KC's sleep study and therapy

KC1965 wrote: ↑

Tue Feb 26, 2019 1:18 am

palerider wrote: ↑

Tue Feb 26, 2019 1:00 am

KC1965 wrote: ↑

Tue Feb 26, 2019 12:03 am

Plans for the next night:
- reducing the max pressure to 10 or 12. I was on 6-20 (as per palerider's suggestion) but maximum that I've reached this night was 9.06;

Then there's no reason, at all, to change the max pressure setting. All you'd be doing is preventing the machine from helping you some night in the future if you needed more pressure.

That makes perfect sense and I've thought about it too.

I think I'm still in a denial stage Is it possible that I don't even have OSA with these results?

Nope, See how the pressure curve was bouncing around because of breathing issues? without that, you'd have had more apneas.

What 'these results' mean is that the machine is working.

KC1965 wrote: ↑

Tue Feb 26, 2019 1:34 am

palerider wrote: ↑

Tue Feb 19, 2019 1:35 pm

KC1965 wrote: ↑

Tue Feb 19, 2019 12:43 pm

2. Are the values for Evaluation Pulseoxymetric something to be worried about?

Lowest Desaturation [%] 67
Min. Saturation [%] 55

2) yes 67 is *really* bad, that may coincide with the longest recorded apnea of over 1 and a half minutes.

Longest Apnea = 1:41 min was at 0:02:56 while Lowest Desaturation was at 23:46:16.

How does that usually happen? I thought the apneas are causing desaturation, not the other way around. So, what was causing that lowest desaturation then? Probably some other apneas before it or... ?

What are other possible causes for O2 desaturation? (will also ask my physician - and google - about that).

*breathing issues* cause desaturations.. not necessarily apneas.

You can hold your breath for a surprisingly long time before you start running out of oxygen. I've held mine for a minute, while wearing an oximeter, hardly registered at all.

So, I'm not surprised that a single longest apnea didn't coincide with your lowest O2 levels.

Thank you for your replies, palerider.

KC1965 wrote: ↑

Tue Feb 26, 2019 1:34 am

Probably some other apneas before it or... ?

This would be my best guess....you had some airway restrictions prior to the lowest O2 reporting...maybe several shorter than the really long apnea event but because you had several of them close together that is why the O2 levels dropped.
Maybe you had a nasty cluster of hyponeas and/or apneas which were of shorter duration but a lot of them back to back eventually caused the desat.

Hold your breath for a minute or two and not much (in terms of desats) would likely happen if it only happened once within an hour.
Now hold your breath for 30 seconds....once a minute for 15 minutes...so 15 times within 15 minutes...probably would see a drop in the O2 levels.
It's not always duration that is the big culprit...it's the frequency that plays such a big factor especially when they line up back to back to each other. A lot of little short apnea/hyponea events close together adds up to worse results than one single prolonged event.

Pugsy wrote: ↑

Tue Feb 26, 2019 6:06 am

KC1965 wrote: ↑

Tue Feb 26, 2019 1:34 am

Probably some other apneas before it or... ?

This would be my best guess....you had some airway restrictions prior to the lowest O2 reporting...maybe several shorter than the really long apnea event but because you had several of them close together that is why the O2 levels dropped.
Maybe you had a nasty cluster of hyponeas and/or apneas which were of shorter duration but a lot of them back to back eventually caused the desat.

Probably that was what happened. Thank you!

Hello again!

Here is a summary of my first 11 nights of therapy:
- settings: 6-20 cmH2O, EPR yes 2, no ramp
- maximum attained pressure 10.92
- AHI bellow 1, there was a night with AHI=0!
- got used pretty easy with the mask on my face
- hard to cope with the aerophagia, I had to stop the machine when the pressure raised and restart it to be at 6
- sleep a bit better than before and feel more rested in the morning, but this could be a result of the HRT killing the hot flashes. Many arousals though.
- a lot of activity in the flow-limitation graph

I am still not convinced that I have OSA. So I've decided to change the pressure to min=max=4 for one night to see the results. Yes, CPAP is not a diagnosing machine, but still wanted to try. (screenshot attached)

AHI was 0.36, no obstructives, 7 RERAs (which I think are real, I was asleep when they occured), 2 real hypopneas.
Sleep hours: 22:30-3:40 and 6:20-7:10 approx.
The flow limitations were more intense.

What do I understand from all these?
- I do have some serious flow limitations during sleep
- In the first 11 nights, the pressure raised as a response to the FL and kept them at a lower level.
- No real apneas, even with a 4 max pressure (I do know that even such a low pressure can prevent apneas for some people)

I have read about other possible causes of FL: COPD, asthma, sinusitis. I have chronic sinusitis, could this be the culprit?
My spirometry test showed FEV1=80% and the pneumonologist said it is a value for 70 year old people, not 53.

People are always asked here about the medicines they take, so here are mine:
- HRT (third week of usage) - it helped me a lot with my night sweats and hot flashes, I no longer wake up because of them.
- 50 mg trazodone (last 3 nights) - didn't seem to make any difference in my sleep quality.

Sorry for my long post, I wanted to provide all the relevant info! And here comes my question: should I continue with the CPAP therapy or should I take further investigations (what kind of?) to diagnose my sleeping problem (or other problems)?

