New CPAP User, Long time sufferer...

Sorry for the mile long images above... after looking at the above and watching the video... to me it seems like a good number of these are while asleep. However, there was only one example (I think) in the video, so I'm not sure just how irregular the activity should look in front of the events before you would normally consider them SWJ.

I welcome feedback on the CA events above.

Pugsy, thank again for taking the time to give such detailed responses, they really do help me gain a better understanding of my therapy and how to get the most from it.

Some of those are real and some are obviously arousal related.
From quick scan look....looks like maybe slightly more than half of those are arousal related.

It's still a little confusing regarding the PS. If the PS doesn't promote deeper breathes or breathes that contain more air... how does a higher PS vs a lower PS have an effect on the C02 level of your blood...

(also, since we are talking about human beings, I feel like the YMMV disclaimer is automatically implied )

Because higher PS causes some people to wash out the carbon dioxide too much...why some and not others isn't really known or I haven't been able to find an easy to understand explanation.
It has to do with how the body does the exchange of gases during the respiration process somehow.

Maybe Palerider can explain it better than I can...all I know is that for some people (and the number is really small) it happens.
He will probably be around later and maybe try to clarify things a bit for you.

That would be great!

Surprisingly, it's not super easy to find information that goes that deep into how it all works. At least not that I've found... yet.

I have had an occasion to try to dig deep and find out "why" about several things over the years and sometimes I just haven't been able to find out why or understand what I found well enough to convey its meaning to anyone else.

I learned to accept that sometimes I don't have clear cut answers to my questions and I move on and expend my time and energy elsewhere.

Oh...shallow breathing doesn't necessarily mean no breathing and normally not an issue unless someone falls into the hypoventilation thing from maybe being obese and they just can't get bigger breaths because the fat is too hard to move away from the diaphragm.

If you are really worried about shallow breathing or if you are moving enough air normally....get some lung function tests done...if for no other reason than peace of mind.
Tidal volume....there's a very wide range of norms depending on multiple factors out there and I wouldn't be relying on the cpap machine breathing data in terms of volume of anything for final diagnosis of anything related to the lungs themselves in terms of air movement.

I guess I don't have too many reasons to suspect that I'm not moving enough air, other than the fact that I compare myself to my wife. When she sleeps... wow.... she breathes so deep you can hear her breathing from the next room lol. Not snoring... just sounds like Darth Vader lol. Perhaps I am just a shallow breather and that's not necessarily a bad thing.

I'd like to know more about the role PS plays in CO2 and O2 in the blood. Maybe over time I can gather enough intel to put together a solid picture.... but I'll try not to lose any sleep over it! (pun very intended)

Boshwash wrote: ↑

Fri Dec 14, 2018 10:13 am

So, to rephrase what you are saying (to ensure I understand)...

PS makes breathing easier... when breathing is too effortless, it can cause someone to breathe 'too' efficiently causing their CO2 levels to drop low enough to the point where their brain doesn't initiate the need to take the next breathe.

So PS is a fine line between 'comfort' and C02 level management.

I increased my PS because I hoped it would help stop me from breathing so shallow (the increase in pressure would 'push' more air in thus increasing the size of the breathe).

I think Pugsy covered this, but I'll reinforce.

It's not something about being 'efficient', it's that the higher PS increases the minute ventilation, ie, how deep a breath you take (just like you hoped), and that extra ventilation causes more gas exchange... which means more co2 is blown off.

A minority of people (one in 7 to one in 20 depending on which study you look at) have a greater sensitivity to the amount of co2, and it disrupts their respiratory loop (http://www.pathwaymedicine.org/control-of-respiration), causing them to just decide "meh, I don't need to breathe for a few more seconds". Typically, this really isn't harmful, until it starts happening so much that the oxygen starts to drop. (and that's well over a few times an hour).

Boshwash wrote: ↑

Fri Dec 14, 2018 10:13 am

I assume you get less false positives on obstructive apneas than clear airway apneas. Would it be safe to say that if you were going to 'chase' something, chase the obstructive apneas first? I was surprised to see so many obstructive apneas after raising the pressure last night. I have also noticed that sometimes, before falling asleep, that I can have an obstructive apnea while exhaling... which seems weird, I figured most people would experience obstruction on the inhale... so maybe that further supports the idea of having a higher EPAP...

I tend to discount centrals, whether they're legitimate sleep centrals, or some sort of post arousal, or transitional central, until they get pretty high...

