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Apparent Hyperventilation
#1
Question 
Apparent Hyperventilation
I have been using an Airsense Autoset 10 for 465 days, and have eliminated obstructive apneas >99% of the time, and generally have an AHI of less than one. The elimination of OAs was a simple change to sleeping on my stomach rather than my back.  Thank you ApneaBoard!!!

Using SleepyHead v 1.0.0-beta-2, simplus full face mask, EPR 3, min. pressure 11 cm, max. pressure 17 cm, with humidifier chamber with climateline air at 76%. My experience with low AHI mirrors many; still don't feel rested when I wake, and wake up at night for no apparent reason.

Looking for help and information about my apparent very high rates of respiration during the night's sleep.  This usually occurs in clusters, and is highest just before I wake up in the middle of the night. A typical chart is as follows:

As noted by many members, hyperventilation lowers the partial pressure of CO2 in the blood, and this causes a rise in blood pH according to the Henderson-Hasselbalch equation. The carbonic anhydrase enzyme that converts bicarbonate to CO2 and water has a very high/fast reaction rate. Prolonged hyperventilation and pH shift upward leads to conversion of the hemoglobin tetramer which is efficient at delivering oxygen to the tissues, to the hemoglobin dimer, which does not deliver oxygen as readily. I am wondering if the lower oxygen levels may be the cause of me waking up.

I have a great deal of respect for many of the experts in this forum who provide far more insight, technical information and help than my current Pulmonologist/Sleep Specialist.  Please weigh in on this hypothesis, and give me you take on the SleepyHead respiration charts.
Wink May the ZZZZs be with you.
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#2
RE: Apparent Hyperventilation
I don't believe those really high rates like >40 /min.

I've seen these machines false trigger. The BPM rate becomes an artifact of how the machine counts a cycle. I'd like to see high sample rate flow and pressure data zoomed in at one of these high BPM times.

Please post as a image link instead of an attachment. Too hard to get detail on attachments.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

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#3
RE: Apparent Hyperventilation
(06-07-2017, 06:34 PM)justMongo Wrote: I don't believe those really high rates like >40 /min.  

I've seen these machines false trigger.  The BPM rate becomes an artifact of how the machine counts a cycle.  I'd like to see high sample rate flow and pressure data zoomed in at one of these high BPM times.

Please post as a image link instead of an attachment.  Too hard to get detail on attachments.

Thanks for your prompt response.  Attached is a word document showing the data zoomed to a apparent high respiration rate time period.
Wink May the ZZZZs be with you.
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#4
RE: Apparent Hyperventilation
(06-07-2017, 06:00 PM)JAR14 Wrote: My experience with low AHI mirrors many; still don't feel rested when I wake, and wake up at night for no apparent reason.

I'll let others who are more knowledgeable address the respiration rate issue.

Having a low AHI is definitely good, but it's not the whole story. You also have to be compliant, meaning you use the machine every time you sleep, all the time you are sleeping. And the other issue is leaks. Just because you have good leak statistics doesn't mean you necessarily have your leaks under control. You need to look at the leak rate graph and hopefully see a nice low leak rate that stays low all night long. Any spikes should be just a few seconds long at most due to a misaligned mask.

Waking up at night is frustrating. The clinical term is fragmented sleep. I had it really bad, which is what prompted me to see a doctor and get diagnosed with sleep apnea. That was more than five years ago. Since that time the condition has slowly improved. There are still some nights where I wake up and can't get back to sleep, but there are also nights where I sleep through. You just have to be patient, realize it's a normal condition because being concerned about it can only make it worse, and do as you're doing now, which is trying to understand your data and optimize your therapy. Remember that you likely spent decades with untreated sleep apnea, which conditioned your body keep waking during the night so you could breathe.
Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Apparent Hyperventilation
Sorry about the Word document.  Hopefully the images will load.


[attachment=3545][attachment=3546][attachment=3547][attachment=3544]
Wink May the ZZZZs be with you.
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#6
RE: Apparent Hyperventilation
Your response is very encouraging.  The endpoint objective of using a CPAP is to provide a tool that allows one to sleep and feel rested and refreshed in the morning. Its use to achieve a low AHI really means nothing if your sleep habits are poor and inconsistent. I have a sleep preparation routine which has helped greatly in relaxing and allowing me to fall asleep quickly. The FP simplus full face mask is very comfortable, and my leak rates are very low and the most difficult part of using the CPAP system was to learn to always sleep on my stomach. If I have an occasional night where obstructive apneas are recorded, I know that I spent some time sleeping on my back. 

