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Apnea event durations
#1
Is there a generally accepted duration for apnea and hypopnea events above which the events should raise a concern?
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#2
I'm not sure if there is a standard set duration, I'm sure there is but in my opinion, any event regardless if it was 1 second or longer is concern enough. The machine will recognize an event lasting 10 seconds to flag it as an event but events can go on for more than a minute.


Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie

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#3
If you see an event followed by recovery breathing, several breaths with noticeably larger volume, then your body is paying an oxygen debt. The recovery breathing is a hint to the extent of O2 desaturation. Obviously longer is worse, and the only way to really quantify that is oximetry data.
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#4
(02-19-2016, 02:09 PM)stanleydean Wrote: Is there a generally accepted duration for apnea and hypopnea events above which the events should raise a concern?

I just logged on to ask the same question.
I was looking back through my data and most events I have are under 15 sec.
I had one night that I only had 2 events, both obstructive and back to back.
The first was 66 sec long followed by one for 18 sec. Right before this happened I had a series of large leaks.
This seems like a long time to me, but don't really know how to interpret this.

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#5
(02-19-2016, 03:03 PM)I_will_never_sleep_again Wrote:
(02-19-2016, 02:09 PM)stanleydean Wrote: Is there a generally accepted duration for apnea and hypopnea events above which the events should raise a concern?

I just logged on to ask the same question.
I was looking back through my data and most events I have are under 15 sec.
I had one night that I only had 2 events, both obstructive and back to back.
The first was 66 sec long followed by one for 18 sec. Right before this happened I had a series of large leaks.
This seems like a long time to me, but don't really know how to interpret this.

Hi I_will_never_sleep_again,

In my view anything longer than 45 seconds is a problem worth discussing with the doctor, but I think some doctors are not alarmed unless an apnea lasts closer to twice that long.

In my experience, central apneas are usually far less of a strain on the body than obstructive apneas. With a central apnea not caused by paralysis or injury, as soon as we get the urge to breathe, we do, usually without much stress.

Your profile says you are using less than your prescribed pressure. If you are using less than your prescribed pressure, it is probably very important to avoid your worst sleeping position, which for most of us usually is rolling flat onto our back while asleep.


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#6


[/quote]

In my view anything longer than 45 seconds is a problem worth discussing with the doctor, but I think some doctors are not alarmed unless an apnea lasts closer to twice that long.

In my experience, central apneas are usually far less of a strain on the body than obstructive apneas. With a central apnea not caused by paralysis or injury, as soon as we get the urge to breathe, we do, usually without much stress.

Your profile says you are using less than your prescribed pressure. If you are using less than your prescribed pressure, it is probably very important to avoid your worst sleeping position, which for most of us usually is rolling flat onto our back while asleep.
[/quote]

Thanks for the comment.
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#7
(02-20-2016, 02:10 AM)vsheline Wrote:
(02-19-2016, 03:03 PM)I_will_never_sleep_again Wrote:
(02-19-2016, 02:09 PM)stanleydean Wrote: Is there a generally accepted duration for apnea and hypopnea events above which the events should raise a concern?

I just logged on to ask the same question.
I was looking back through my data and most events I have are under 15 sec.
I had one night that I only had 2 events, both obstructive and back to back.
The first was 66 sec long followed by one for 18 sec. Right before this happened I had a series of large leaks.
This seems like a long time to me, but don't really know how to interpret this.

Hi I_will_never_sleep_again,

In my view anything longer than 45 seconds is a problem worth discussing with the doctor, but I think some doctors are not alarmed unless an apnea lasts closer to twice that long.

In my experience, central apneas are usually far less of a strain on the body than obstructive apneas. With a central apnea not caused by paralysis or injury, as soon as we get the urge to breathe, we do, usually without much stress.

Your profile says you are using less than your prescribed pressure. If you are using less than your prescribed pressure, it is probably very important to avoid your worst sleeping position, which for most of us usually is rolling flat onto our back while asleep.

Using SleepyHead and CMSD50+ to monitor, I am experiencing many long obstructive apneas of >45 seconds, and some well over 60 seconds. The oxygen saturation can be seen to drop during these long no breathing periods. AHI last night was 24 with obstructive apneas at 124 and 37 of these greater that 50 seconds. The AHI seems to be getting worse as I try to approach 16 cm pressure specified by the sleep specialist. I am currently at 15 cm max, and 13.5 cm min. Has anyone experienced this type of apnea increase going up to higher pressures? Should I be concerned about the drops in SpO2 (78 events, average duration 100 sec) which go below 93? Sleep specialist does not believe in SleepyHead monitoring, and blew off the data when I showed the results on my laptop in his office. Any suggestions/comments would be appreciated.
Wink May the ZZZZs be with you.
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#8
(02-20-2016, 11:34 AM)JAR14 Wrote: . . . Sleep specialist does not believe in SleepyHead monitoring, and blew off the data when I showed the results . . .

