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Breathing Stops When First Falling Asleep
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Tommy C Offline

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Post: #31
RE: Breathing Stops When First Falling Asleep
(08-17-2012 01:04 PM)SuperSleeper Wrote:  
(08-17-2012 12:25 PM)Tommy C Wrote:  As I mentioned, using the prescribed 4-20 cm/H2O pressure is causing up to 90 second long CA events, which is life threatening, thus my caution and wanting to consult the doctor with this data before proceeding.
Tom
Glad you're checking with the doc on this. That's a good thing to do.

A true Central event is a neurological event and your CPAP machine has no way to positively determine such an animal. This is not to say that all your Clear Airway events are not centrals; (but rather that you just can't assume that they are without the proper lab equipment).


Yes, I wondered the same thing, SS. Just how does the machine really know the difference? They have a air pulse system that supposedly tests by reflection, but then again, many of the CA events look much like OSA events on the chart, though labeled CA.

The only reason I lean to CA is because I have it happen all day - I simply "forget" to breathe and start feeling light-headed until I snap out of it. Always when focused on something. It doesn't hurt my performance - just an annoyance. I'm hoping this large attention I'm giving to breathing will help train my subconscious to learn a regular breathing pattern. We'll see.

I also notice that even at 15 cm/H2O, these events are not cleared out - they just go on and on, up to 90 seconds, thus my suspicion they are CA, not OSA. The prescribed setting of 20 cm max may change this.

I'll see what the doc says. In the meantime, I may try the prescribed 4-20 cm/H20 setting again tonight and see what the data shows. If the CA events are not killers and it shows a decent AHI, I will continue with it. I realize the body needs weeks to adjust.

But you know the old commercial warning - if you have an erection lasting more than 4 hours, see your doctor ... :-) Well I saw the equivalent on the charts so backed off.

Having the data is such a blessing. Many here have been able to tweak their AHI to under 1. I know I will have a more difficult time at it, but it will happen eventually, I'm determined.

I'll run the original prescribed settings again tonight and report back.

BTW, I feel GREAt today after that 7.4 AHI sleeping session last night. The apnea fog has diminshed, even after only one good night of sleep.

Tom
08-17-2012 03:51 PM
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Sleepster Offline
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Post: #32
RE: Breathing Stops When First Falling Asleep
(08-17-2012 03:51 PM)Tommy C Wrote:  I'll see what the doc says. In the meantime, I may try the prescribed 4-20 cm/H20 setting again tonight and see what the data shows. If the CA events are not killers and it shows a decent AHI, I will continue with it. I realize the body needs weeks to adjust.

If you realize the body needs weeks to adjust you'll leave the machine set at 4 - 20. Moreover, when you show the data to your doctor it'll mean something. Keep changing the setting like you have been and it makes the data far less meaningful.

If you are really concerned that the 90-second CA's are "killers" get an oximeter and see what happens to your oxygen level. The bottom line is that you have sleep apnea so you are going to experience apneas without the machine. The oximeter will let you see just how low your oxygen level goes then, too.

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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.
08-17-2012 05:12 PM
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PaulaO2 Offline
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Post: #33
RE: Breathing Stops When First Falling Asleep
Quote:The only reason I lean to CA is because I have it happen all day - I simply "forget" to breathe and start feeling light-headed until I snap out of it. Always when focused on something. It doesn't hurt my performance - just an annoyance. I'm hoping this large attention I'm giving to breathing will help train my subconscious to learn a regular breathing pattern. We'll see.

Central Sleep Apnea is called sleep apnea for a reason. It primarily only happens when we sleep. When you are awake, your body will automatically breathe without the brain having much to do with it. There are rare cases where it results in hypoventilating during the day but it is primarily newborns (Google Congenital Central Hypoventilation Syndrome, CCHS) and those with Cheyne-Stokes respiration and Rett Syndrome.

