Newbie, First Sleepyhead post

mdemers800 wrote:Palerider,

thanks again for the offer to look at my data and help me. I did upload a zip of my SD card to your dropbox. I was not sure which files, so I did them all, the size was modest. I also uploaded my sleep study which showed zero clear airway apneas. It was a home study with no EEG, so I am not sure how they concluded that.

You did fine, the proper thing to do when someone asks you to upload the sd card data is to zip up the whole card, like you did, and send that. it is possible to trim out some of the files, but if you don't know which ones are ok, you can end up sending a bunch of data that can't be read on the other end because just one file that's important didn't get sent. again, yours came through fine.
Ok, so here's what I found... now, don't take this the wrong way.... you're weird.

here's a chunk of one night where everything is peachy:


and here's a chunk from earlier that night, where things are really wierd:


you're (to my eye) clearly asleep, and in no distress at all, yet you're just breathing REALLY REALLY REALLY slow... note the respiration rate trace on the two screenshots.

I don't know what to make of this, and won't even guess. I've never seen anything quite like this, and I don't know if it's anything to be concerned about. you're clearly having apneas, but my guess is they wouldn't be scored as such in a lab, because there's no apparent arousal afterwards... they're just caused by really slow breathing. Lowering the epr might cause you to blow off less co2 and raise your respiration rate a bit, but... i don't know if you *need* to do so... (based on your oximitry you posted)... :scratching head: I'm quite interested in Pugsy and others take on this.

mdemers800 wrote:Following is my Sleepyhead for last night. I also did a screen shot of my Pulse Ox readings. It shows that even though I have these CA events, my pulse ox levels never drop much. There are some pulse spike, which I would like to understand because my most serious complications of SA are my heart arrhythmias. I don't know if these spikes are within normal range. I do have bradycardia, amd my heart rate averages in the low 40s at night. Even though I loaded the pulse ox files into sleepyhead, they would not be in the SD card files I sent. I am not sure how to send those.

no worries. I'm not even going to hazard a guess with the bradycardia and stuff, anything I did say would be a guess, and you don't need that. that'd be something to talk to your doctor about. my only guess is that when you slow way down, your breathing does too.

mdemers800 wrote:To help your interpretatin a bit: I did not got to bed until 1:30am. I did not feel like I slept until 3:30 or so. My best sleep was from 3:30 to 5:30. I woke up about then with dry mouth. I am exhaling through my mouth, I don't feel I am inhaling through it. I did sleep uneasily form 5:30 to 8:30. All of my CAs seem to be in the restless times. My flow rates look best between 3:30 and 5:30 when I was sleeping best... with no CAs then.

Jay Aitchsee is currently sharing the virtues of using a sweatband/headband across your lips to help keep them close and cut down on air flowing out the mouth... it's pretty comfortable and effective... give it a try

mdemers800 wrote:I also uploaded my sleep study which showed zero clear airway apneas. It was a home study with no EEG, so I am not sure how they concluded that.

Did you wear something around your chest to measure respiratory effort? That's usually what they use to figure out if a flow reduction was central or obstructive.
EEGs are mainly for sleep status and not to measure whether something is obstructive or central in nature.

palerider wrote:I'm quite interested in Pugsy and others take on this.

Beats the hell out of me.
About all we can do is the "give it time" thing. When he knows for sure he is sleeping soundly the data is boring. It gets weird when the sleep status gets iffy.

I would make sure that I had an appointment with my sleep doc at an appropriate time and get his/her take on things.
Right now all a doc would say would be "give it time"...time to get more used to sleeping with all this stuff and there is always the remote chance that if (big IF) these are real they might go away with time anyway.

Is it a boatload of sleep onset centrals bouncing him in and out of sleep? I don't know. It wouldn't be totally impossible but you are right...it is weird.
I think that we fall back on what we know we can fix with this machine....obstructive apneas and deal with those optimally, give it time and see if once there are longer solid blocks of sleep that these centrals reduce or not.
We can't fix these centrals (if they are real) with this machine anyway.

