CPAP newbie question: Is it useful to visit a neurologist for hypopneas?

[Snurkel]

Hi all, I started CPAP about 4 weeks ago, and since have been using it for 8 hours a night. I didn't get any instructions or guidance in using the CPAP so I was very happy to find this great site! Reading all the info and downloading SH has helped me tremendously in understanding what it's all about.

My question (probably the first of many):I was diagnosed with light sleep apnea, but nevertheless have been extremely fatigued for the last couple of years (including concentration/memory issues etc. etc.). The doctor who set the diagnose told me I mostly have hypopneas, and added that CPAP therefore won't do much for me and I should see a neurologist to seek additional treatment. He couldn't tell me any more about possible neurological treatment so I was wondering if any of you have experience in this.

(By the way: regardless the remark of the sleep doctor I meanwhile have been able to get my AHI down from 6 to, on average, 2.2 (and one night even 0.7), according to SH).

[justMongo]

Hyponeas are generally treated with positive pressure.
It sounds like your present treatment is effective.

I think your doctor was implying that your tiredness might have a neurological component.

[Snurkel]

I think he referred me to a neurologist because he suspects that my hypopneas are not caused by obstruction but are of the central kind.

[trish6hundred]

Hi Snurkel,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and hang in there for more responses to your post.

[richb]

A few hypopneas are OK and can be ignored as just part of your nights sleep. If hypopneas are at a significant level even with CPAP treatment, they very well could be Central Hypopneas vs Obstructive in nature. In that case a specialized machine called an Adaptive Servo Ventilator or simply an ASV machine is used. ASV machines are just more complicated and expensive versions of CPAP machines. That being said, you may be experiencing numerous episodes of periodic breathing which are not being scored by your machine. This is where Sleepyhead can be helpful. Take a look at some 5 minute snippets of your top graph. Look for periods of rising and falling flow rate which indicates periodic breathing. These events might be too short to score as hypopneas but can still interfere with sleep quality. You could also post a screen shot of your graphs when you have a few more posts. Keep in touch. By the way I loved visiting The Netherlands.

[Snurkel]

A few hypopneas are OK and can be ignored as just part of your nights sleep. If hypopneas are at a significant level even with CPAP treatment, they very well could be Central Hypopneas vs Obstructive in nature. In that case a specialized machine called an Adaptive Servo Ventilator or simply an ASV machine is used. ASV machines are just more complicated and expensive versions of CPAP machines. That being said, you may be experiencing numerous episodes of periodic breathing which are not being scored by your machine. This is where Sleepyhead can be helpful. Take a look at some 5 minute snippets of your top graph. Look for periods of rising and falling flow rate which indicates periodic breathing. These events might be too short to score as hypopneas but can still interfere with sleep quality. You could also post a screen shot of your graphs when you have a few more posts. Keep in touch. By the way I loved visiting The Netherlands.

I'm pleased to read you liked our little country, I'm also quite fond of it myself:-)

I've taken a look at the top graph every morning, and after 'busy' nights the flow rate varies significantly through most of the night, though SH doesn't mark it as periodic breathing.
Thanks for pointing out the ASV machine, I'll ask about it at my next appointment with the sleep analyst (who doesn't analyze my sleep btw; she doesn't seem to be very interested in my data). Meanwhile I will go on with tweaking my machine, there are still too many nights with a (relatively) high AHI and me feeling exhausted all the time.

As soon as I'm allowed to post screenshots I will do so; there are some odd things happening during some nights, like abrupt changes in breathing pattern and AHI events after a certain point in time, but I will get back on that.
It's great to be able to ask questions in here and get help from experienced CPAP users.

[PaulaO2]

You can post screenshots now via attachments.

If your AHI is that low, then the hypopneas are being treated. That's the H in the AHI numbers.

If you do change the pressure settings, do so slowly and make note of what you did when. Typically, let a change run for about ten days so you get plenty of data. You are looking for trends, not a single night's worth.

[richb]

Hi again Snurkel. Neither Sleepyhead nor your machine will mark Periodic Breathing as a hypopnea. Periodic breathing is related to central apnea. On a flow graph it looks like a Sine Wave. During periodic breathing you don't completely stop breathing. I am alerting you to it so that you can look for it as a cause of your feeling like you didn't get enough sleep. This is something that you want to rule out.

Rich

[chill]

I have a lot of sine-wave like repetition in my breathing. Not anywhere near Cheyne-Stokes respiration in terms of the minimums, but a clearly repeated pattern through much of the night. My machine scores zero central apneas. I am wondering about this as my AHI is usually well below 1 and my RDI below 2 and I still feel like I need more sleep when I wake up. I was thinking maybe UARS but this is a new idea.

[cate1898]

Welcome to the forum Snurkel! Hope you get answers to all your questions from all the helpful members on here. Good luck with optimizing your therapy, it will come in time!