Your advice to persist and be patient is very well received.  It's really good to hear that others with the same sleep fragmentation are making good progress. This forum provides an enormous amount information and valuable resources for people struggling to get a good night's rest. Thank you, thank you, thank you.

Perhaps the pulmonologists and sleep specialists should visit this site to educate themselves so they can actually help their patients.
Wink May the ZZZZs be with you.
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#7
RE: Apparent Hyperventilation
Your flow rate is very "ragged". Looking below at pressure you can see your fundamental breath rate; followed by a trigger back to EPAP that shouldn't happen. I do not believe you are hyperventilating (high BPM). The BPM count is being doubled and tripled. We need to figure out what is causing that ragged flow rate. Every zero crossing (minus to plus) in the flow is counted as a breath. The count is an artifact of that; and is not real. Your true rate is in the teens.

So, what does the corresponding snore and flow limitation graph look like. I think, as a guess, that you are snoring.
Probably not enough EPAP pressure. From you graphs, I deduce you have EPR set to 3. You could reduce EPR. Then your EPAP pressure would be higher; and might fix that expiratory flow wiggle.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#8
RE: Apparent Hyperventilation
as well as trying to adjust your CPAP, That looks pretty rough to me, I'd get to a doctor without delay for a check up
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min at 'med' median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#9
RE: Apparent Hyperventilation
I have seen similar traces.  since you have included the mask pressure, you can see that the machine thinks you are initiating a new inhale so it tries to assist by raising the pressure.  your body submissively allows itself to inflate a bit, and then naturally relaxes and exhales this.  (realize that during sleep your body 'passively' exhales not through activating muscles - it just deflates. but, the brain plus body initiates inhale by muscle energizing, thus 'actively' inhales.)

I have heard of this phenomenon called a CPAP bump. [edited: actually it was called CPAP bounce.]

So, the body is really getting slight inhales between your body's initiated breaths.  I don't know if the result is less successful or less effective sleep.

In cases like this, reduction of EPR is generally helpful.  I agree that changing EPR from 3 to 2 should help somewhat.  Along with the change in EPR of 1 cm, suggest reduction of the min pressure to 10 vice 11 (because the exhale pressure would therefore be controlled at the same level [8 cm] which seems effective for OA control)

QAL

p.s. also, your machine may have a response sensitivity, and it may be set to fast, versus medium.  moving it to medium may have a similar effect.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#10
RE: Apparent Hyperventilation
(06-07-2017, 08:25 PM)JAR14 Wrote: Your response is very encouraging.  

Thanks. The biggest obstacle to success is failure to comply, and the best remedy for that is support groups. These are clinically established facts. So that's the reason we're all here, to provide that kind of support for each other.

Quote:The endpoint objective of using a CPAP is to provide a tool that allows one to sleep and feel rested and refreshed in the morning.

That's perhaps the strong version of the objective, whereas the weak version would be to keep you breathing while you're sleeping so that you can achieve the strong version.

Quote:Its use to achieve a low AHI really means nothing if your sleep habits are poor and inconsistent.

Well, even if you get some sleep with a low AHI that is better than no therapy at all, especially if you have severe sleep apnea. If you've ever watched a person with severe sleep apnea snooze, like perhaps while watching a boring movie, you can see that they don't really get any sleep at all. They nod off in between breaths, having to wake up to take each and every breath. When you ask them about it they have no memory of doing it.

Quote:I have a sleep preparation routine which has helped greatly in relaxing and allowing me to fall asleep quickly.

That's an example of what's called good sleep hygiene.

Quote:Your advice to persist and be patient is very well received.  It's really good to hear that others with the same sleep fragmentation are making good progress. This forum provides an enormous amount information and valuable resources for people struggling to get a good night's rest. Thank you, thank you, thank you.

You're welcome. Most of us know what you're going through because we went through it, too. And the encouragement is a key part of the support structure.

Quote:Perhaps the pulmonologists and sleep specialists should visit this site to educate themselves so they can actually help their patients.

You know, mine listens to me, and seems receptive, but she makes the excuse that her employer will not allow her to install the software she'd need to do that on her computer. Her assistant reads the SD card and prints out a summary. She admits that the summaries from the Respironics machines (using Encore) are much better than the summaries from ResMed machines (using ResScan). Those summaries might be helpful for someone whose therapy is lousy, but those of us trying to optimize they're pretty much useless.

It's hopeless! I have to do my own research, explain to her the reasoning I'm using to reach my conclusions, and she does provide help when we discuss that.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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