And make sure there is an appropriate followup visit scheduled no longer than 30 days from now if at all possible for the doctor to review all this stuff if it's still showing up at that time.

I see no reason for panic though. Oxygen levels are good. It's only been 2 nights now and we just need more sleep and more nights to get a better idea if this is something here to stay or fades away once more solid blocks of sleep are attained.

If no follow up appointment has been made yet...make one. It can always be cancelled should all this ugly magically go away on its own and never return.

My gut says it is related to sleep status some how but I can't prove it and it sure isn't normal. This is why the doctors get the big bucks.

Pugsy wrote:I would make sure that I had an appointment with my sleep doc at an appropriate time and get his/her take on things..

I don't know enough about the specialization to know if a sleep doc or a pulmonologist would be better to address the "really slow respiratory rate" thing. my guess is a generic sleep doctor wouldn't know as much, but, I've honestly got nothing to base that on.

Pugsy wrote:Is it a boatload of sleep onset centrals bouncing him in and out of sleep? I don't know. It wouldn't be totally impossible but you are right...it is weird.

That was a fairly representative sample, it looks like perfectly normal sleep, if you don't notice how many seconds there are between breaths. I put the mask pressure line in so we could see that FOT(frequency oscillation technique for anybody that's wondering, google it) was kicking in pretty much every breath... in some spots, I saw RR under 4. 's like he's going into hibernation at night mdemers800, are you part bear?

Pugsy wrote:I see no reason for panic though. Oxygen levels are good. It's only been 2 nights now and we just need more sleep and more nights to get a better idea if this is something here to stay or fades away once more solid blocks of sleep are attained.

sounds good, keep a close eye on things.

Pugsy wrote:This is why the doctors get the big bucks.

based on what I've seen from people relating their treatment here, I'd rather follow your advice instead of most doctors when it comes to cpap setup.

mdemers800, feel free to upload another copy of your SD card if you want me to take another look at later data.

palerider wrote: I don't know enough about the specialization to know if a sleep doc or a pulmonologist

A large number of sleep doctors are also pulmonologists. It's very common. Mine is. He's board certified in both.
Gotta start somewhere though and a sleep doctor would be better than family doctor even if he didn't also have a board certification in pulmonary stuff.

palerider wrote:based on what I've seen from people relating their treatment here, I'd rather follow your advice instead of most doctors when it comes to cpap setup

Run of the mill plain jane vanilla OSA issues are fairly simple to address with simple logic but when weird stuff starts showing up that takes it out of run of the mill category and I am smart enough to know that I don't know all there is to know once it goes out of the "run of the mill" category.
I will still try to help but strongly urge follow up with a physician.
That's what I say here...do what needs to be done for the obstructive stuff because that's nice and simple and logical.
We can't do anything about those centrals at this time no matter what is causing them except cross our fingers that they go away.

Pugsy wrote:

palerider wrote:based on what I've seen from people relating their treatment here, I'd rather follow your advice instead of most doctors when it comes to cpap setup

Run of the mill plain jane vanilla OSA issues are fairly simple to address with simple logic but when weird stuff starts showing up that takes it out of run of the mill category and I am smart enough to know that I don't know all there is to know once it goes out of the "run of the mill" category.

see? that's why I trust your advice, you know enough to know when to say, and aren't afraid to say "I don't know", instead of making some bad guess.

Has your physician opined on a cause for the slow heart rate?

Maybe if it was caused by the high number of previously untreated apneas the heart rate will improve? Just wondering, I don't know if that condition can be reversed or if it causes CAs.

I've only had a couple of days of severe low heart rate before I switched to asv, and I never did figure out what caused it. My heart rate has gone up a little since switching to asv for the CAs.

Kinda funny couple of the guys at work have been diagnosed with sleep apnea but don't use their machines and take naps, and they think the low heart rate at 50 is a sign of great health, but I tell them it may just be a side effect of untreated apneas and to look in the mirror. They tried my oximeter and had a lot of time with 02 under 80. Still won't use the machine.

