Treating flow limitation causes more central apneas?

ozij wrote: ↑

Tue Sep 05, 2023 12:12 am

Your flow limitations are negligible

I can trust that you are correct on this, but for my information may I ask how you determined that my flow limitations are negligible?
I see that there is a flow limitation graph in OSCAR, but I have no idea how mine ranks. And the shape of my patterns looks strange (class 5 according to some diagram I saw?) but I'm also unsure about the significance.

Also, would you say that I have inspiratory or expiratory flow limitations?

ozij wrote: ↑

Tue Sep 05, 2023 12:12 am

The first thing I'd do, if these were my results would be to use the machine as it was used in the sleep study:
A fixed pressure of 10, no EPR.
If you find that change too uncomfortable, reduce the EPR gradually, first to 2 then to 1 then to 0. Give yourself time to get used to each change.

Ok sounds good, I will gradually try to do this

knarf wrote: ↑

Tue Sep 05, 2023 7:47 am

ozij wrote: ↑

Tue Sep 05, 2023 12:12 am

Your flow limitations are negligible

I can trust that you are correct on this, but for my information may I ask how you determined that my flow limitations are negligible?
I see that there is a flow limitation graph in OSCAR, but I have no idea how mine ranks. And the shape of my patterns looks strange (class 5 according to some diagram I saw?) but I'm also unsure about the significance.

On the chart you posted, you can they appear rarely, they're not very high, and you can see this on the left side where is says flow limitations:
95% of the night they are at a score of 0.01 (of 1.0) or lower. They are at a score of 0.09 or higher for only 0.5% of the time you sleep. The score takes the shape / pattern into account.

Also, would you say that I have inspiratory or expiratory flow limitations?

I have no idea.

ozij wrote: ↑

Tue Sep 05, 2023 12:12 am

The first thing I'd do, if these were my results would be to use the machine as it was used in the sleep study:
A fixed pressure of 10, no EPR.
If you find that change too uncomfortable, reduce the EPR gradually, first to 2 then to 1 then to 0. Give yourself time to get used to each change.

Ok sounds good, I will gradually try to do this

Tell us how it goes - share the charts (good or bad) and be patient.

knarf wrote: ↑

Mon Sep 04, 2023 9:39 pm

palerider wrote: ↑

Mon Sep 04, 2023 9:31 pm

SEEMS, but your body simply did not want to breathe, did not *need* to breathe, because your CO₂ levels were low, when they built up, you started breathing again.

I know the machine uses some algorithm involving pulses of air to determine whether the event is a CA or an OA, but I'm wondering if there's any chance the algorithm could have made a mistake? How do I reassure myself that I didn't just have a 50 second obstructive episode, which I assume would very much need to be dealt with?

The machine doesn't pulse the air, it vibrates it, 4 times a second, that's the hashyness you can see on the flow graph, while the pressure graph stays pretty flat, if it were an obstructive, you'd see no flow, and you'd see the vibration in the pressure graph instead, plus, you wouldn't just gently start breathing again towards the end of it, you'd have a big gasp of a recovery breath at the end, and disturbed breathing for at least a few breaths until you went back to sleep.

ozij wrote: ↑

Mon Sep 04, 2023 10:17 pm

Because the algorithm was tested before the machine was given FDA approval.

It may tag central apneas as obstructives,

Only if the throat closes during the central, which can happen.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

palerider wrote: ↑

Mon Sep 04, 2023 9:27 pm

because they're not happening very often, it's not disturbing your sleep.

Yea it's not very often, but I did notice that on Aug31st (when my pressure was significantly higher at 10.2), I had a lot of central apnea events. I felt so awful on that day I'm almost afraid to try that pressure again, although I recognize it might be some coincidence.

Where did you reduce your EPR there? oh, right, you didn't.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

It seems like, based on the shape of my respiration, that my flow limitations were still not fixed at 10.2 of pressure. (Again please correct me if I'm wrong)[/quote\
Ok, you're wrong.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

Based on what you two are recommending, if I understand correctly, I should try bumping up the pressure right?
But then if I do that, how can I avoid a massive spike in CA events?

3 is not a "massive spike". a CAI of 20 would be a "massive spike".

