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Central Apnea While Awake
#11
(08-06-2015, 09:58 AM)vsheline Wrote:
(08-06-2015, 06:39 AM)Rob S Wrote: after first reading this i started thinking back to when i first started noticing problems with my sleep and breathing.
i came up with.... shortly after i had a major electrical shock at work...18,000 volts, 60 amps. it actually burned holes in my shoes and my legs burned from the knees down.

To calculate the heating power (wattage) one multiplies the electric pressure (voltage) times the electric current (amperage).

18,000 Volts times 60 Amps would have been 1,080,000 Watts. You are extremely lucky you survived that, even for a fraction of a second.

He is, and it would have been, but not precisely. A megawatt+ of power would have vaporized him pretty quickly; maybe not if he got instantly blown across the room and the connection was just for the tiniest split second.

60 amps was most likely the potential of the circuit (it was a "60 amp circuit"), and likely not the actual current that flowed through the short, which would have been limited by the resistance of his body. That is quite different than being part of a circuit that dissipated a megawatt of power, even for an extremely short event. There is no way to even guess what the actual current that flowed might have been, since we don't know the resistance, so we also don't know how many watts of heat were dissipated.

18,000 volts at 60 amps even through a straight piece of #6 copper wire (which actually does have some resistance) would be equivalent to a bolt of lightning, or a catastrophic plasma event, something that would be seen and heard for miles. Probably not survivable if you were a part of that short circuit.

For example, if a 1500W microwave oven is 50% efficient and you want to boil 1L of 20C water... 1000mL*80C*4.19[joules--it takes this many joules to create a calorie of heat]=335,200J 335,200J/750J/s=447s=7.45 minutes to boil that water.

If you dissipate 1,080,000 watts in that same endeavor it would take less than a third of a second to do that; the blink of an eye.

Still, not a fun day at work, and I could imagine it might have lasting effects on respiration.

A good friend and colleague of mine was cleaning a cabinet for a 5 megawatt TV transmitter when the interlock failed and he got across that and got nailed pretty good. His son was with him and quickly used a push broom to break him away, but he was "stuck" for a good 30 seconds. He is still working for that company, 30 years later, with no real continuing medical issues other than some horrific scars.

But there is no way that a transmitter tube cabinet with the potential to generate 5,000,000 watts actually meant he was part of a circuit that dissipated 5,000,000 watts for 30 seconds.
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#12
(08-06-2015, 12:37 AM)Jim Bronson Wrote: While fully awake, I sometimes find myself breathing very shallow or holding my breath for several seconds with no obstruction present. Afterward, I breathe deeply for a breath or two and then get back to a normal breathing pattern. This pattern repeats often during a day. I have been doing this for many years without knowing what to label it. Since I've been using CPAP, I've noticed such a pattern on the Sleepyhead graphs, so it looks like I also have this same pattern while I'm asleep. My AHI is typically less than 4 with centrals usually comprising the majority of events.

It fits the definition of central apnea, and I don't think there's a remedy for it. So now I'm now curious whether other CPAP users also experience this breathing pattern while awake.

There's some evidence to suggest that anxiety may cause such a wakeful central apnea pattern, but I don't find enough evidence to conclude that's the cause. Comments welcome.

JB, I also have been noticing times when I either hold my breath or breathe very shallowly during the daytime. I do not recall any such incidents before I started CPAP treatment, but maybe I had them but just did not think them significant. In my case, the frequency of such events appears to be increasing. A couple of times I have had difficulty in switching over from shallow breathing to breathing more deeply while awake, and most recently I was stuck in shallow breathing mode for an entire day until I went to bed for a good night's sleep, after which I resumed breathing normally.

My current threory is that my abnormal daytime breathing patterns are a result of my body gradually developing bad breathing habits during nightly CPAP usage. My nighttime breathing now definitely seems more shallow than it was a couple of months ago. I am hoping that my sleep disorder doctor will adjust my CPAP treatment in order to correct the shallow nighttime breathing, and that my body will then gradually return to a more normal daytime breathing pattern.
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#13
Thanks for the interesting replies. I've had the wakeful breathing problem as far back as I can remember, and I never considered it a serious health issue. I've only been on CPAP for nine months, and I finally began to compare the wakeful symptom to the sleep symptom, and they seem to be congruent. It is difficult to compare a Sleepyhead graph trace to a physical symptom, so I can't be sure. One possible test is to use the machine during a lengthy wakeful period and hope for an episode that matches my central sleep apneas. I'm pretty sure it isn't a disorder that requires treatment, and it's good to know there are others who have similar symptoms. For those CPAP-ers, I wouldn't worry about it unless it gets worse and you have to catch your breath continuously while awake. I would hope any sleep doctor would be familiar with the problem, since it does tie in to sleep apnea.