Thanks to everyone for the very helpful comments. I realize this is an investment of time on your part to think about this and reply. Let me also say that Sleepyhead is brilliant and much appreciated. When I get a moment, I will find the donate button and do so.

palerider wrote:you're (to my eye) clearly asleep, and in no distress at all, yet you're just breathing REALLY REALLY REALLY slow... note the respiration rate trace on the two screenshots.

I agree. I googled normal adult respiration rates and they are 12-20. I switched my statistics from median to weighted average and I average a bit above 9. More-so, my respiration rate and tidal volume tend to vary quite a bit. I think I am a "lazy" breather. I am going to look into yoga breathing and other training exercises. That said, my resting pulse is typically in the 40s and when I wore a 3 week heart event monitor, my heart rate went consistently to 40 at night and some nights to 30. I seem to have a slow biology for these things. My cardiologist did not seemed to be too concerned.

palerider wrote:Jay Aitchsee is currently sharing the virtues of using a sweatband/headband across your lips to help keep them close and cut down on air flowing out the mouth... it's pretty comfortable and effective... give it a try

Thanks for that suggestion. But for multiple reasons, tonight I am going to try switching from the P10 I have to an F10 that I also have. I am loath to do it, but I have looked at the data a lot and I believe that, and my dry mouth, is telling me I am mouth breathing. It is worth a one night experiment. My autoset pressure changes seem to be in response to leaks not events, that is another reason for the test. I a pretty certain the pillows are not leaking, so I am going to test the full face mask, to see if I can stand it.

Pugsy wrote:Did you wear something around your chest to measure respiratory effort?

yes I did, thanks for mentioning that.

Pugsy wrote:I see no reason for panic though. Oxygen levels are good. It's only been 2 nights now and we just need more sleep and more nights to get a better idea if this is something here to stay or fades away once more solid blocks of sleep are attained.

I completely agree with that. Since I am also wearing a pulse ox each night, and my O2 is fine, I think the trend is more important than the number of CAs. Also, the longest one was 17 seconds, most were less, so lets see what happens when I settle in more. My sleep study was not done by sleep doctor, but a cardiologist. I decided to pursue getting the machine through a pulmonologist, so I will follow up with him if this does not converge over time.

klv329 wrote:Has your physician opined on a cause for the slow heart rate?

Maybe if it was caused by the high number of previously untreated apneas the heart rate will improve? Just wondering, I don't know if that condition can be reversed or if it causes CAs.

My cardiologist says sleep apnea is the cause of more arrhythmias in her practice than anything else. Not sure about the slow heart rate, but she was not as concerned about that. Since my oxygen levels are solid, she was more concerned about the arrythmias developing into A fib and the general stress of sleep disturbances on cardiac health. I used to run a lot and thought that was the reason for my slow heart rate, but I stopped 2 years ago and my heart got slower.... so much for that theory.

Thanks again, you guys are the best....

Update:
I used an Airfit F10 full mask last night and my centrals went from about 10 to about 5. Pretty big change in one night with just a mask change. But my large leaks went from 5% to 15% and I just am not comfortable with that mask. I was claustrophobic to the point of anxiety and I really had to force myself to continue with the mask through the whole night. I will keep experimenting with getting my mouth leaks down with the P10 vs comfort of the F10 and see how all that affects the CAs over time. I am suspecting the CAs are a nuisance and not a real issue, at least not as big an issue as me getting comfortable with a particular mask and getting restful sleep. My oxygen sat remains above 94 at all times, and averages 97. I am now searching the forum for posts about mouth breathing/leaks and full face mask leaks/comfort. My resp rate, tidal volume and minute vent all improved modestly, so I will keep and eye on that also.

