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AHI that varies GREATLY daily - CSR and Periodic breathing
#11
Rich, couldn't the clusters of apneas also be caused by REM sleep? Some people have much more obstruction in their airway during REM sleep than during NREM sleep. I can't tell just from looking at the graphs, of course, but Daisy may know from her sleep study if she had a lot more events during REM sleep.
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#12
(06-28-2016, 09:21 PM)green wings Wrote: Rich, couldn't the clusters of apneas also be caused by REM sleep? Some people have much more obstruction in their airway during REM sleep than during NREM sleep. I can't tell just from looking at the graphs, of course, but Daisy may know from her sleep study if she had a lot more events during REM sleep.

It would be worth a look at the sleep study to check that idea out. My suspicion is that Daisylouu is having issues with her palate and or collapsed airway when she is facing upwards.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#13
So what exactly do I look for as far as wave forms / flow / etc. etc. in the areas where I have CSR?
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#14
(06-29-2016, 10:20 AM)Daisylouu Wrote: So what exactly do I look for as far as wave forms / flow / etc. etc. in the areas where I have CSR?

Your Obstructive clusters are what are of most concern to me. If you look at these groupings and at the Flow Rate during these periods, a lot more flow is occurring than when you are breathing normally. That doesn't mean that you don't stop breathing. It means that you are being stimulated to breathe more deeply when you can breathe. This pattern could be causing a bit of hyperventilation which could lead to Periodic Breathing and CSR. If you can eliminate those Obstructive clusters I think everything else will settle out.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#15
Okay. First you have a lot going on as you of course already know. I had different things, but my Doctor was reacting about the same. I would bring in sleephead printouts and he would look at them in my had and say "what's that?" and not take them. By the end of the visit he would indeed take them, but that never helped in the end. He finally referred me to a pulmonologist that did Dx me with COPD and that helped a lot, but was not all I needed.

Sorry but many Doctors just don't go past the basics of SA. Your Doctor most likely will not have seen sleepyhead graphs, and it can be a lot to take in "on the spot" in front of a patient.

1. You have snoring, that usually indicates that the low pressure is too low. This is also true for hypopneas.

2. my guess about why body position keeps coming up is that one of your plots is very stable after a rough start and a rough end. Sleeping in a "good" position? and the other is unstable all night, "bad" position? well that could be going on, we do all kinds of things while sleeping that we don't know about because we are asleep. I just did a search and there are several time lapse apps for android phones and I assume also for apple products that you could use to find out how "quiet" you are while sleeping. Now this could be the cause of the problem, or it could be your reaction to the problem. If you are quiet on good and bad nights, then it rules out sleeping position. Just don't get an app that auto up loads to youtube Smile

If it were me I would first focus on decreasing my snoring and hypopnea's by increasing (slowly) my lower limit and see if I got better control without causing more centrals (clear airway) on my good nights

Next I would get ready to address my Doctor. They tend to like numbers, sometimes. "I spend xx nights of of xx with CSR above x.x" How many nights are good verses bad? exact numbers, not "it feels like". Have a print out that shows representative nights for each.

I would like to see some close ups of the two nights posted . The 26th could be sleep/wake junk depending on how long it takes you to go to sleep and wake up. I would like a close up of the good are just to see what your "normal" breathing is like.

The a close up of the other graph showing 5 minutes around 2am, find an "interesting" area that show something that is not your "normal".

Your leak rate on the "bad" night looks to be much higher than the "good" night, but you also have higher pressure then. Are you getting flags for mask leaks?

How is your access to Doctors? long drive? Pretty much on one is around? In a major city and have your pick of many?



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#16
I do not move during the night, I am in a recliner in the same position, I may turn head from left to right or my chin up or down, but that would be the extent of "moving". That's what has me so puzzled with the obstructions. I did see an allergist who told me my throat is very small and the back of my tongue thick which could add to my obstruction, but a surgery for that kind of thing would not be suggested.

I do tape record my self on my ipad, that is how I first suspected apnea, because I was snoring like a champ. Most nights I am very quiet, very rarely does it pick up a snore.

My machine never flags leaks.

During my sleep study I don't remember them telling me it was worse during REM sleep, but again, they don't tell me much. I do feel like I have breathing difficulty in general, even during waking, I've never been a good "breather" swimming or doing yoga, etc.

I did see a pulmonologist, it is his nurse practitioner who follows me from my sleep study. I live in a rural area, but travel over an hour away to see this group of doctors and had my sleep study in a fairly large and respected hospital in Pennsylvania.

I think I will try to email the nurse practitioner again and tell her of my concerns. She usually just keeps telling me that some people never get good results, my original sleep study was around 32AHI? and they consider it "success" if they cut it in half?

I just really feel tired, and am concerned of my overall health, which I feel much worse than I should for my age.

I truly appreciate your help because I feel like no one is listening to me or guiding me.

I'm not very Sleepyhead literate, nor computer literate.......but I will try to post closeups....which closeup gets the best info? flow rate? tidal?
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#17
Flow rate. left click in the graph area and it will zoom in where you click, left/fright arrow on keyboard will move it left or right.

Recliner pretty much rules out different positions causing the variation.

The stats does show snoring which CPAP should stop if set to the right pressure. If you don't feel comfortable doing this then the NP should be able to do this remotely. If you want to do it get the clinicians manual for your machine and it will tell you how to do it. Just remember small changes, 1cm or less at a time so you slide into the new pressure. You might ask the NP if it's okay if you raise the minimum pressure, my Doctor finally said I can change anything I want.

Insurance says success is <5 AHI and not cut in half. It sounds like they have run out of things to try. ( we have not Smile


Any reason to think you may have COPD? That can cause trouble breathing while awake.

"throat is very small and the back of my tongue thick" CPAP should be able to deal with this, but it may take higher pressure.
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