Periodic Breathing Exponentially More Important Than AHI?

Ive been at this over 3 years, and I maintain that AHI is comparatively unimportant compared to Periodic Breathing. Perhaps this is
in particular a BIPAPers sentiment.

At this point I can wake up and tell EXACTLY what kind of night i had. I can predict all the numbers.

AHI can be 7.3 and if PB is below 2 im golden.

Reverse that, and Im trouble for the day. Breathing asthma type problems, exhausted, stress hormones releasing, need to take a klonopin (my drug of choice for neurological flares).

Im one of those few people who switched themselves to BIPAP because i realized my airways was collapsing upon exhale. Sleep "EXPERTS" never even suggested such a possibility, and i dont "perform" well on sleep tests.

QUESTION: Anyone told their sleepdoc they wanted to get on AVI and found improvement? Im thinking it might help me breathe "easier" without as much effort.

Not sure about Periodic Breathing.

I'm no expert, but I always thought airways collapsing on exhale was pretty typical occurrence with OSA. Exhaling against the continuous pressure keeps things open.

That is one of the reasons EPR can hurt therapy for some because it decreases pressure on exhale.

But if things are working well for you, you should probably keep going in that direction.

As for AHI, I have always been in the camp that event duration/clusters are equally, if not more, important than the number of events. I'd rather have more 10 second obstructive events than a few 60 second events, especially in succession.

John

I think that we, as a group, are dealing with a few different sources of our apneas. We all know about CAs, OAs, hypopneas, Cheynnes-Stokes (sp?), etc. In my case, I have almost no events other than obstructive apneas and hypopneas. For me, AHI (or possibly RDI - though I don't have a machine that can measure RERAs), seems to be the whole story. I understand that your situation may be different and I'm not going to try to convince you that what works for me will work for you. Apnea is a syndrome - that means it is group of symptoms that may arise from various sources. The etiology of my apnea is probably not exactly the same as the etiology of your apnea. I'm glad that you've found something to monitor that helps you determine how your therapy is going. Please don't insist that I should be monitoring the same thing as you, but thank you for pointing out that there is something else to be aware of!

DavidCarolina wrote: Im one of those few people who switched themselves to BIPAP because i realized my airways was collapsing upon exhale. Sleep "EXPERTS" never even suggested such a possibility, and i dont "perform" well on sleep tests.

QUESTION: Anyone told their sleepdoc they wanted to get on AVI and found improvement? Im thinking it might help me breathe "easier" without as much effort.

When sleeping on my back my mouth opens just before I fall asleep. I have always thought that this is because my upper air is collapsing. Does this happen to you? (I’m trying bipap now to fix this…..don’t know if it is the right thing to do). Hope other people comment on this because I sure need help on this one! Hope this is not “off topic” for you!

David: Your experience and my experience were exactly the same. If I had 5% a night of periodic breathing it would knock me out for the whoke day, regardless of my AHI. I had textbook classic Cheyne–Stokes respiration. The next day it felt like Pugsy's aliens were using my diaphragm and lungs for an inflatable Jump House.

Three things (over a year's time) seems to have helped. First was using an ASV machine which simply does not allow PB breathing to occur. Second, taking daily magnesium and phosphorus supplements (Seriphos for phosphorus, google it) to dampen my adrenal glands. Thirdly, I cut out most processed foods and food additives from my daily diet.

I can't say things are perfect but that blown out and fatigued PB dreadful morning after feeling seems to be in the past, - and I hope it stays there. Early on, some erudite folks on this forum told me that PB wasn't a big deal since it was just a waning/waxing of the natural breathing cycle and not uncommon... I didn't believe them then and I certainly don't believe that now. IMO, PB breathing can be a crippling and terrible condition for some people. I think it's imperative that one gets it under control. I'm not saying my three step plan is right for everyone but in my case I enjoyed good results.

Significantly more important? Maybe yes; maybe no.

Exponentially more important? Probably not. Because "exponentially" does not refer to comparison (implied by "more"); it instead refers to an increasing/decreasing rate of change.

People tend to panic over Cheyne Stokes breathing, periodic breathing, and central apnea.

There are some very serious and scary medical problems that will lead to Cheyne Stokes or central apnea. However, fairly normal CPAP treatment can induce PB, centrals, etc. in otherwise fairly normal people. It may or may not be bad enough to really matter.

However, Cheynes Stokes breathing, PB, or central apnea can be bad enough to be serious.

Just don't panic because someone uses the word, or your machine reports it. It's a warning you need to analyze and figure out what it means for you.

Where is PB reported in SH? Perhaps Resmed doesn't record PB?

digitalepiphany wrote:Where is PB reported in SH? Perhaps Resmed doesn't record PB?

I believe you are correct that ResMed doesn't report PB, at least not in the AutoSet and lesser models. I'm not sure about higher end models, but I don't think so.

SH puts a PB section in the flags display and a green overlay in the flow rate graph for PRS1 machines.

digitalepiphany wrote:Where is PB reported in SH? Perhaps Resmed doesn't record PB?

s9 machines don't flag that, as10 machines do have a CSR flag, though CSR is just one type of periodic breathing.

Sir NoddinOff wrote:David: Your experience and my experience were exactly the same. If I had 5% a night of periodic breathing it would knock me out for the whoke day, regardless of my AHI. I had textbook classic Cheyne–Stokes respiration. The next day it felt like Pugsy's aliens were using my diaphragm and lungs for an inflatable Jump House.

Three things (over a year's time) seems to have helped. First was using an ASV machine which simply does not allow PB breathing to occur. Second, taking daily magnesium and phosphorus supplements (Seriphos for phosphorus, google it) to dampen my adrenal glands. Thirdly, I cut out most processed foods and food additives from my daily diet.

I can't say things are perfect but that blown out and fatigued PB dreadful morning after feeling seems to be in the past, - and I hope it stays there. Early on, some erudite folks on this forum told me that PB wasn't a big deal since it was just a waning/waxing of the natural breathing cycle and not uncommon... I didn't believe them then and I certainly don't believe that now. IMO, PB breathing can be a crippling and terrible condition for some people. I think it's imperative that one gets it under control. I'm not saying my three step plan is right for everyone but in my case I enjoyed good results.

How much Phosphorus and Magnesium do you take daily? Do you balance the Magnesium with Calcium and other cofactors?