PR,
I zipped and sent another SD file, including the last 2 nights. On 9-11, I wore an F10 mask and slept worse but had better data. On 9-12, I wore a P10, which I prefer, but was back up to double digit CAs per hour. Some comments from me:

• I changed the order of the charts, as I am noticing large variability in tidal volume and respiration rate that seems to correlate highly with the CAs. When those measures appear agitated, the CAs show up. Not sure which is the chicken and egg here. Pulse ox measurements remain good, but sleep is bad.
• When I wear the P10, I have longer periods of calmer sleep, but the agitated periods and CAs seem more intense. I can see this by flipping back and forth between 9-11 and 9-12 daily views. Conversely, the F10 seems to provide very limited truly calm/restful periods, but is yielding half the amount of CAs.
• I can clearly feel the agitated periods, you can see a break in data on 9-12 at about 3:20, where I felt I had to take of the mask for a few minutes and the most agitated data is right before and after this event.
• I tried the sweat band over my mouth last night to help with the mouth breathing, but I still seemed to have a quite a bit and I had pretty bad dry mouth.
• If I have to stay with a full face, I don’t think the F10 is the one for me. This hybrid mask with nose pillows looks conceptually attractive to me, but it does not get good reviews. https://www.cpap.com/productpage/RespCa ... -Mask.html
• PR… I am not trying to prove your point that I am weird, but it does seem to be true. I am going to keep looking at the data today to see if I can figure out anything… if you would look also, I would appreciate it.

mdemers800 wrote: • I changed the order of the charts, as I am noticing large variability in tidal volume and respiration rate that seems to correlate highly with the CAs. When those measures appear agitated, the CAs show up. Not sure which is the chicken and egg here. Pulse ox measurements remain good, but sleep is bad.

the egg is the centrals, the chicken is the TV/RR. when you stop breathing, your TV goes drops because you're not breathing. likewise, when you're only taking a few breaths per minute, your RR drops. remember that the only thing the machine actually measures is the flow rate, and the pressure, everything else is calculated from those values.

mdemers800 wrote: • When I wear the P10, I have longer periods of calmer sleep, but the agitated periods and CAs seem more intense. I can see this by flipping back and forth between 9-11 and 9-12 daily views. Conversely, the F10 seems to provide very limited truly calm/restful periods, but is yielding half the amount of CAs.

you may be rebreathing more of your co2 with the F10 and almost none with the P10, that would possibly account for the lower centrals.

mdemers800 wrote: • PR… I am not trying to prove your point that I am weird, but it does seem to be true. I am going to keep looking at the data today to see if I can figure out anything… if you would look also, I would appreciate it.

I looked at it when I got the dropbox notice that it had come in.

I posted one of the pics of your data over on freecpapadvice and asked what jason (owner, sleep tech) thought, and one thing he said was to try turning down the EPR, which goes along with my idea. for some poeple (not all, by any means) the extra tidal volume they get from the difference in pressure between inhale and exhale causes them to blow off too much co2, (co2 buildup in your blood is what makes you want to breath) (EPR is what gives the blue pressure line above the sharkfin bumps as pressure rises and falls when you inhale and exhale.

PR,
thanks again, I commented on the other forum. If you want me to add here also, let me know. I figured I could give info directly over there, if that is not cool, let me know. In brief, I decided to go low pressure in CPAP mode for one night to see the impact, as I don't seem to be tolerating the pressures very well and not getting good rest. In short, CA cut in half and OA went up so total was the same.

mdemers800 wrote:PR,
thanks again, I commented on the other forum. If you want me to add here also, let me know. I figured I could give info directly over there, if that is not cool, let me know. In brief, I decided to go low pressure in CPAP mode for one night to see the impact, as I don't seem to be tolerating the pressures very well and not getting good rest. In short, CA cut in half and OA went up so total was the same.

well, when you drop the heck out of your pressure, (you set base pressure down to *FOUR*) you're gonna get more obstructives.

yeah, I get that, but I was not tolerating the current pressures, so my theory is to go down and slowly increase and hopefully adjust. only time will tell. I know I need to get back up....

mdemers800 wrote:yeah, I get that, but I was not tolerating the current pressures, so my theory is to go down and slowly increase and hopefully adjust. only time will tell. I know I need to get back up....

what do you mean by ' I was not tolerating the current pressures"?

It's great that you are willing to experiment and collect data and learn right from the beginning. Keep up the good work!!