Thank you!

KC1965 wrote: ↑

Sat Mar 09, 2019 2:23 am

I am still not convinced that I have OSA.

You may not have OSA, or at least not OSA that takes a lot of pressure to resolve, but you *clearly* have SDB.

https://www.youtube.com/watch?v=-gie2dhqP2c

palerider wrote: ↑

Sat Mar 09, 2019 3:18 am

You may not have OSA, or at least not OSA that takes a lot of pressure to resolve, but you *clearly* have SDB.

https://www.youtube.com/watch?v=-gie2dhqP2c

Agree. Thanks for the video!

I experience a lot of sleep fragmentation and (as my sleep study revealed) serious oxygen desaturations.

After I woke up at around 3:40 last night, I just couldn't fall back asleep. That is the most disturbing thing in my sleep pattern. Of course, at that point my mind starts racing, I only think about the terrible day ahead if I don’t fall back to sleep. And I don't, for hours!

So, I do have SDB. How do I treat it? With CPAP therapy, I suppose. I will have to play with the min/max pressure values to see what works best for me. I need an interval that reduces FLs but does not wake me up. 10-11 cmH2O causes bloating and gas pains and arousals. Less could be not effective for FLs. Any suggestion?

Look up UARS Upper Airway Resistance Syndrome
It is a maybe explanation

Pugsy wrote: ↑

Sat Mar 09, 2019 5:00 am

Look up UARS Upper Airway Resistance Syndrome
It is a maybe explanation

Thanks, Pugsy. Indeed, UARS might explain a lot of things. I've read here a very comprehensive article about SDB, UARS and OSA. I can recognize myself in many of the UARS symptoms:
- all UARS patients have some form of fatigue, almost all state that they are “light sleepers,” and almost invariably, they don’t like to sleep on their backs.
- Due to repetitive arousals at night, especially during the deeper levels of sleep, one is unable to get the required deep, restorative sleep that one needs to feel refreshed in the morning.
- You may realize that you are waking up sometimes, but the vast majority of arousals are subconscious.
- Your hands or feet can become cold or numb, in general, activated by cold temperatures or stress.
- constipation, indigestion, acid reflux or bloating.
- Classic migraine and tension headaches are also frequent in UARS along with TMJ problems due to grinding and clenching of the teeth secondary to sleep arousals initiated by UARS.
- Many people also state that they have crazy or vivid dreams or sometimes no dreams at all.

Also, the Wikipedia UARS page describes exactly my experience:
- Fatigue, daytime sleepiness, unrefreshing sleep, and frequent awakenings during sleep are the most common symptoms.
- Many patients experience chronic insomnia that creates both a difficulty falling asleep and staying asleep. As a result, patients typically experience frequent sleep disruptions.
- A typical UARS patient is not obese

Bottom line, from wiki:
Therapeutic trials have shown that using a CPAP mask with pressure between four and eight centimeters of water can help to reduce the number of arousals and improve sleepiness. CPAP masks are the most promising treatment for UARS.

Tonight I am going to try a pressure of 4-8. Fingers crossed!

The machine may not respond optimally if the settings are 4 to 8 as in auto range. It likely won't move off 4 very much.
When they say 4 to 8 range I think it means a fixed or baseline setting of a number somewhere in that range.
From the few people we have here on the forum with UARS....their baseline minimums had to be a lot higher than where the machine would want to go on its own.

The level of flow reduction/limitations associated with UARS is often below what will trigger the auto adjusting response of the auto algorithm.

You might do better with a minimum of 8 and maybe max of 12.
The machine won't auto adjust optimally for UARS issues...it will come up short.

Pugsy wrote: ↑

Sat Mar 09, 2019 9:04 am

The machine may not respond optimally if the settings are 4 to 8 as in auto range. It likely won't move off 4 very much.

When I had the machine set to 6-20, it raised to a max of 10.92, and the average was 6.99.

Pugsy wrote: ↑

Sat Mar 09, 2019 9:04 am

You might do better with a minimum of 8 and maybe max of 12.
The machine won't auto adjust optimally for UARS issues...it will come up short.

Anything more than 10 seems to cause me aerophagia and arousal. But I will try this setting too and see what happens.

If over 10 causes aerophagia then limit the machine to 10. We don't want to just trade problems...not worth it.
It's the baseline minimum that does 99% of the work when people have UARS. The machine won't vary much no matter what it is set at with UARS.

KC1965 wrote: ↑

Sat Mar 09, 2019 7:13 am

Bottom line, from wiki:
Therapeutic trials have shown that using a CPAP mask with pressure between four and eight centimeters of water can help to reduce the number of arousals and improve sleepiness. CPAP masks are the most promising treatment for UARS.

Tonight I am going to try a pressure of 4-8. Fingers crossed!

THAT is one thing you really should ignore. Never take pressure settings from any wiki, pressure needs are far too individualized

Pugsy wrote: ↑

Sat Mar 09, 2019 9:04 am

The machine may not respond optimally if the settings are 4 to 8 as in auto range. It likely won't move off 4 very much.

She's got wicked flow limitations, it'll move