded the question wrong...

essentially I was previously told that CAs that sleepy head had been recording werent real CAs, but more likely me moving around. My recorded OAs exhibit similar characteristics in wave form and I was wondering if this are misreadings as well.

Well it does look a bit like SWJ with some of those OAs doesn't it?

While I can easily hold my breath and simulate a central apnea I can't close off my airway to similuate an obstructive apnea. Now I have known people who say they could do it but I never could.

On the June 4 report the second OA looks like it's right in the middle of asleep breathing but the first one looks like it came about after a bit of irregular breathing but maybe you were asleep because it appears that the breathing was in the process of becoming more regular when the first one happened.
Maybe a very brief arousal followed by going right back to sleep.... I dunno.

This microscopic level of looking at this stuff is difficult and really needs someone who is specially trained in understanding the various subtle changes in breathing patterns....like someone who does this sort of stuff for a living.
Big changes I can usually spot with some small amount of confidence but subtle changes I will be the first to admit that I am not all that comfortable with.

Would you do anything differently if they were or were not "real"?

If they weren't real, I'd consider reasons for arousals like this.

However, if they are real, I'd consider upping my pressure.

Okay. I will await to see what others might say as to real or arousals from unknown source.
I honestly can't say with 100 % certainty...some look like they are real and some don't to me.

Ever thought about changing the auto to a small range just to see what the machine wants to do with them?
How are you feeling? Sleeping well?
I see you have chosen to include everything and gone with customized AHI/RDI....any special reason for this? Nothing wrong with it but I was just wondering why.

If those were my results, I would consider them to be the result of disturbances. I say this because most of the events are preceded by rapid deep breaths. Further, there are few hypopneas and Flow limitations preceding the events contrary to what might be expected in the case of too low a pressure allowing OA's. But I am not an expert.
The shape of your Flow Rate waveforms indicates considerable mouth breathing as you noted.
So, if these are disturbances, what's the cause? That's the really hard question. It could be dry mouth from mouth breathing, or some other anomaly caused by mouth breathing. It could be pain. It could be medications. Or, It could be a failure to follow good sleep hygiene principles. Since your AHI is relatively low and you are spending 10+ hours in bed but do not feel rested, I suspect the latter. However, I know of no way to tell. It's a process of elimination.
I recommend you review good sleep hygiene principles and make sure you are following them to the letter. You might try taping (even with a FFM), just to see if that produces any positive changes, and I think I would consider lowering the pressure, rather than raising it, to see if it produced a more restful sleep. I think you should concentrate on what makes you feel better rather than a specific metric. I also agree with Pugsy that setting the machine to Auto with a narrow pressure differential (1-2 cm) might provide more insight as to what is happening.

I stayed at a holiday inn express last night, so qualified.

I agree that each of these occurrences follow some disruption but not necessarily arousal.
-Jun 2 and Jun 3 have sleep breathing before and after with no evidence of breath holding. weak response or none to pressure pulse.
-Jun 4 and Jun 5 show signs of arousal to awake like breathing after disruption.
-Jun 5 is the only event clearly showing a breath holding during first and second disturbance before the first and second OA, and anything after the second disturbance looks like awake state.

None of the OAs shown were followed by a distressed or recovery type response.

Jun 5 occurrences were the most disruptive to continued sleep, but the least likely to be counted as sleep apneas (apneas occurring while asleep).

I am pretty sure a higher splint pressure would not have reduced or eliminated these specific events.

GGF

Jay Aitchsee wrote:If those were my results, I would consider them to be the result of disturbances. I say this because most of the events are preceded by rapid deep breaths...
The shape of your Flow Rate waveforms indicates considerable mouth breathing as you noted.
So, if these are disturbances, what's the cause? That's the really hard question. It could be dry mouth from mouth breathing, or some other anomaly caused by mouth breathing. It could be pain. It could be medications. Or, It could be a failure to follow good sleep hygiene principles. Since your AHI is relatively low and you are spending 10+ hours in bed but do not feel rested, I suspect the latter. However, I know of no way to tell. It's a process of elimination.
I recommend you review good sleep hygiene principles and make sure you are following them to the letter.... I also agree with Pugsy that setting the machine to Auto with a narrow pressure differential (1-2 cm) might provide more insight as to what is happening.

My reasoning was the same as you bolded reasoning.
What about my wave forms indicate mouth breathing?
Sleep hygiene could be an issue. I use a FFM because I am often too congested for higher pressures. I'm on multiple treatments for it including Rx sprays, irrigations, and oral antihistamines without too much success--I've tried afrin in the past and its the only thing that has helped (opens me up like no other). I've also experimented with different humidity settings.

GoodGuysFinish wrote: I agree that each of these occurrences follow some disruption but not necessarily arousal.
-Jun 2 and Jun 3 have sleep breathing before and after with no evidence of breath holding. weak response or none to pressure pulse.
-Jun 4 and Jun 5 show signs of arousal to awake like breathing after disruption.
-Jun 5 is the only event clearly showing a breath holding during first and second disturbance before the first and second OA, and anything after the second disturbance looks like awake state.

None of the OAs shown were followed by a distressed or recovery type response.

Jun 5 occurrences were the most disruptive to continued sleep, but the least likely to be counted as sleep apneas (apneas occurring while asleep).

I am pretty sure a higher splint pressure would not have reduced or eliminated these specific events.

GGF

How did you gather "no evidence of breath holding. weak response or none to pressure pulse"? And regarding the second time you mentioned some breath holding before an event, how can you tell?

Thank you so much for you attention and help, I really appreciate it!

Pugsy wrote: Ever thought about changing the auto to a small range just to see what the machine wants to do with them?
How are you feeling? Sleeping well?
I see you have chosen to include everything and gone with customized AHI/RDI....any special reason for this? Nothing wrong with it but I was just wondering why.

I've done a range of 2 before, however it as 6-8. I still feel tired and fatigued during the day and like I am not there cognitively. RE: "are you sleeping well?" upon rising in the morning, I can definitely tell right off the bat if I tossed around the night before, and my AHI/RDI usually corroborates my hunch. Chose to do RDI because it will give me the worse number of the two.

schn00gins wrote:My reasoning was the same as you bolded reasoning.What about my wave forms indicate mouth breathing?Sleep hygiene could be an issue. I use a FFM because I am often too congested for higher pressures. I'm on multiple treatments for it including Rx sprays, irrigations, and oral antihistamines without too much success--I've tried afrin in the past and its the only thing that has helped (opens me up like no other). I've also experimented with different humidity settings.

Rapid exhale (quickly returning to near zero flow) is indicative of mouth breathing. See your chart below.

Sleep Hygiene = https://www.google.com/?gws_rd=ssl#q=sl ... 6919286089