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Breathing Stops When First Falling Asleep
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Tommy C Offline

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Post: #11
RE: Breathing Stops When First Falling Asleep
(08-15-2012 05:13 PM)Sleepster Wrote:  Then it's not due to high pressure. Your machine should be left at the same 4-20 pressure range prescribed by the doctor. You need to try to get used to the mask by wearing it while you're awake.


Yep, I definately need more hours in the mask during the day. At night I feel like I'm buried and breathing thru a straw.... Oh-jeez

Hope the S9 works. I see the ResMed VPAP Adapt SV for central apnea has dropped in price from about $6K to $3K. It looks like the same thing as the S9 on the outside. I'm paying out of pocket so it would hurt to upgrade.

Will let ya know how it goes over the next few nights. The carrot is getting all this fun data to view the next day.

T
08-15-2012 05:55 PM
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Tommy C Offline

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Post: #12
RE: Breathing Stops When First Falling Asleep
I did some interesting tests today...

With the auto pressure running at the minimum 4cm, I worked at my desk with the mask on for 45 minutes. I paid no attention to my breathing and focused on computer work. In that time I had 9 central apnea events lasting between 11 and 15 seconds. This produced an AHI of about 10. The pressure remained constant at 4cm, which is good.

I then held my breath twice for 60 seconds and the S9 labeled them both as OSA events. This pushed the AHI up to about 13. The pressure jumped up from 4 to about 9.3cm. If this was a CA event, I imagine increasing the pressure would be the wrong thing to do. Should holding the breath for one minute be technically classified as a CA or OSA event?

I wonder if anyone else has tried this "awake test" with a low pressure to simulate normal breathing to see if they have any short, waking CA events? I'm starting to wonder if I am hard-wired for CA events whether awake or asleep.

Tom
(This post was last modified: 08-15-2012 09:03 PM by Tommy C.)
08-15-2012 08:59 PM
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Sleepster Offline
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Post: #13
RE: Breathing Stops When First Falling Asleep
(08-15-2012 08:59 PM)Tommy C Wrote:  With the auto pressure running at the minimum 4cm, I worked at my desk with the mask on for 45 minutes. I paid no attention to my breathing and focused on computer work. In that time I had 9 central apnea events lasting between 11 and 15 seconds. This produced an AHI of about 10. The pressure remained constant at 4cm, which is good.

So that proves that when you're concentrating on something, you stop breathing. That's very common. Nothing unusual about that.

Quote:I then held my breath twice for 60 seconds and the S9 labeled them both as OSA events. [...] Should holding the breath for one minute be technically classified as a CA or OSA event?

It would be a OA rather than a CA because your airway was (intentionally) blocked.

The machine sends pressure pulses down your airway during an apnea in an attempt to see if your airway is obstructed. If obstructed, it scores a OA, if not it scores a CA.

Quote: I wonder if anyone else has tried this "awake test" with a low pressure to simulate normal breathing to see if they have any short, waking CA events? I'm starting to wonder if I am hard-wired for CA events whether awake or asleep.

To some extent you are, but the good news is that you didn't do this during your sleep study, so when you are fully asleep you don't do it. When dozing off, maybe you do. It's weird, though, that it lasted so long that one time last night. Need more data!

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.
08-15-2012 10:06 PM
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vsheline Offline

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Post: #14
RE: Breathing Stops When First Falling Asleep
(08-15-2012 05:55 PM)Tommy C Wrote:  At night I feel like I'm buried and breathing thru a straw....

When I started APAP a few years ago, my sleep tech initially set my minimum pressure to 6 (with max of 20), and after a week I asked him to raise the min to 8 (he did, of course), and a week after that I had him raise it to 9. Too low pressure makes me feel like I am suffocating, horribly annoying. I like to have the machine help me breath in. (One of the reasons I never use the ramp feature.)

If you have a hard time, you might want to suggest to your doctor or sleep tech to raise the minimum pressure to 6. I also suggest asking for your your max pressure to be lowered to 15 or so, unless/until your data shows you occasionally need more than 15, and high pressure does not increase your incidence of CA very much.

By the way, 4 cm H2O is the lowest allowable minimum pressure for the S9 Autoset, and EPR (pressure reduction during exhalation), even if enabled, will never lower the pressure below 4. But, if EPR is enabled and you have obstructive events which cause the machine to raise your pressure above 4, EPR would start to operate and would make it easier to exhale while the pressure is higher than 4.

Especially if your minimum pressure is increased above 4, I suggest asking your doctor or sleep tech to also set the EPR to "Full Time" and "Patient" so you can experiment with it to see if it helps you to fall asleep more comfortably and stay asleep longer, but I would suggest setting the EPR to not more than 1 for at least the first few days.

Take care.

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.
(This post was last modified: 08-16-2012 02:27 AM by vsheline.)
08-16-2012 02:24 AM
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EyesWideOpen Offline

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Post: #15
RE: Breathing Stops When First Falling Asleep
I agree with vsheline about raising the low pressure to at least 6. I found 4 way too low; like I wasn't getting enough air. It may not take care of the CA, but If nothing else it should make you more comfortable with the mask while you're awake.
08-16-2012 06:06 AM
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Tommy C Offline

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Post: #16
RE: Breathing Stops When First Falling Asleep
(08-16-2012 06:06 AM)EyesWideOpen Wrote:  I agree with vsheline about raising the low pressure to at least 6. I found 4 way too low; like I wasn't getting enough air. It may not take care of the CA, but If nothing else it should make you more comfortable with the mask while you're awake.