When I was a potter, I found I was holding my breath a lot and not knowing it. I sometimes would get dizzy and see stars. I was so into what I was doing, I guess. I do the same thing when I write or read. My breathing matches what I am doing. Same with computer games, meditation, etc.

My thinking is that you are getting yourself worked up. You are looking for monsters in the closet when there may not be any. But that's actually quite common! When I was first diagnosed, I was scared sh....silly. To think I held my breath while asleep for an average of how many seconds??? And how many times an hour??? Many of us have been there, done that.

It's good you're going to see your doc. Gather data, accurate data, by leaving the settings alone. Talk to the doc, tell him/her your fears, your thoughts, your concerns.

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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.
08-17-2012 06:04 PM
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Tommy C Offline

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Post: #34
RE: Breathing Stops When First Falling Asleep
(08-17-2012 05:12 PM)Sleepster Wrote:  If you are really concerned that the 90-second CA's are "killers" get an oximeter and see what happens to your oxygen level. The bottom line is that you have sleep apnea so you are going to experience apneas without the machine. The oximeter will let you see just how low your oxygen level goes then, too.


Yes, I plan on getting an oximeter once I settle on a permament machine. I wish I had one now, though.

How fast do they respond? IE, would the oximeter give a true O2 peak reading if there was a "short" 15 second apnea or does it give more of an average integration over 5-10 minutes of time, etc?


T
08-17-2012 06:08 PM
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Tommy C Offline

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Post: #35
RE: Breathing Stops When First Falling Asleep
(08-17-2012 06:04 PM)PaulaO2 Wrote:  My thinking is that you are getting yourself worked up. You are looking for monsters in the closet when there may not be any. But that's actually quite common! When I was first diagnosed, I was scared sh....silly. To think I held my breath while asleep for an average of how many seconds??? And how many times an hour??? Many of us have been there, done that.

Monsters in the closet - you got that right! Too-funny

Having an engineering background, I attack problems looking to eliminate all the incorrect general paths and then hopefully follow the right one and tweak to perfection. Yes, I can be impatient, no doubt.

You described the breathing exactly. Breathing depth and rate is totally governed by what I am working on and how involved. It's so difficult to get it even.

I was just looking at my best stretch of sleep last night - it lasted two hours - with no apnea events! The breathing was like a sine wave, perfectly regular and moderate. (actually a differential waveform) So it IS possible. Then came the CA events to spoil the party for 30 minutes... [sigh]

T
08-17-2012 06:17 PM
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Post: #36
RE: Breathing Stops When First Falling Asleep
(08-17-2012 06:08 PM)Tommy C Wrote:  Yes, I plan on getting an oximeter once I settle on a permament machine. I wish I had one now, though.

Why wait?

Quote:How fast do they respond?

I don't know. Fast enough.

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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.
08-17-2012 10:40 PM
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Dreamcatcher Offline

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Post: #37
RE: Breathing Stops When First Falling Asleep
Please put down the data and step away from the desk.

Its ok having all this data and charts and printouts but it aint going to do you any good at the start. You should put all the data stuff in a draw and forget it for a few weeks or months. You need to get to know your mask and how your body is responding to your equipment. Also your body needs to adjust and you cant get that in a chart or a readout. Its like when you start reading medical books and you go into sick mode, a cough and suddenly you have cancer. It was a year before I started even looking at my data let alone messing with the settings, give yourself time to adjust then start looking at ways of improvement.

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08-17-2012 11:31 PM
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Moriarty Offline

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Post: #38
RE: Breathing Stops When First Falling Asleep
(08-17-2012 11:31 PM)Dreamcatcher Wrote:  Please put down the data and step away from the desk.

to Tommy C...
This is very good advice....

It is possible that you have a problem that your Respiratory Physician should be involved in diagnosing... This is especially the case if there are events lasting for more than the brief 10 seconds or so required to be recognised by the machine as an event...


However - and as a general statement without reference to you in particular:
It is easy to 'over think' things when confronted with the amount of data available from these machines - especially without understanding exactly how the machines tell the difference between OAs and CAs.

