Severe mixed apnea at the age of 35

Herbert wrote: ↑

Thu Feb 23, 2023 3:23 am

Could you let me know how you've been able to include my O2 data into oscar?

Me? Do I even have your Oscar file?

Rubicon wrote: ↑

Thu Feb 23, 2023 3:33 am

Herbert wrote: ↑

Thu Feb 23, 2023 3:23 am

Could you let me know how you've been able to include my O2 data into oscar?

Me? Do I even have your Oscar file?

I looked through my Oscar files and I don't have it.

Must be another Rubicon.

Rubicon wrote: ↑

Thu Feb 23, 2023 3:46 am

Rubicon wrote: ↑

Thu Feb 23, 2023 3:33 am

Herbert wrote: ↑

Thu Feb 23, 2023 3:23 am

Could you let me know how you've been able to include my O2 data into oscar?

Me? Do I even have your Oscar file?

I looked through my Oscar files and I don't have it.

Must be another Rubicon.

strange, I'm pretty sure you showed me a Screenshot where you laid my o2 data directly under sleep data.... hm okay. then I must be wrong- sorry

No it was a .csv file so I just slapped it into a basic graph program:

Long time since my last visit. Was quite busy with the baby, work and stuff. But I wanted to report back with something interesting (at least for me), that makes me think about my current therapy and therapy in general:

While scrolling through the recordings i did with my o2 ring during the last 10 months the old ones of June 2022 (2 months prior to my diagnosis) caught my attention. What really surprised me, and I didn't remember that anymore to be honest, my stats have been completely the same as they are right now under CPAP. O2 oxygenation ranges between 90 - 98% for almost all of the 11 consecytuve nights I recorded back then. Theres only one night where I dropped below 90% to 85% but only for 12 seconds in total. Same with my heartbeat. Ranges have been 37- 95 bpm almost every night abck then already.

This is bringing so many question to my mind...
- is my apnea really that bad in the first place (AHI 58)?
- why are the home studies (AHI 18) so much different than this one diagnosis night in the lab (AHI 58)?
- does my current CPAP therapy really anything for me?
- is my O2 saturation the right/only relevant indicator?
- why has my heartbeat such a huge range at night (with and without therapy) while my cardiologists keeps telling me my heart is completely healthy and 24h holster monitoring not showing anything to be concerned about?
- and finally: how should I continue? New in lab sleep study one night without any xpap ans then maybe 2nd night with asv to compare to cpap and no therapy figures?

My mind is really racing right now. maybe somebody can give me an opinion on my thoughts...

Herbert wrote: ↑

Fri Apr 14, 2023 1:56 pm

- why are the home studies (AHI 18) so much different than this one diagnosis night in the lab (AHI 58)?

Home studies are to lab studies as Apple watches are to 12-lead EKG monitors - inferior.

Herbert wrote: ↑

Fri Apr 14, 2023 1:56 pm

- and finally: how should I continue? New in lab sleep study one night without any xpap ans then maybe 2nd night with asv to compare to cpap and no therapy figures?

My mind is really racing right now. maybe somebody can give me an opinion on my thoughts...

You have to look for the most reliable source that will diagnose you in a way that will set your mind at rest.
Most people don't buy and use an O2 ring "just like that".

Herbert wrote: ↑

Fri Apr 14, 2023 1:56 pm

While scrolling through the recordings i did with my o2 ring during the last 10 months the old ones of June 2022 (2 months prior to my diagnosis) caught my attention.

Rubicon told you, over and over that your Wellue O2 ring measurements are too coarse, that it's an unreliable device for your needs. (See for example here viewtopic/t186035/Severe-mixed-apnea-wi ... 5#p1433670).

Whatever made you go back to your results from June should send you to a sleep lab.

Herbert wrote: ↑

Fri Apr 14, 2023 1:56 pm

This is bringing so many question to my mind...
- is my apnea really that bad in the first place (AHI 58)?
- why are the home studies (AHI 18) so much different than this one diagnosis night in the lab (AHI 58)?

Without knowing what kind of a home test you had and what kind of data it gathered, it's hard to compare a home study to a diagnostic night in the lab.

In particular, if the home study overestimated the time asleep, that would underestimate the true AHI. Also important is what the scoring criteria for hypopneas were for both the lab based study and the home study. Many home studies do not count hypopneas with arousal that do not have an associated 3 or 4% O2 desat, but most labs will count these hypopneas. If most of your in-lab diagnostic study's AHI was based on hypopneas with arousal, that could account for a substantial part of the difference. (In my case if you drop the hypopneas with arousal from the AHI on my in-lab diagnostic sleep study, my diagnostic AHI goes from 23.6 to 3.5.)

- does my current CPAP therapy really anything for me?

That's impossible for us to definitively answer. But do keep in mind that O2 desats are not the only problem caused by sleep apnea.

- is my O2 saturation the right/only relevant indicator?

I would say that O2 saturation is not the only relevant indicator of the severity of OSA. Nor is it the only relevant indicator of what kind of damage OSA might be causing the body. Some people with OSA have a tendency to arouse themselves just enough to restart the breathing before an O2 desat can occur. This is particularly true if most of a person's untreated events are hypopneas with arousal rather than desats.

The thing is: All those arousals play havoc with the sleep architecture, and that can leave you feeling less than well rested and less than refreshed when you wake up in the morning. In my case, the main thing the BiPap does is that it allows me to sleep without lots of cortisone rushing through my system in a flight or fight response every time my airway collapses enough to trigger a hypopnea with arousal. That means I no longer wake up every morning feeling like I slept with my hands and feet in fists all night. Not waking up with hand & foot pain is enough to keep me papping these days.