Yes, I agree with both of you. I had already raised the min pressure to 6cm yesterday, for those reasons.

Well, got a full set of data for 8 hours sleep last night. The AHI is maybe 50% better than the sleep study, but still not acceptable so far.

Seems the pressure varied between 6 to as high as 16, my max setting. The AHI was between 18-24 overall. SleepyHead shows the OSA seemed to be REASONABLY better above 15cm - however the CA events were overwhelming and dominated the events with no effect from pressure. There were CA events lasting as long as 90 seconds... [gag]

I see many patterns that suggest I need to sleep on my side. There was one time slot (45 minutes) where there were NO events at all. Beautiful sleep. Then there were times with mixed CA and OSA events every minute for an hour.

I will continue to experiment with this and let my body adapt. Maybe it will take a few weeks of fine tuning, though the CA still has me concerned. At least I got by the hump of sleeping the whole night with the mask on.

The CA events occur both when the pressure was at 6 or as high as 16 - no correlation that I can see. It appears I will be talking to the boys about a possible upgrade to an S9 Adapt - servo ventilation machine that specializes in central apnea. The CA was about 60% of the events pie chart, so is significant. [sigh]

I'm determined to get these overall AHI numbers below 5, whatever it takes.

T
(This post was last modified: 08-16-2012 01:04 PM by Tommy C.)
08-16-2012 12:59 PM
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jfmusil Offline

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Post: #17
RE: Breathing Stops When First Falling Asleep
You may want to check and adjust your "ramp" time. It may be set for the standard 40 minutes ramp time. I have reset mine to 15 minutes.
08-16-2012 02:24 PM
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Sleepster Offline
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Post: #18
RE: Breathing Stops When First Falling Asleep
(08-16-2012 12:59 PM)Tommy C Wrote:  I will continue to experiment with this and let my body adapt. Maybe it will take a few weeks of fine tuning, though the CA still has me concerned. At least I got by the hump of sleeping the whole night with the mask on.

Congratulations. That's awesome! Congrats

I agree that you should let your body adapt. If your AHI stays above 5 for over a week I'd definitely discuss the situation with your doctor.

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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.
08-16-2012 04:13 PM
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Tommy C Offline

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Post: #19
RE: Breathing Stops When First Falling Asleep
(08-16-2012 02:24 PM)jfmusil Wrote:  You may want to check and adjust your "ramp" time. It may be set for the standard 40 minutes ramp time. I have reset mine to 15 minutes.

Good point, since CA can be common while falling asleep and the pressure should be at the minimum to help it along at that time.


Thanks, Sleepster... :-) I took your suggestion and took a sleeping pill. I usually avoid drugs of any kind, but you were right about the anxiety causing the panic problem.

*** Well, I talked to the sleep clinic tech today and he thought I may be a candidate for an upgrade based on the latest data. I will get a week's more data and the sleep doctor will evaluate my S9 data, compare it to their sleep study data and if he agrees, write out a new prescription for a VPAP SV or BiPap machine. The sleep study also showed a large concentration of CA - just like SleepyHead does now.

He will program the VPAP machine since the parameters are supposedly much more complex and tailored for central apnea. This is something where they MUST have a prescription, unlike the CPAP machines that generally slip by.

I'm looking to upgrade to either an S9 VPAP Adapt servo-ventilation machine OR maybe a ResMed BiPap of some kind. I was told the ResMed has finer parameter adjustments. Anyone have a preference or bias towards either - or can recommend another? I may be looking for a deal on a used one if I can find one.

I see several folks on the board using them. I would love to hear any stories of how they may have helped your central apnea problem and if you might have had limited overall AHI results with a CPAP or APAP....

Tom
(This post was last modified: 08-16-2012 04:24 PM by Tommy C.)
08-16-2012 04:16 PM
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Tommy C Offline

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Post: #20
RE: Breathing Stops When First Falling Asleep
Interesting reading below. The central apnea study below, by the Mayo Clinic, has certainly given me more hope about using an ASV machine. (servo-ventilation or VPAP by ResMed)

I am seeing similar results as shown - the APAP is suppressing the OSA events, but the remaining CA events are still there, thus, a lower AHI, but still not good.

Tom

---------------


Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes.

Allam JS, Olson EJ, Gay PC, Morgenthaler TI.


Source

Division of Pulmonary and Critical Care Medicine and Mayo Clinic Sleep Disorders Center, 200 First St SW, Rochester, MN 55905, USA.


Abstract

BACKGROUND:

Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV.

METHODS:

Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center.

RESULTS:

ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive apneas decreased, but the appearance of central apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AHI to a mean of 5 events per hour (range, 1 to 11) vs baseline and vs CPAP (p < 0.0001). ASV also resulted in an increase in rapid eye movement sleep vs baseline and CPAP (18% vs 12% and 10%, respectively; p < 0.0001). Overall, 64 patients responded to the ASV treatment with a mean AHI < 10 events per hour. Of the 44 successful survey follow-up patients contacted, 32 patients reported some improvement in sleep quality.

CONCLUSION:

The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.
08-16-2012 05:24 PM
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