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[Diagnosis] Periodic breathing
#1
Question 
I have been drifting happily along for 20 years on CPAP and then APAP but this year I have been sleeping badly which initially I thought was as a result of radiotherapy for prostate cancer.  about 6 weeks ago i wondered if my APAP therapy was not as effective as I have been used to.  when I phoned my sleep clinic they asked me to read the figures displayed on my machine - and they were not happy!.  I was asked for a 14day sleep diary followed by a night of Respiratory Polygraphy at home.  I am now awaiting the "contact in the near future to discuss the results".  In the meantime i have found and joined the forum  and wonder if someone can help me.  I have installed sleepyhead and been looking at the statistics and graphs.  I have what I believe is a high proportion of periodic breathing and it seems to me that this is actually even understated .  I have periods that are recognised as PB separated by a couple of what look virtually the same PB cycles as in the surrounding PB periods.  I have 3 snaps from one day a night last week and attach one  for anyone to have a look and see if I am right and if they can give me some further info about this .  I assume that it is the machine that decides how to label all the events it identifies.   Sorry if this is a bit rambling but I will be very grateful for any help please.  (I can only attach one snap to this post I believe)
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#2
I don't think a CPAP is going to do it for you anymore I think they will switch you to an ASV. If you want to post more images just use imgur and put a space in the web address, I will add them if you want. Read this first  Posting an Image in 5 Easy Steps.

Dave
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#3
You're having a lot of clear airway apneas, which may represent central apneas - where the brain basically doesn't kick you to breath - which is why an ASV was mentioned.
A sleep study may show if your pressure has gotten too high, which will result in too little CO2 to trigger breathing - another cause of clear airway events.
At the top of the page is a link to request many setup manuals; you may wish to get yours and read it over. Fine tuning your pressure range so it starts closer to where you need it might be helpful, too.
Read over the Wiki up at the top, too. It'll help you understand the terminology so you can discuss your apnea more easily with your provider.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#4
Hi bigtonio,
WELCOME! to the forum.!
Hang in there for more answers to your questions and good luck as you continue CPAP therapy.
trish6hundred
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#5
well we can get it a bit better for now, but because of all the CA, you may need an ASV or a ST vaps. depending on your heart.
you may have developed a PLMD, that can mess up your chart too. That will be found in a sleep study.

For now, you need to raise your minimum pressure, I would start at min 12cm, max I would leave at 20. You will probably need to raise the minimum more, when you post tomorrows chart.

There are some good bit during the night, did you have the mask on then? If you did, there may be a lot of positional apnea, you may be bringing your chin to your chest. go and buy a soft foam, cervical collar from a drugstore or chemist for under $20. It will rule out one variable and may help a lot.
new user http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or sleepyhead, set the min CPAP 1cm below median pressure. Or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#6
The amount of periodic breathing and the high number of central apneas does indicate a problem which will not be fixed with a conventional CPAP or APAP machine. This pattern can be associated with congestive heart failure and that is probably the first avenue you should explore with your GP, just to rule out anything nasty.

If you haven't already done so, talk again to your clinic and tell them about the number of central apneas and periodic breathing. Mention the term Cheyne-Stokes Respiration - that may influence the type of home sleep test they arrange. If the option is available to you, try and get a hospital-based test where they wire you up with 19 different probes and sensors to do a really thorough evaluation. I think this would be more effective than a standard home test in your case.

As mentioned above, you may well be a candidate for an adaptive servo-ventilator (ASV). This is a glorified CPAP which responds on a breath-by-breath basis and totally eliminates central apnea and periodic breathing. ASV machines (especially the Resmed) are extremely effective, but also expensive, being several times the cost of a normal CPAP / APAP. However if you have pre-existing congestive heart failure with a low left ventricular ejection fraction an ASV is contraindicated. This is a case where the doctors need to work together as a team to work out exactly the best course of treatment for you - and I know that's easier said than done.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#7
If you do not have a Cardiologist, ask your sleep specialist to refer you to one.
Your breathing looks like CSR (Cheyne Stokes Respiration), periodic breathing with clear airway events.

We are not doctors here, but feel strongly that you need a good team of doctors that will work together to see if you will be able to use an ASV machine.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#8
bigtonio, I am very concerned about the apparent Cheyne Stokes Respirations you are showing in these charts. In addition to consulting your physician for congestive heart failure evaluation, I recommend we change your CPAP settings from 4-20 to a limited range of pressure that may avoid some of these events. Let's start in Auto Mode at a minimum of 8.0 and maximum of 10.0 and see what falls out.

in future charts, please include the following graphs:
Events
Flow Rate
Pressure
Snores
Respiratory Rate

These will give us much more information and help us to see the correlations of pressure to events.
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#9
Thanks for all your replies  - I am working to produce better snaps using Dave's advice - however could someone please clarify whether leak data is more important to show than resp rate? 

I have however had a problem with last nights download where after a period in bed (with CPAP) I got up I sat in my chair and instantly fell asleep (not with CPAP).  When I awoke (3 hours later but feeling more refreshed than I have any morning for months) i went back to bed (and CPAP).  i downloaded the data to sleepyhead but the second session data shows no events - just my usual dreadful flow chart (from which I would expect my usual plethora of events)  how can I force it to try to download again (in the hope that more data is there!)

The other concern I have is that my treatment (and machine) is provided under the NHS.  This makes me somewhat nervous about altering the settings.  Most of the members of the forum seem to be from USA Canada and Australia.  Surely I cannot be the only UK member - I would like to hear from any about their experience in dealing with a UK NHS sleep clinic   If anyone can point me to any threads which refer to this I would be most grateful (NHS) is too short to be used as a search term.  I certainly don't want to upset my sleep clinic as it is part of the best hospital for respiratory and cardiac treatment in UK. (should I have opened a new thread to raise this point? - please excuse me as a newbie)

From my experience last night I plan to decide when I am ready to settle down whether I will sleep in bed or chair (with CPAP whichever I decide) and if i start in bed, get up and sit in my chair I will bring CPAP with me.  It seems that I can expect to wait another 5-6 weeks before I hear the results of the initial investigations so I have to work out the best options for me pro tem! 

Thank you also for confirming what I thought I was seeing - there are many comments along the lines of 'dont worry about a few PB'  my level (even if it is not - as I suspect - understated) is not in the few category.


I was puzzled by a comment  asking if my mask was on - my mask is on if the CPAP is on - surely it would show as breathing not detected if I didnt?  I would not have respiration flow either surely?  I really do wish I could get nice steady sleep respiration all night not the few minutes at a time that is the best I get at present.

I have an appointment with GP at the end of the month and will talk to her about the situation.
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#10
If you can't fit everything on one screen shot just do two. Make sure you get everything Sleeprider asked for in his post. Since it looks like it will take 5-6 weeks to hear anything back I think you see your doctor ASAP. You could bring your charts with you.

Dave
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