Mountains out of molehils.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

I guess I still don't fully understand how flow limitations and CA events can affect one another

WHAT 'flow limitations'?

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

If I were to speculate

It would be better if you didn't. You're verging on hypochondria.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

And because my flow limitations lessened, my body was getting enough oxygen,

Flow limitations don't restrict oxygen.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

therefore it doesn't need to breathe as often, therefore increasing CA events?

Oxygen has nothing to do with CAs, or respiratory drive.

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

Could that be what happened?

NO!

knarf wrote: ↑

Mon Sep 04, 2023 10:23 pm

But if that's the case, then how come I felt so horrible waking up the day after Aug31st? If my flow limitations improved why did I feel worse?

And on the other hand, if my flow limitations actually did not improve, then what could be triggering my increasing in CA events that night?
I'm very confused about all of this. Anyways, would this new data point change your assessment of my situation?
Thanks!

:sigh:

knarf wrote: ↑

Tue Sep 05, 2023 7:47 am

ozij wrote: ↑

Tue Sep 05, 2023 12:12 am

Your flow limitations are negligible

I can trust that you are correct on this, but for my information may I ask how you determined that my flow limitations are negligible?

Have you actually *looked* at the charts you're posting?

knarf wrote: ↑

Tue Sep 05, 2023 7:47 am

I see that there is a flow limitation graph in OSCAR, but I have no idea how mine ranks.

Negligible.

knarf wrote: ↑

Tue Sep 05, 2023 7:47 am

And the shape of my patterns looks strange (class 5 according to some diagram I saw?)

You're seeing what you WANT to see, not what's there.

knarf wrote: ↑

Tue Sep 05, 2023 7:47 am

but I'm also unsure about the significance.

We're not.

knarf wrote: ↑

Tue Sep 05, 2023 7:47 am

Also, would you say that I have inspiratory or expiratory flow limitations?

You're just bound and determined to have something you don't, aren't you?

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

Where did you reduce your EPR there? oh, right, you didn't.

I did actually reduce my EPR , and I did so on the day after Aug31st, because the increase in the number of events on the 31st had me concerned.

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

WHAT 'flow limitations'?

These were the diagrams I saw which made me concerned.
https://www.apneaboard.com/wiki/images/ ... 148d1f.jpg
https://www.apneaboard.com/wiki/images/ ... lasses.png

I did actually look at my graphs before posting them, and I noticed that my respiratory patterns before I fell asleep were perfectly normal.
But after I fell asleep they began to resemble the abnormal graphs I saw on those diagrams.

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

Flow limitations don't restrict oxygen.

Honestly I'm confused again, don't flow limitations mean there's airway resistance and I'm not getting as much air?

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

3 is not a "massive spike". a CAI of 20 would be a "massive spike".

Yea I suppose I mischaracterized it. I suppose I meant relatively speaking, since my AHI on the 30th was 0.79 but my AHI on the 31st was 3.27
Probably still not a spike, but combined with the long duration of my CA events, it had me concerned.
Now I'm less concerned about this, given all the explanations you guys have provided, and they have been very helpful. But again I'm just providing context into my frame of mind in the past, when I had more limited knowledge and experience.

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

It would be better if you didn't. You're verging on hypochondria.

Yea sometimes I definitely do have hypochondria. I suppose sleep apnea has been bothering me for too long and I want to figure out why I'm tired asap.

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

Oxygen has nothing to do with CAs, or respiratory drive.

Right, but I thought CO2 does have an impact on CA's? Ozij had mentioned something about CO2 being expelled.
Whether oxygen or CO2, I was under the impression that breathing more does affect CA events? At least that's what I understood from the explanations of the other users. Maybe I'm just dense.. (and I'm not even being snarky here, I just don't care that much I guess, I'll ask what I need to)

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

:sigh:

I can understand why you might be frustrated, and I apologize if that means anything. I would definitely agree that I'm being impatient here, because I wanted to get out as much information as possible for the next time someone reads my replies. Meaning I type a block of text in which most of it is probably wrong since I have no feedback in between.

