Muscles of exhalation compromised with CPAP

lovehatemyCPAP · Post by **lovehatemyCPAP** » Wed Mar 24, 2021 4:49 pm

Thank you ChicagoGranny - I figured out where it shows the length of time after reading through your posts on the forum. I attached the image. They all are under 20s. I read that you said that this may be me reflexively holding my breath while changing positions. On my worst nights I have 28 and 41 events. Would you say this isn't a true central apnea since it was for short duration?

The elevation is 1,888 m (6,194 ft). Although it could be slightly higher as Im outside of the city.

Thank you!

ChicagoGranny · Post by **ChicagoGranny** » Wed Mar 24, 2021 5:16 pm

lovehatemyCPAP wrote: ↑
Wed Mar 24, 2021 4:49 pm
How do you determine how long the events were?

Seconds in parentheses. Yours are all short events.

Look at that cluster of centrals around 9:00 on the 21st. I bet you were awake or drifting in and out - that's not sleep apnea.

Are you more restless in your vacation bed? With a change in bed, daily activities and maybe diet, it's easy to have poorer sleep independent of sleep apnea and CPAP.

lovehatemyCPAP wrote: ↑
Wed Mar 24, 2021 2:16 pm
heart pounding and with the sensation that I was not breathing

When this happens, turn your machine off momentarily and then back on. The next day, you will be able to see where it happened on your OSCAR Daily View graph. Then, you can zoom in on the breath wave forms to see what was happening just before you awoke.

lovehatemyCPAP · Post by **lovehatemyCPAP** » Wed Mar 24, 2021 5:51 pm

Ok I will do that.. shut it off when that happens. I have been here two weeks and it has been happening every night the last week. My bed here is pretty comfortable. I am actually sleeping at my parents house. No meds, no extra stress. I am in shape.

If they are short events (under 20 seconds) do you assume it was just moving around/changing positions and not true central apnea? One of my nights was 41 events. I should not be alarmed? I was waking up once or twice a night before to go to the restroom. Now I just wake up randomly like 4-5 times. Besides the heart pounding, I am also get very hot despite it being cold in the house.

I was looking at a link that Pugsy posted before to determine if you have a true central or not.
http://freecpapadvice.com/sleepyhead-free-software

I looked at graph and everything seemed normal before and after the event. I attached the image here. Would that indicate a true central?

Pugsy · Post by **Pugsy** » Wed Mar 24, 2021 6:45 pm

What is your altitude at home? Much lower than in the mountains by chance?

Sometimes higher altitudes trigger centrals in some people. You might be one of those people.

You could maybe turn off EPR and see if that makes a change in the centrals or not...it might and it might not.

lovehatemyCPAP · Post by **lovehatemyCPAP** » Wed Mar 24, 2021 7:44 pm

Thank you Pugsy - I will shut off my EPR and see if that helps. And yes I went from Miami to Mexico! From Elevation. 6 ft (2 m) to 1,888 m (6,194 ft). There are multiple articles I just looked up on this. I guess that is what it is. It's increasing my centrals. Very fragmented sleep. It's weird because it wasn't too bad for the week or two being here and then got gradually worse this past week. Let me know if you think I should be changing anything else with my settings. This is the first time I have posted and haven't touched my settings since they gave them to me 2 years ago. Thank you!

Pugsy · Post by **Pugsy** » Wed Mar 24, 2021 8:42 pm

There's really no other tweaks that you can do to affect the centrals if turning off EPR doesn't help.
Centrals won't respond to more pressure or less pressure for the most part especially if it is the altitude that is the culprit.
It sucks that your sleep is crappy when on vacation and I don't know if turning off EPR will help or not but it is really the only thing we can do that might help so you can get better sleep while on vacation.

Some of your centrals might be secondary to being awake from the poor sleep but some might be from the centrals and the centrals might be causing arousals.
So it at least makes sense to try the one thing that might help. It is not a guaranteed fix though...it's a maybe.

I suspect once you get home you will readjust to normal fairly quickly.

lovehatemyCPAP · Post by **lovehatemyCPAP** » Thu Mar 25, 2021 10:48 am

Thank you Pugsy. I tried with EPR off last night. Definitely a different feeling. While awake, it was like I had to take a really deep inhale in order to emit enough force for a full exhale against the pressure. Who knows what happened while sleeping. I still had disturbances but at least I didn't stay wide awake like other nights. Maybe too early too notice and I'll try another night. I see a max respiratory rate of 28. Is that bad?