If you notice a marked increase in wakeful episodes after starting CPAP, and you can't identify any other contributing factor, it would be a good idea to see your doctor ASAP. The CPAP might be changing wakeful breathing patterns, and that would need to be treated.
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#14
Central Apnea / Periodic Breathing are usually referring to sleep events. There is very little in the literature that I have surveyed referring to the daytime version of Periodic Breathing. The one area of study involves High Altitude Sickness. That said it seems to me that a few people have suppressed breathing reflexes. I am also one of those people. This situation doesn't seem to be much of a problem during the day since there are other mechanisms that will stimulate breathing such as lactic acid production during exercise. The problem for some is that at night the breathing system that is already suppressed winds up relying solely on CO2 levels to stimulate breathing. CO2 levels are monitored by the Carotid Body. The Carotid Body measures blood pH which fluctuates with the level of CO2 in the blood. The dissolved CO2 forms carbonic acid which lowers blood pH. The lower pH stimulate breathing which in turn removes CO2 from the blood. This organelle is probably faulty in those with periodic breathing. During the day a person with periodic breathing could have a pause in breathing because the carotid body is not responding to the increase in CO2. At night these pauses can become cyclic producing the Hypopneas characteristic of periodic breathing. In some cases there will be actual Central Apneas depending on the severity of the problem. Now comes the polysomnogram and a prescription for some form of CPAP or BiPap. Cpap and BiPap are notorious for removing additional CO2 from the system (CO2 washout). Now what were once Hypopneas are now Central Apneas occurring on a cyclical basis resembling Cheyne Stokes Respiration. Some sleep Docs will refer to this as Complex Sleep Apnea since they believe they have seen some Obstructive Apneas during the Sleep Study. In any case, most Sleep Centers will eventually prescribe an ASV machine providing a backup breathing rate which tries to stimulate breathing and flatten out the periodic/central apnea breathing pattern. There are a number of people on this site with this problem and some who have had success with the ASV machine. I am personally waiting for the delivery of a new ASV machine set with a backup rate that hopefully will address this very problem.

rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#15
richb's post may help to explain why I have recently been having daytime episodes of shallow or irregular breathing. He mentions that during the day people with suppressed breathing reflexes may be stimulated to breathe by lactic acid production during exercise. It so happens that for the last ten weeks I have been banned from exercising, except for walking a minimum of three 15-minute walks per day, while I have been receiving treatments for venous insufficiency in my legs. This is very different from my usual routine which includes swimming, strenuous yard work, etc. It therefore seems possible that, if my breathing reflexes are suppressed, my recent comparative lack of exercise may be responsible for my unusual daytime breathing patterns.

But how would I know whether I have suppressed breathing reflexes? And what causes breathing reflexes to be suppressed? I have started searching but have not yet found any answers.

The limitation on my ability to exercise normally will continue for at least one more week. I have an appointment with my sleep doctor scheduled for next Friday.
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#16
Thanks a lot richb. That's some good info.
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#17
(08-07-2015, 08:10 PM)OpineCone Wrote: richb's post may help to explain why I have recently been having daytime episodes of shallow or irregular breathing. He mentions that during the day people with suppressed breathing reflexes may be stimulated to breathe by lactic acid production during exercise. It so happens that for the last ten weeks I have been banned from exercising, except for walking a minimum of three 15-minute walks per day, while I have been receiving treatments for venous insufficiency in my legs. This is very different from my usual routine which includes swimming, strenuous yard work, etc. It therefore seems possible that, if my breathing reflexes are suppressed, my recent comparative lack of exercise may be responsible for my unusual daytime breathing patterns.

But how would I know whether I have suppressed breathing reflexes? And what causes breathing reflexes to be suppressed? I have started searching but have not yet found any answers.

The limitation on my ability to exercise normally will continue for at least one more week. I have an appointment with my sleep doctor scheduled for next Friday.

There are a few things that can suppress breathing reflexes. One such thing is Congestive Heart Failure. Another is High Altitude Sickness. You probably don't have either. You probably have a misaligned peripheral breathing sensor system. That is your carotid body is not sending the proper signals related to the level of CO2 in your system. This has probably been the case for a while. Your current sedentary life just brings this problem to the surface. The problem is that during sleep the periodic breathing gets worse and may include Central Apneas. This type of breathing results in O2 desaturation and stress. The increase in stress makes sleep more difficult and reduces the time spent in the deepest levels of sleep. This in turn makes one feel tired during the day and could cause high blood pressure due to the release of adrenalin during sleep. Studies of people suffering from High Altitude Sickness confirm the sleep problems associated with periodic breathing. As others can testify ASV machines and sometimes medications can flatten out the periodic breathing wave form. This in turn can allow deeper sleep. There is some research that suggests that deeper sleep levels can also suppress Central Apneas. So the ASV machine can promote deeper sleep which in turn controls more of the periodic breathing. In reading through research I find researchers calling for more study of Idiopathic Central Apnea. In the meantime I find that this site has encouraged discussion of Central Apnea and has offered success stories is some cases.
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
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#18
In any case, I think it helps respiration for everyone if they exercise their breathing muscles. When you do aerobic activity, you do this naturally because it makes you WANT to breathe deeper and harder. But yoga, Tai-Chi, and many forms of meditation can be helpful as well. I am trying to do all of those things, so far with limited (but positive) success.

Namaste
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