Oh well.. I honestly don't regret any of this though, since this is the first time I've gotten so many replies
All my previous threads either got no replies, or were not as illuminating as this one.
The three of you definitely have tons of experience, and I'm happy you guys decided to chime in.
Cheers

palerider wrote: ↑

Tue Sep 05, 2023 7:30 pm

You're just bound and determined to have something you don't, aren't you?

I am absolutely looking to have something . And if I'm wrong then so be it I guess. I'm still tired every day and something's bound to be causing it.
In total I haven't used CPAP for long, true, but my younger brother has used his CPAP under guidance from his sleep physician for almost a year.
And he has felt zero difference.

knarf wrote: ↑

Tue Sep 05, 2023 7:59 pm

I'm still tired every day and something's bound to be causing it.

You know that there is a mile long list of things that can cause fatigue and sleep apnea and/or airway issues is but one item on that very long list.

Also....people can have more than just one item on that very long list screwing up how they feel or wish they could feel.

BTW....I did vote in your poll. Pretty obvious what my choice was.

I know you are frustrated and grasping at straws here but you need to start looking elsewhere.
In your desire to find a problem (and fix it) you are making mountains out of molehills and the molehills aren't likely the main problem.

Hell you might just be one of those unlucky 20% who have persistent fatigue despite decent cpap reports and no one knows why.

Maybe you aren't getting enough good sound sleep...
Maybe you are waking frequently which sure messes with sleep quality...
Maybe some sort of medication side effect....
Maybe some other health condition (physical or mental) is a factor.
Lots of items on that mile long list could be the culprit(s).

Pugsy wrote: ↑

Tue Sep 05, 2023 8:15 pm

You know that there is a mile long list of things that can cause fatigue and sleep apnea and/or airway issues is but one item on that very long list.

Yes unfortunately there is a long list. I've had more blood tests than I can count to look for any alternative explanations.. testing for things like chronic viruses, endocrine problems, vitamin & electrolytes, different protein markers, genetic conditions, etc.. I won't get into all of it. I hope that given the context, maybe I don't sound as crazy anymore for trying to dig into sleep apnea so much.

Pugsy wrote: ↑

Tue Sep 05, 2023 8:15 pm

BTW....I did vote in your poll. Pretty obvious what my choice was.

Yea I somewhat expected that I was going to be misguided in many ways, so I made that an option in my poll.

Pugsy wrote: ↑

Tue Sep 05, 2023 8:15 pm

Maybe you aren't getting enough good sound sleep...
Maybe you are waking frequently which sure messes with sleep quality...
Maybe some sort of medication side effect....
Maybe some other health condition (physical or mental) is a factor.
Lots of items on that mile long list could be the culprit(s).

I would love to find out, and I'm asking the experts in various fields.
But here I'm on the CPAP board, and you guys are the experts, so I decided to only ask sleep apnea questions here.

I suppose I have awkward way of saying thank you lol. But at the same time I do need to explain myself somewhat.

No need to explain yourself. I see myself in you. I recognize some of the same frustrations and desires to have my cpap machine fix all my problems. Unfortunately it can't.. It can fix one thing only and that is stent the airway open and if your airway issues are NOT the cause of the fatigue or crappy sleep or whatever.....you won't be able to have the cpap machine fix a problem that isn't fixable by a cpap machine.
BTW even when we know the cause of rather crappy sleep it's not always a slam dunk to get it fixed and live happily ever after. Trust me...been there...done that and have the Tshirt to prove it.

Another BTW from a quick glance at some of your reports those centrals you are so fixated on are primarily arousal related and you were probably awake (you may or may not remember) and the centrals are a symptom of crappy sleep but not necessarily the cause of the crappy sleep. Your sleep looks a lot like mine looks...fragmented with arousals and the more arousals I have the crappier I feel that next day. After over 14 years on cpap I pretty much know what my stats are without ever looking. Always, always I know that any AHI I might see is going to be 75% arousal related and one time I had an AHI of 9.4 with 90% centrals (very unusual for me).

The machine doesn't know if you are asleep or not. It only measures air flow and it can and will sometimes mislabel one of the apnea events. I have seen it often but only with arousal related breathing.