I don't have 'exact' knowledge because the manufacturers guard their IP closely but there is a bit out there to read for understanding.

The CPAP/APAP machines are very cleverly programmed and have very well developed pneumatics and electronics but, unlike a Sleep Test with neuro-sensors, all their software has to work with is the back pressure and probably flow rate (although flow rate can be inferred from back pressure). The algorithms use measurements of the back pressure and Flow rate and variations in them to measure the breathing cycle and infer the occurrence of apnea and other events.

In particular, when the machines detect a cessation of the breathing cycle they make a small change to the pressure and look at the resulting change in back pressure. If the back pressure rises sharply in line with the probing then it is likely to be seen as an OA in the top of the airway, where as if the response is a slower rise then the it is likely to be seen as a Clear Airway event. The difference can however be a bit blurry.

I have tested this on the Respironics PRS1 and Resmed S9 units when I was trialling them for a few weeks. I could repeatedly produce CAs by not breathing while taking care not to block the airway - and OAs by holding my breath and using my tongue to block the back of the nasal passages. I could also produce PBs and Hypopneas by pacing the depth and rate of my breathing.

If all that sounds a bit odd then I plead guilty - as an engineer I like to test and understand (even if in a rudimentary sense) the assumptions embedded in software controlled measuring tools I use.... It helps me to put the appropriate amount of faith in the results.


It is almost certain that it is the machine that decides what to call the various events and stores those descriptions in the file - not SleepyHead which derives its event descriptions from the machines' data log stored on the memory card.
(This post was last modified: 08-18-2012 06:45 AM by Moriarty.)
08-18-2012 06:30 AM
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Tommy C Offline

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Post: #39
RE: Breathing Stops When First Falling Asleep
Thanks for the advice, guys.

You are certainly correct that I am overthinking the data. And, the data is measured by a skin and bones method of sensing the airway.
I appreciate the advice, really.

It is alarming to me that this data, as flawed as it might be, pretty well matches the sleep study that showed quite a bit of CA.

Anyway, I have the doc looking over my SD card and he is aware of my concerns. We'll see what he says.

BTW, last night I went back on the prescribed 4-20 cm/H2O pressure like a good boy. The AHI soared back up to 26, and if the data can be believed, the CA's stretched out again to over a minute in many cases. I feel foggy.

This is compared to my experiment the previous night using a constant 4cm and getting an AHI of 7.4 with short duration CA events.
I felt great yesterday.

Anyway, I'm results oriented and it's obvious what I need to do until I hear from the doc.

Moriarty - Interesting on your simulated apnea event experiments with the software. I did the same thing and it certainly reveals the limitations of the airway analysis technique. Still, when we stop breathing, that is accurate and there's no denying O2 levels must be dropping. Labeling them is the difficult thing.

The temptation to learn everything possible about this technology and hear real world experiences of others is overwhelming to me. In the end, I will have the correct machine, settings and sleep hygiene to get this problem licked.

T
(This post was last modified: 08-18-2012 11:29 AM by Tommy C.)
08-18-2012 11:26 AM
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Moriarty Offline

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Post: #40
RE: Breathing Stops When First Falling Asleep
(08-18-2012 11:26 AM)Tommy C Wrote:  .... Still, when we stop breathing, that is accurate and there's no denying O2 levels must be dropping. Labeling them is the difficult thing.

Absolutely.... and if I was not breathing for the durations you are seeing I would be alarmed.

As far as I can tell the breathing pattern waveform shown in Sleepyhead when zoomed in is accurate and I could see whether breathing stopped after inhalation or after exhalation. I don't have many CA's and I think most of them are wrongly tagged but, interestingly, a number of my 'genuine' CA's are after I have inhaled indicating that I am taking a breath then holding it in my sleep. Of course I didn't need the machine to tell me that - my wife has been saying it for years..... Smile
08-18-2012 05:43 PM
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