- why has my heartbeat such a huge range at night (with and without therapy) while my cardiologists keeps telling me my heart is completely healthy and 24h holster monitoring not showing anything to be concerned about?

My guess is that the variability is being caused by normal increases in heart rate and normal fluctuations in heart rate that occur during REM. You could ask for more specific details about what the 24h holster monitoring showed and why they're not worried about it.

- and finally: how should I continue? New in lab sleep study one night without any xpap ans then maybe 2nd night with asv to compare to cpap and no therapy figures?

That really depends on what specific problems you are trying to solve.

I've re-read this whole thread, and I'm still not sure what specific problem you are trying to solve. And I don't mean "fix the PB-like breathing" stuff.

What symptoms led you to get your first sleep test? Have any of those symptoms changed since starting CPAP? If so, how?

And keep in mind that you still have a newborn. And a newborn in the family means that sleep for all is going to be disrupted for quite a while by the needs of the new one. And that means everyone (except the newborn) is going to be seriously sleep deprived fora while.

My mind is really racing right now. maybe somebody can give me an opinion on my thoughts...

Anxiety is what causes the mind to race on and on and on.

So what are you anxious about right now?

Thanks a lot gor your answer once again.

@robysue1: You're right. One doesn't simply buy an o2 ring. I bought it since I started having afib in my young age and became suspicious about the mild o2 desats (lowest was 87% once) my smartwatch showed me in the mornings. Those episodes of nightly starting afib have decreased a lot, but they already did before I started CPAP, so I don't know if there's any causation.

You could sum up the problem I want to solve as: I want to sleep well again and especially without causing further harm to my body. As I mentioned here and there I still feel not very well rested and wake up too much. Also I'm scared that the whole periodic breathing stuff might cause further harm to my heart and even might worsen over time, as the root cause is completely in the dark.

I totally agree that I need to contact my cardiologist once again. Besides the general wide range of ups and down of my heartbeat, at the moment the down scare me more than the ups. While Rubicon was completely right that the o2 ring is not suitable to really help my current situation, I trust it with the simple task of measuring heart beat. That's where it gets scary: Tonight it showed a heartbeat minimum of 33 bpm. As far as I know this is the lowest it can get if the Sinus node is doing nothing. What I certainly know is, that it's not normal...

Herbert wrote: ↑

Fri Apr 14, 2023 11:54 pm

While Rubicon was completely right that the o2 ring is not suitable to really help my current situation, I trust it with the simple task of measuring heart beat. That's where it gets scary: Tonight it showed a heartbeat minimum of 33 bpm. As far as I know this is the lowest it can get if the Sinus node is doing nothing. What I certainly know is, that it's not normal...

Maybe you should re-read Rubicon on the Wellue and bardycardia.

Rubicon wrote: ↑

Thu Feb 02, 2023 6:24 pm

OK so 3 things:

1. The Wellvue download indicates significant HRV (and it's probably bad HRV). However, it generates data at 4 second intervals, and there's probably some signal averaging done so IMO that thing may be VERY inaccurate in bradycardia. All we need from the Holter is confirmation that it's NSR or maybe sinus arrhythmia during sleep and not a lot of LF junk. If your guy or report says it's fine then we should believe him.

And after re-reading this, maybe another read of the quoted post (click on the upwards pointing arrow) will help you know how to go on.

Right now, you're using an inadequate tool to track a problem that has you extremely worried.

@ozij: Thanks for pointing this out. I wrote and read so much over the past months, that I tend to forget even important stuff. So basically this suggests that the ring doesn't work well in bradycardia range. It's not hard to believe that as it clearly does the same in tachycardia range (wore it a few time will running and it went all over the place with O2 and pusle). I will try to reach my cardiologist on Monday and ask those questions specifically about my las holster monitoring night. I bet he has some Infos for me.

Still I'mstill not quite sure to continue with my apnea. I have an appointment in another sleep lab in end of May to get a second evaluation. I hope they will be able to tell me a bit more and are more experienced with CSA. It's really a pain in the a** to find any doctor that has more than a mere definition he read once during his medical courses....

What I would appreciate the most is to finally get an answer on if my cardiac problems are the cause or the consequence of the apnea. This would really ease my mind I guess, even though I might not be able to do anything against it. But this uncertainty is really the wirst for me

So after all the questions about my first diagnosis and the doubts about competences of my sleep lab, I finally got another appointment with a new sleep lab in May. I would like to verify my first diagnosis and hope to get answers to all the questions that have been raised during this threat. As this time I want to be prepared, I would like to ask you if I forgot anything that might be of interest. I will put special focus on the following topics:

- heart behavior during the night (heart rate, variability, pulse spikes, bradycardia)
- periodic breathing (suspected root cause, counter measures)
- complexSA or just central SA?
- snoring, which nobody ever heard me do before
- PLM (relevant for arousals?)
- Arousal Index?
- and finally I might try asv....

did I forget anything? @Rubicon: If you might stumble over this post, maybe you can add sth that I might have forgotten?

BR

no hints at all?

Ok I guess this threat is dead now

Herbert wrote: ↑

Fri Jun 02, 2023 12:27 am

Ok I guess this threat is dead now

Actually, it's your turn to report. What did your sleep guy say? I there anything new? Cause we were starting to rehash old stuff.