I took your advice ChicagoGranny and shut it off and back on after a couple minutes after two heart pounding waking episode. What do I show you on my reports? It looks like only one 5 hour 47 min period was recorded instead of 3 different periods. Did I do something wrong?

Two screenshots attached.

Thank you!

Pugsy · Post by **Pugsy** » Thu Mar 25, 2021 11:01 am

I wouldn't worry about the max respiration rate. It's possible that reflects a little artifact that we sometimes see when the machine incorrectly records the heart beat or echo and counts that as a respiration. Would need to zoom in on the section of flow rate that is showing the higher respiration rate to be sure and I am not sure it is worth all the work because it is probably short lived anyway.
I have seen people showing near 50 respiration because of this cardiac echo thing but when we go count it manually...roughly half of the 50 is what the rate really was. You can manually zoom in to do this but it's work and the other thing is that sometimes we just have a faster respiration rate for some reason....bad dream maybe...or even a good dream maybe.

If falling asleep without EPR is a bit of a challenge you can set EPR to be on during ramp only and then make use of the ramp period available as a setting choice. Easy peasy to do if you want to. Turn ramp on...set it to however long you think it might take to fall asleep and then set EPR to be on at the setting of your choice but only during ramp time.

Pugsy · Post by **Pugsy** » Thu Mar 25, 2021 11:07 am

This post/topic contains links to further discussion about that cardiac echo thing miss counting respiration rate....if you want to dig deeper. It's common and normal and means absolutely nothing to see it happen.

viewtopic.php?f=1&t=181147&p=1374369&hi ... c#p1374369

ChicagoGranny · Post by **ChicagoGranny** » Thu Mar 25, 2021 11:27 am

lovehatemyCPAP wrote: ↑
Thu Mar 25, 2021 10:48 am
It looks like only one 5 hour 47 min period was recorded instead of 3 different periods.

The three periods can be seen in OSCAR. Look at the pressure line. Where you see the two breaks is when you turned the machine off. What your graph shows is high machine pressure points just before the machine is turned off for a moment. Your airway was unstable, and the machine raised the pressure to compensate. Did you feel a high heart rate or fast breathing at those two points?

If you zoom in on the Flow Rate chart just before the pressure increases, you might be able to see the Flow Rate become irregular and shallow.

lovehatemyCPAP wrote: ↑
Thu Mar 25, 2021 10:48 am
While awake, it was like I had to take a really deep inhale in order to emit enough force for a full exhale against the pressure. Who knows what happened while sleeping.

Your awake brain is thinking about breathing and thinks it is difficult to exhale against the pressure. Put the brain to sleep, your autonomic nervous system takes control of breathing, and it is easy to exhale against the pressure.

lovehatemyCPAP · Post by **lovehatemyCPAP** » Thu Mar 25, 2021 2:58 pm

Thank you for sharing that Pugsy. I see you have covered the RR topic many times on the forum. I zoomed in to a few areas to manually count. I just don't know when/what time that max of 28 was recorded. Is there a way to know that besides manually going through the whole night? Like you said it's a lot of work and may not be worth it. I'm glad I don't have to add another thing to freak out about. Good

I will make that adjustment with the EPR if needed. I actually never have an issue falling asleep. I pass out right away. Maybe from the exhaustion of having apnea and not being well rested.

I woke up the first time around 4:08AM. That is the first two images attached
I woke up the second time around 5:41AM. That is the 3rd image attached.

I can see the shallower breath that you are referring to close to when I get woken up. Is there anything we can do with that info besides make the connection?

When I wake up I often feel the pounding of my chest and higher heart rate and a "deoxygenated" feeling. I usually take a series of deep breaths to get back to feeling normal. A high heart rate for me is relative because when I take it laying down before going to sleep it is in the upper 40s and 50s. Bradycardia isn't something I recall having before but something doctors have noticed over the last 5 years. I know it could be a side effect of sleep apnea.

I've gotten to the point where I am dreading going to go to sleep

I guess there is nothing else I can do now besides mess with the EPR and cross my fingers this all improves when I return to sea level.

Thank you.

Pugsy · Post by **Pugsy** » Thu Mar 25, 2021 4:46 pm

Breathing is part of the autonomic nervous system meaning it is automatic and we have zero control over shallow or bigger breaths when asleep.
Flow rate just varies for any number of reasons and not a darn thing you can do to change it.

Finding where it wants to count 28 breaths per minute ....you have to just look at the peaks of the respiration rate graph and manually zoom in.

Muscles of exhalation compromised with CPAP

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