Grrr (AHI)

I know, I have a cold and shouldn't read into my numbers too much, but how can I have obstructive events that last 60 seconds? Does a head and chest cold really mess with the machine that much?

Here is a visual of what I am seeing.

Everything took place in a 30 minute window. What were you doing between 1:10 and 1:40 AM?

What pressure is being used? Looks like pressure was maxed out during that time frame. So for some reason the pressure wasn't enough to to deal with the events. Causes?
Supine position or REM super duper events maybe needed more pressure..
Or the cold symptoms ....
I can get clusters like this on a rare occasion with some really long events but usually not as many as I see with your report because I have my max at 20 (I use 10 min) and sometimes I might see a time frame where the machine goes to 18 or 19 and I can't blame it on leaks. I am documented much worse in REM sleep and often I see these increases in pressure in the wee hours of the morning like this when I probably am in a REM cycle. I assume REM related. I was not particularly worse when sleeping on my back.

I don't have time right now but I will try to look back on some of my reports and see if I can't spot one of my odd ball clusters. I don't have them every night.

Perry,

Good input from Pugsy. The only thing I wondered, seeing your pressure range looks like 4cm-14cm (I can't really read graph well), do you spend a lot of time at the low end of that range? Maybe your minimum is too low?

You had hardly any snore going on so that doesn't seem to be an issue. When I have obstructive events they are almost always related to snore.

Maybe just while you have a cold you can increase max to 20 to see if pressure will deal with these events? Seeing as you hovered around your max of 14 for quite a bit, if you increase it you will have room to go up in pressure if needed. If you are at 14 most of the time and you increase it, you will see if your true maximum is higher.

I don't really have experience with colds since I haven't had one in a few years, and only started cpap 6 months ago, but I might try a pressure increase if it were me. But I would defer to more experienced people like Pugsy if she suggests something different.

The aliens have landed.
Again!
Seriously, colds mess me up big time--I wouldn't be surprised.

My pressure range is 4cm - 14cm, and maybe I do need more pressure with the cold.

Here is a picture of the 8 hour window and as you can see I'm throwing events all over the place. It has been like this the entire time I have had my cold. On the flip side. the one night I had my CPAP without a cold, my AHI was around 5.5. I hope this is all from the cold, but until this clears up I really won't have a way to tell.

Maybe tonight I will increase the upper range to 20cm and see what happens. Scary that I am stopping breathing all these times, or could these be false readings?? I'm not sure what would cause them with the cold.

Also, how does one tell if they are in REM sleep without all the wires hooked up to you? Can it be figured out from the wave graphs?

Re: Frustrated

by Perrybucsdad on Thu Sep 22, 2011 11:49 am

Thanks everyone, that's all excellent advice. The type A person I am forgot the basics that I employ in my real job as a IT Systems Engineer. You make one change and see how that works over a burn in period. If you make multiple changes, it's hard to tell what affected what. I keep thinking of my body as a binary system, but it is made up of hundreds if not thousands of smaller systems that I sometimes don't have control over (i.e. my cold).

I'll go back to baseline and set my pressure to 7cm - 14cm with EPR off. I was trying the machine last night with EPR off and it wasn't that difficult with the pressure higher so I should be okay. Run with that for a week and then make adjustments based on a weeks data vs only one night's data.

Thanks again,

Perry, what happened to this plan?

Jay

Jay Aitchsee wrote:Perry, what happened to this plan?

I was wondering that myself when I saw that minimum of 4 cm. We had already determined it wasn't going to work.

Perrybucsdad wrote:Also, how does one tell if they are in REM sleep without all the wires hooked up to you? Can it be figured out from the wave graphs?

Not reliably from the wave patterns There is no sure fire way but one can closely look at normal REM patterns and see if the times sort of correlate and if in the sleep study the AHI was higher in REM a person can have a good idea.
In reality it doesn't really matter if you know for sure if REM or not...those clusters are unwanted.
If positional as in supine a person can try staying on their side to see if that alone deals with clusters.
If they are REM related we can't control REM and don't really want to. So we let the machine do what it is designed to do and even if supine sleeping events...let the machine do what it is designed to do if trying to stay on our side isn't working.

This is the beauty of the APAP..If pressure variations do not disturb sleep... let the machine do its job but we have to help it by having a good base point to start from... the minimum pressure.

Here at this link is a hypnogram that shows normal stages of sleep. First one usually comes around 90 minutes after sleep onset and as the night goes on we have more REM.. explains why things can sometimes be real ugly in the wee hours of the morning.
On right side below the kid sleeping. Not a huge image but you can see the cycles enough to get an idea.

http://en.wikipedia.org/wiki/Sleep

I don't remember how long you've been on CPAP, but I see you joined September 12. I would not give one apnea of 60 seconds a lot of weight. See how you're doing when your cold goes away. A cold affects everyone differently.
I agree with sticking to the plan you came up with.
Keep us posted. Get well soon.

Well, I went back to the range the doctor originally prescribed (4 -14) and figured I would let the machine take care of the rest.

The issue with the 60 sec event is there have been quite a few of those this past week. I haven't counted all of them out, but I would say at least a dozen in the 45+ second range (I count 4 alone last night).

So should I just not monkey with anything, or do I need to increase the min and or the max? I'm just really confused right now. I went into this with a positive attitude, but I did not plan on getting sick on the second day.

Thanks,

John

Minimum is most critical. Have to give the machine enough of a head start so it can get to those events that seem to need maybe 14 cm of pressure quickly enough. Simply takes too long to get there from 4 cm. Also with a little higher minimum the situation where those 14 cm events seem to pop up might even be prevented.

Your 7 to 14 range was a great place to start. Give it a few days sans the upper respiratory infection and then evaluate.
See if the max had been reached very much. See how many clusters are occurring..See how many 60 second events occur. See if maybe they are now mainly 15 second events. Even without having a cold we vary from night to night and can't be changing things every night. Needs a few days to a week unless there is something out of the ordinary pop up.

So, so frustrated... I just want to feel better and rested. Why isn't this working?

Here are my numbers from last night: