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Hypopneas - Central/Obstructive?
#11
Great information ... from everyone ... thanks ...
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#12
Here is my latest Sleepyhead report from last night. I have completed 26 days of APAP. My scores from day to day are fairly random. My overall AHI is 5.1

Here are the events listed:

CSR - 12 events, ranging from 55 seconds to 264 seconds
Clear Airway - 32 events
Flow Limitation - 3 events
Hypopnea - 44 events, ranging from 11 seconds to 38 seconds
Obstructive - 5 events
Pressure Pulse - 61 events
RERA - 4 events
Vibratory snore (2) - 4 events

I always get hypopnea event scores in the 30's/early 40's. My CSR score is usually between 2% to 3% in Sleepyhead. My overall periodic breathing score in the PR 560 is 6% over 26 days. These scores have me concerned, because they don't seem to budge.

Given the relatively low amounts of flow limitation, and snoring, wouldn't this suggest that my hypopneas are central in origin?

Based upon the data, wouldn't these graphs suggest mixed or complex apnea, and not obstructive apnea (my initial diagnosis)?

Should I just give APAP more time, or should I start to advocate for an ASV machine, based upon the data? I visit the Sleep Clinic on Thursday.

Thanks so much for any observations/insights/opinions ... There is great information and support on this site.
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#13
xdocgx,
I feel your minimum pressure of 5 is too low. Looking at your charts, you are staying at a pressure of 8 and under for 95% of the time, with your medium range at 5.5.

You may see an improvement if you would raise the starting pressure to 6.5 or 7.
Keep your max pressure where it is for now. Raising it could increase clear airways.
OpalRose
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#14
It would not do much good to advocate for ASV unless you are consistently having CA of over 5.0 per hour.

For most people the CA tend to fade away to minimal. In my first month, I had CAI ranging for .3 to 12.3, but averaged about 3. In the second month my CAI did not go above 3.8, and my average was 1.2. (most of the second month was at a 6 cmH2O minimum setting, adjusted up from 4 cmH2O.)

QAL



Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#15
The
(09-12-2015, 06:53 PM)OpalRose Wrote: xdocgx,
I feel your minimum pressure of 5 is too low. Looking at your charts, you are staying at a pressure of 8 and under for 95% of the time, with your medium range at 5.5.

You may see an improvement if you would raise the starting pressure to 6.5 or 7.
Keep your max pressure where it is for now. Raising it could increase clear airways.

(09-13-2015, 10:55 AM)quiescence at last Wrote: It would not do much good to advocate for ASV unless you are consistently having CA of over 5.0 per hour.

For most people the CA tend to fade away to minimal.

Hi xdocgx,

The way to recognize a central hypopnea in your Flow waveforms is to look for absence of Flow Limitation during the hypopnea and also look for a smooth, gradual increase of the Flow or Tidal Volume while the hypopnea is ending.

Tidal Volume (abbreviated TV or Vt) is a short-term average (over a few breaths) of the volume of air we are inhaling (or exhaling) per breath. If there is a plot of Minute Volume but not Tidal Volume, the the Minute Volume is equal to the Tidal Volume times the number of breaths per minute.

Obstructive hypopneas tend to end with an arousal and a sudden sharp increase in the Flow and in the Tidal Volume.

Central events tend to end gradually, smoothly.

Your AHI is a little high, so I would expect your doctor will try raising the Min Pressure to 6 or 6.5. In my view, this is certainly worth trying. If raising the Min Pressure Results in a decrease in AHI (referring to the average AHI for a week or month, not daily numbers) then a further increase may be tried.

Your CSR/PB percent is also a little high. I think CSR-like breathing which is induced by CPAP therapy is not considered an indicator of COPD (Chronic Obstructive Pulmonary Disease) or TBI (Traumatic Brain Injury) or heart disease, and, unless the Central Apnea Index (which is estimated by your machine) plus the Central Hypopnea Index (hard to measure unless in a sleep lab with full instrumentation) is at least 5.0, a bilevel machine with a respiratory "backup rate" (such as an ASV or one of the other non-invasive ventilator machines) will usually not be covered by insurance.

In a few months, if nothing brings your RDI (Respiratory Disturbance Index = AHI + RERA Index) below 5.0, then I think your doctor may be willing to prescribe an ASV Titration to see if ASV is able to improve your RDI. (An ASV machine will treat/prevent both obstructive and central events.) Lab titrations tend to be horribly expensive so I suggest you choose a facility which is in your insurance's provider network and verify pre-authorization for an ASV titration before scheduling (or at least before having) the titration. Actually, I suggest that at least 3 days before the ASV titration (look up their cancelation policy), if the facility still claims it "cannot" give you the final amount which you will need to pay out-of-pocket, I would suggest canceling and asking the sleep lab to get its act together and call you when they can give you a total amount that you would need to pay out-of-pocket.

I suggest it is too early to be much concerned about your central events (CA and CSR/PB and central hypopneas). In a few more weeks or months your system may adapt to CPAP therapy, and the central events may reduce to only 2 or three central events per hour, which I think would be considered of no concern unless unusually long in duration and accompanied by large desaturations in SpO2 (blood Oxygen saturation percentage as measured with a pulse oximeter).

I suggest paying especially close attention to your machine's sleep data whenever you are on pain medications or sleep meds, since some pain killers (especially opioid meds) and some sleep meds can cause the number of central events to skyrocket.

Take care,
--- Vaughn

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.
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