Central Sleep Apnea + Autism

Pugsy · Post by **Pugsy** » Mon Aug 31, 2020 1:01 pm

You went to all that trouble and didn't include the flow rate graph which is what is important when we zoom in on anything.

Actually....get me this same night above but do the detailed daily regular image.....normal stuff on the left without calendar, on the right side graphs...Events, flow rate, pressure (the regular line and not mask pressure), leak, Flow limitations. That's all I want.

But also get me a detailed daily regular image of a night in auto mode....I especially need to see what the pressure wants to do when it can move around. In cpap mode...it won't move so that really doesn't help me.
I am trying to figure out if maybe we can reduce his pressure on the bilevel and make things more comfortable for him and crossing my fingers that if he is more comfortable he will sleep better.

I will download from your links later. Short on time at the moment.

palerider · Post by **palerider** » Mon Aug 31, 2020 1:05 pm

HalfMadDad wrote: ↑
Mon Aug 31, 2020 11:14 am

I zoomed in on one of the longer apnea events. Please let me know if I should have done this differently.

Please review http://cpaptalk.com/wiki/index.php/Oscar:organize

You cut off the breathing, what would have told us something, and showed a whole lot of graphs that don't show anything most of the time.

If you standardize what you screenshot, according to the guide, you'll end up saving yourself, and us, a good bit of time in the long run.
Thanks.

HalfMadDad · Post by **HalfMadDad** » Mon Aug 31, 2020 1:52 pm

Hi Pugsy and palerider

My kids are just about to go into meltdown. I had to do this quickly. I will read the guidelines and post a proper screenshot in an hour or two. Sorry

Pugsy · Post by **Pugsy** » Mon Aug 31, 2020 2:03 pm

Take care of the kids.
I don't want any zoomed in stuff unless I ask for it.
I want the overall big picture non zoomed in to start with but I can at least see that during this small segment he maxed out at 10.
And those are obviously all awake/arousal flagged events.
The machine didn't know he is awake and it just responds per the auto algorithm so it maxed out the pressure.
I need to see how high the pressure was when asleep.

His auto mode settings were 5 min and 10 max and the reason you see the 4 cm is because the ramp was used and it starts at 4.

HalfMadDad · Post by **HalfMadDad** » Mon Aug 31, 2020 3:09 pm

Hi Pugsy

I am back again. Thanks for your patience.

I am attaching another screenshot of my son's results, hopefully following guidelines better.

HalfMadDad · Post by **HalfMadDad** » Mon Aug 31, 2020 3:12 pm

If I could bother you guys just a little more.

Here is a screenshot that is zoomed in. It is an 60 second apena event from my wife's data last night. There are many other long apnea events :
37, 50, 45, 52, 45, 52, 45, 60, 45, 43, 43, 42, 49 etc

all of the ones I looked at show no flow at all. Is it fair to say that she was not breathing at all?

I did backtrack to the 111 second event from a few days ago and indeed there was flow there so maybe the software should have called that a hyponea?

HalfMadDad · Post by **HalfMadDad** » Mon Aug 31, 2020 3:13 pm

shoot I didn't attach the image

HalfMadDad · Post by **HalfMadDad** » Tue Sep 01, 2020 4:41 am

Hi Guys

I hope I am not over-posting to the forum, especially with all these images.

Please see my son's results from last night. He had 5.3 AHI and several of them were quite long. I zoomed in on a 29 second one. There was slight flow for a couple of short ones but pretty much all the other events show the same, no flow.

This can't be right, no? He is at 8/12 pressure with his BPAP, surely we are at a high enough pressure for a 14 year old kid?

Julie · Post by **Julie** » Tue Sep 01, 2020 5:15 am

Unfortunately his age has nothing to do with it, no more than his designation of e.g. mild, moderate or severe does when tested. The settings need to match his level of obstruction, how much pressure's needed to hold his particular airway open even if e.g. he was only tested as 'mild' in terms of number of apneas/night. And someone else with a 'severe' designation might only need the lowest pressure to keep their airway open due to physical factors keeping it 'obstructed'.

HalfMadDad · Post by **HalfMadDad** » Tue Sep 01, 2020 5:22 am

Thanks Julie.

Okay. I am new to this but it does seem very alarming that he is not breathing for 29 seconds and my wife 60 seconds. Not to mention that there are so many of these events in one night and often back-to-back.

I don't know why they are not waking up? My wife woke up gasping for breath at 4:30 AM yesterday after many back-to-back events but it still seem weird that she did not wake up after the 60 second one.

Julie · Post by **Julie** » Tue Sep 01, 2020 6:46 am

I could guess that they need more pressure, but would rather leave this to Pugsy as she has more info and experience here.

Pugsy · Post by **Pugsy** » Tue Sep 01, 2020 7:05 am

That 29 second apnea...he wasn't asleep...it doesn't matter that there was a 29 second reduction in air flow.
His flow rate immediately prior to the flow reduction clearly shows arousal breathing...he wasn't asleep.
And yes...people breathe very shallowly all the time while awake...They hold their breath and don't move air at all while awake.
He woke up (he may or may not remember it) and either was breathing very shallowly or maybe not at all. It doesn't matter because he wasn't asleep.
All the pressure in the world won't fix this sort of awake flagged event. Awake flagged stuff...they simply don't matter.
The CA flagged after the OA...not real either.

Now your wife's .....I need to look at her data more and examine the flow rate prior to the cluster but hers may be real asleep flagging and not unexpected. We already know she needs more than 9 cm pressure.

palerider · Post by **palerider** » Tue Sep 01, 2020 7:15 am

Please stop posting with the list of events on the left, click back to the "details" tab before making your screenshot.

Only have

Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limit.
Snore

on your charts unless asked for more.

The charts that I've seen the detailed info showing on show that the max pressure setting is too low for both people.

Set the max pressure at 20 on the 'for her' machine and set maxipap at 25 on the VAuto, let the machines try and do their jobs at suppressing obstructive apneas. As it is, they machines are constrained from being effective at controlling obstructive apneas.

HalfMadDad wrote: ↑
Tue Sep 01, 2020 4:41 am
surely we are at a high enough pressure for a 14 year old kid?

Clearly not.

HalfMadDad wrote: ↑
Tue Sep 01, 2020 5:22 am
I don't know why they are not waking up?

Clinically speaking, they are, they're just not waking up enough to not fall back asleep right away.

People with bad obstructive sleep apnea will wake up hundreds of times a night, and not remember any of it, because of the way the brain works, and doesn't form memories while sleeping.

HalfMadDad · Post by **HalfMadDad** » Tue Sep 01, 2020 7:30 am

Thanks again Pugsy and palerider.

My wife has a lot of pain in her face at 9 cmH2O.

She can't chew food on that side of her face yet there is nothing wrong with her teeth or jaw. There is some sort of pain that no one has been able to figure out. She doesn't seem to be able to tolerate the nasal mask but maybe we should try out another brand.

Pugsy · Post by **Pugsy** » Tue Sep 01, 2020 7:38 am

I know you are in Canada so not so easy to get some stuff but take a look at the mask I use...link in my equipment.
It is available on Amazon.

Otherwise tell me what nasal masks she has tried and not been able to tolerate...and why...then maybe I can think of one that might be worth trying that would be easy for you to get somehow.

I don't think your son needs more pressure....at least at this point.
Awake breathing flagged events simply don't need treatment of any kind other than maybe try to reduce the poor sleep but I still don't see the son having his waking being related to airway issues.

Central Sleep Apnea + Autism

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