Good luck in your quest. I am off to bed myself. Lots of stress in my life lately which compounds my other health issues messing with my sleep. I am worn out.

Anxiety really sucks.
At some point, one might seek the expertise of a mental health professional.
Misery until the problem is resolved.

chunkyfrog wrote: ↑

Tue Sep 05, 2023 9:06 pm

Anxiety really sucks.
At some point, one might seek the expertise of a mental health professional.
Misery until the problem is resolved.

To be honest I didn't really have anxiety about my sleep apnea for the longest time. Mostly just acceptance, especially considering my brother's experience. But after doctors gave me other tests and found nothing, I thought what hell, maybe it's sleep apnea, and decided to start doing some research and ask questions.
I'm not sure if anything will end with a mental health professional though, because I do have a fatigue problem and even if I do zero investigation the fatigue is still there. All I can say is that anxiety-wise I'm feeling fine right now, specifically ever since Ozij's last reply, since all their answers have been satisfactory enough for me. I would even say more than satisfactory.
My plan was to simply continue using CPAP the way Ozij had recommended and then report back maybe in a few months and see where things go from there.

To all the other experts reading this, no worries. I'm good. Now I'm basically just explaining why I thought the way I did in the past, which is not very productive. I don't regret it of course, since I'm simply learning something new, nothing wrong with that. But yea now it's done and I'm happy with the results of this thread.
But if I come back in a few months, I would welcome the help as always
Thanks everyone!

This is good.
Thank you for keeping us informed.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

I did actually look at my graphs before posting them, and I noticed that my respiratory patterns before I fell asleep were perfectly normal.
But after I fell asleep they began to resemble the abnormal graphs I saw on those diagrams.

not any that you posted, you're imagining things. Or maybe you want picture perfect breath shapes, and those just don't exist.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

Flow limitations don't restrict oxygen.

Honestly I'm confused again, don't flow limitations mean there's airway resistance and I'm not getting as much air?

No. that would be hypopneas. Where ever did you get the impression that flow limitations meant a reduced volume of air? because that is simply wrong.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

3 is not a "massive spike". a CAI of 20 would be a "massive spike".

Yea I suppose I mischaracterized it. I suppose I meant relatively speaking, since my AHI on the 30th was 0.79 but my AHI on the 31st was 3.27
Probably still not a spike, but combined with the long duration of my CA events, it had me concerned.

You can make anything look outrageous by playing with statistics.

0.2 to 1.0 is *FIVE HUNDRED PERCENT AS MUCH!!!* but it's still insignificant.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

Yea sometimes I definitely do have hypochondria. I suppose sleep apnea has been bothering me for too long and I want to figure out why I'm tired asap.

spinning yourself into a tizzy isn't going to get things any better any faster.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

Oxygen has nothing to do with CAs, or respiratory drive.

Right, but I thought CO2 does have an impact on CA's?

what did you just respond to? What did I just say?

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

Ozij had mentioned something about CO2 being expelled.
Whether oxygen or CO2, I was under the impression that breathing more does affect CA events?

See above. I tell you one thing, and you say "but someone else said *SOMETHING ELSE ENTIRELY!*

She and I are both 100% correct in what we said, the things we said are not in conflict with each other.

Go back and read again, and try to understand.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

, I just don't care that much I guess,

Well, if you don't care, it's going to become damned hard for US to care.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

palerider wrote: ↑

Tue Sep 05, 2023 7:25 pm

:sigh:

I can understand why you might be frustrated, and I apologize if that means anything. I would definitely agree that I'm being impatient here, because I wanted to get out as much information as possible for the next time someone reads my replies.

And we're back to what was pointed out about 90 people giving you garbage answers and 10 giving you good ones. If you really just want quantities of (probably) wrong answers, go to facebook or reddit. there's LOTS of people there that'll be happy to spew ignorance at you.

knarf wrote: ↑

Tue Sep 05, 2023 7:55 pm

Oh well.. I honestly don't regret any of this though, since this is the first time I've gotten so many replies
All my previous threads either got no replies, or were not as illuminating as this one.
The three of you definitely have tons of experience, and I'm happy you guys decided to chime in.
Cheers

Yes, irritating people is certainly one way to get more replies.