Obstructives, on the other hand, need to be addressed.

Try this exercise: hold your breath for 10 or 20 seconds.. no biggie, you can do that easily without any adverse affects. That's a centrals apnea.

Now, pinch your nose shut and *TRY* to breathe... try hard, fight for air for the same time. That's an obstructive, it's work, it's effort, it 'riles your body up', for want of another phrase, and it's very disruptive to any rest you're trying to get.

Boshwash wrote: ↑

Fri Dec 14, 2018 11:01 am

It's still a little confusing regarding the PS. If the PS doesn't promote deeper breathes or breathes that contain more air... how does a higher PS vs a lower PS have an effect on the C02 level of your blood...

(also, since we are talking about human beings, I feel like the YMMV disclaimer is automatically implied )

it *does* cause deeper breathing.. that's it's whole point, supporting the lungs in moving more air... that's why they call it "pressure support".

When doing classic bilevel respiratory therapy in the hospital, for people with breathing problems, not sleep apnea, they set the EPAP to maintain oxygenation, and they set the PS to control CO2.

Boshwash wrote: ↑

Fri Dec 14, 2018 11:19 am

That would be great!

Surprisingly, it's not super easy to find information that goes that deep into how it all works. At least not that I've found... yet.

You have to get out of the 'webmd' world and into things like respiratory therapist training videos, medscape, www.ncbi.nlm.nih.gov, and such for that kinda stuff.

here's a good starting point: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417331/

Boshwash wrote: ↑

Fri Dec 14, 2018 11:56 am

I guess I don't have too many reasons to suspect that I'm not moving enough air, other than the fact that I compare myself to my wife. When she sleeps... wow.... she breathes so deep you can hear her breathing from the next room lol. Not snoring... just sounds like Darth Vader lol. Perhaps I am just a shallow breather and that's not necessarily a bad thing.

I'd like to know more about the role PS plays in CO2 and O2 in the blood. Maybe over time I can gather enough intel to put together a solid picture.... but I'll try not to lose any sleep over it! (pun very intended)

If you're concerned, buy a recording oximeter and see how your oxygen levels are.

Your breathing is primarily regulated by the acid level of your blood, which is greatly influenced by the dissolved co2 in your blood... so your tidal volume (the amount of air taken in a breath) is controlled by that. as long as your TV is enough that you're getting enough oxygen in, you're good, As Pugsy says, if you don't have OHV (Obesity Hypoventilation Syndrome) (or other (unrelated) lung diseases), you're probably just fine with whatever breaths you're taking... but, an oximeter would show how you're doing. They're relatively inexpensive, most under 100, some under 50$ (cms50D+, cmsr50e, cms50f, cms50i are commonly used inexpensive models).

Your wife may have narrowing of her airways which is what's causing the noisy breathing... one would have to strap something on her to measure her TV...

Hey palerider!

Thanks for the info, that does help things make more sense. It seemed to me that the increased pressure should help the breaths be deeper. I probably didn't understand Pugsy when she tried to explain it the first time.

That does make sense to me. Also the correlation between PS and minute ventilation is good to know too. It's interesting now that I see it, when I changed the minimum PS from 4 to 5, there is roughly 1L/min. increase in my median minute ventilation. Which if the charts are to be believed fits what you're saying. An increase in PS theoretically should be an increase in Minute Vent.

I'm also gathering that I should not worry so much about the centrals right now (as my sleep specialist also told me). Concentrating on clearing up the obstructive apneas still seems like the better use of time. Not sure how to go about that, but I do have a full night titration study scheduled for the 17th of January. So more data should be inbound soon.

PS will help you take a bigger breath IF your body tries to take a bigger breath.
It can't force you to take a bigger breath. It can't inflate your lungs without you doing your part. It's there if you use it and will make the exchange a bit easier and smoother but it can't even blow up a balloon at the maximum pressure available...despite what it sometimes feels like.

I hear ya, and yes - sometimes it does feel like i could float off the bed like a zeplin!

Pugsy wrote: ↑

Fri Dec 14, 2018 3:52 pm

PS will help you take a bigger breath IF your body tries to take a bigger breath.
It can't force you to take a bigger breath. It can't inflate your lungs without you doing your part. It's there if you use it and will make the exchange a bit easier and smoother but it can't even blow up a balloon at the maximum pressure available...despite what it sometimes feels like.

Well, I'd say there's a caveat, enough ps will do that, since that's how nice machines work... Forcing in air to make you breathe through centrals.