I appreciate a specialist being frustrated looking at the data stream coming out of sleepy head and trying to address the concerns that some patients will have, many of which are based on a lack of education and understanding.

I have no appreciation for any doctor that looks at any data, no matter how detailed and/or misinterpreted it may be, that then blows it off without a meaningful explanation as to why it is unimportant and what a viable alternative approach may be.

My opinion: Demand responsible feedback from your doctor addressing your concerns (no matter how naive or misinformed they may or may not be) or get another doctor!!
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#9
(02-20-2016, 11:34 AM)JAR14 Wrote: Using SleepyHead and CMSD50+ to monitor, I am experiencing many long obstructive apneas of >45 seconds, and some well over 60 seconds. The oxygen saturation can be seen to drop during these long no breathing periods. AHI last night was 24 with obstructive apneas at 124 and 37 of these greater that 50 seconds. The AHI seems to be getting worse as I try to approach 16 cm pressure specified by the sleep specialist. I am currently at 15 cm max, and 13.5 cm min. Has anyone experienced this type of apnea increase going up to higher pressures? Should I be concerned about the drops in SpO2 (78 events, average duration 100 sec) which go below 93? Sleep specialist does not believe in SleepyHead monitoring, and blew off the data when I showed the results on my laptop in his office.

When showing your sleep doctor data from your machine, it may help to use reports printed using the manufacturer's program, ResScan in your case. These are professional programs he may be familiar with. But, on the other hand, SleepyHead is better because it is able to show the SpO2 and pulse data conveniently time aligned to the CPAP machine's data.

But if your doctor was unwilling to take the time to look closely at the machine's data, perhaps his issue was that the machine was set lower than the prescribed pressure, so of course it's reporting problems?

Those frequent long obstructive apneas are a serious problem which will surely ruin your health if not prevented.

I suppose the long obstructive apneas are not occurring during times of very large Leak, when your machine is unable to maintain its target pressure?

If not, then my guess would be that the higher number of obstructive apneas when using higher pressure settings may be caused by an unnoticed change, such as while asleep rolling more frequently into a worse position.

Obstructive Sleep Apnea is usually strongly positional, and some of us need to take precautions to prevent rolling onto our back while asleep. Some have found great benefit in wearing a light knapsack to bed filled with something light but bulky. Others wear a teeshirt with a couple tennis balls in a sock or pockets sewn on the back, along the spine between the shoulder blades or higher. Others place long body pillow(s) under the sheet to help keep them on their side. Others, who may be unable to sleep on their side, sleep in a comfortable reclining chair or adjustable bed, so their head and neck are aligned but elevated. Whatever it takes.

If guarding against sleeping in a worse position is not successful in preventing those frequent long obstructive apneas, then I would think higher pressure settings would be needed, such as raising the Min Pressure and Max Pressure.

Also, perhaps lowering EPR may help. Higher EPR usually makes it easier to exhale, but may increase the likelihood of obstructive apneas starting after exhalation has finished but before inhalation has started, while the pressure is still low.

It appears that you have been struggling to raise your pressure settings to your prescribed pressure.

I use high pressure settings, and I am a mouth breather using a full face mask. I find I must use a mask liner to control leaks and eliminate mask burping/fluttering/trumpeting.

I wish that ResMed would have displayed greater concern for patient welfare by including the gentler AutoSet For Her treatment algorithm as an option in the standard A10 AutoSet, but unfortunately they did not. I think many men might find they would have fewer issues with leaks and with air swallowing and rapid pressure swings if given the choice of using the For Her algorithm.

Take care,
--- Vaughn


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#10
(02-20-2016, 12:57 PM)nsherry61 Wrote:
(02-20-2016, 11:34 AM)JAR14 Wrote: . . . Sleep specialist does not believe in SleepyHead monitoring, and blew off the data when I showed the results . . .

I appreciate a specialist being frustrated looking at the data stream coming out of sleepy head and trying to address the concerns that some patients will have, many of which are based on a lack of education and understanding.

I have no appreciation for any doctor that looks at any data, no matter how detailed and/or misinterpreted it may be, that then blows it off without a meaningful explanation as to why it is unimportant and what a viable alternative approach may be.

My opinion: Demand responsible feedback from your doctor addressing your concerns (no matter how naive or misinformed they may or may not be) or get another doctor!!
Thank you nsherry61. I was treading lightly in presenting the SleepyHead daily results because I expected a more receptive response. I will regroup and be more assertive with the sleep specialist. Perhaps he was embarrassed about his lack of knowledge of the data generated by SleepyHead. This software is extremely useful and powerful in generating information about you sleep apnea.
Wink May the ZZZZs be with you.
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