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If I don't sleep through my events increase
#11
Welcome mwarshofsk! Glad you stopped by.

AHI readings can get somewhat confusing. Example below demonstrates how we can get confusing pictures of AHI.
- suppose I have a section of 10 minutes with 9 events, and only one more event that hour. in addition I have 4 more in the remaining 7 hours of sleep.

Therefore, my 1 day AHI is (14 events/8 hours) = 1.75.

But I want to see what is up during that highly active period, so I zoom in using sleepyhead to encompass the 10 minutes (and end up having a window of 5 minutes either side of it - for a total of 20 minutes visible). Above the flow graph the AHI shown is 27! I zoom out to one full hour including the active period, and now the AHI shown is 10. Not satisfied, I pick exactly the beginning and end of the 10 minute period. And, holy crap, the AHI is 54!! Yikes!

The fact is that our night score is an AHI of 1.75. The period where it is 54, if it were to continue for a long time would be significant, but it is not continuing. It is isolated. I don't think the problem is worthy of our time to solve.

If we have periods where there are like 1 per minute, then the length of each event might come into play (since they would be one on top of the other.) If I look at that small section of time and events last over 20 seconds or if a combination of events last 30 seconds out of 2 contiguous minutes, I may have an oxygen desaturation worthy of hunting for a solution.

I agree with DV that you probably woke up needing to get up because your sleep in that period where you had AHI < 1 was disrupted somewhat by flow restrictions or RERAs, neither of which became adults (and counted into the AHI). The same thing just probably progressed after returning to sleep and they became countable.

I suggest if you do need to get up, that some form of hygiene be added, such as nasal spray or salt water gargle. Then go off back to sleep and see if the result is different.

Anyway, I hope you'll figure it out, it is awesome when you can get truly quiet sleep!

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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#12
(02-09-2015, 06:05 PM)mwarshofsk Wrote: Daria, I was not familiar with the RDI - thanks for the education! A brief read tells me that is a possibility for me as well as different levels of congestion. Thanks

Sgear, I wondered if while I was trying to get back to sleep if I was having false CA's. Honestly, I am still not clear on exactly what a CA is. Also, its interesting that the nights I wake up to pee, but fall right back to sleep I maintain an AHI between 2 - 3. It only escalates when I am having trouble getting back to sleep.

Back to Daria, I think I may be experiencing both false CAs and untreated CAs. I have had only one night that I woke up literally feeling suffocated. I had never felt like that for the 5+ years I had untreated apnea or any other night in the last 2 months. Didn't like it Sad I blamed it on the hotel room I happened to be in that evening along with extra congestion.

80+ percent of the nights I have had the CPAP (only 2+ months now) my sleep has been great and my AHI < 5. I am an IT guy, so I was psyched to find this forum and get the ResScan software. I love data as I am a database programmer Smile There literally has been less than 10 nights where my AHI > 5. I haven't slept through the night in 6+ years and I am doing that half the time now. I love feeling rested and excited about life! So being armed with data I can see that my sleep pattern (number of AHIs throughout different hours of the night) is pretty consistent night to night. The outliers bother me as I covet my sleep and CPAP machine now ... LOL ... so just wanting to tweak things a little if it makes sense.

How do you treat untreated CAs? Thinking-about

Are my expectations too high to want an AHI < 5 ALL the time?

As its been only two months, might I need a bit more time to adjust to the therapy? Dont-know

Lastly, am I better off going to an APAP at some point?

Thanks so much for your thoughtful responses! Bigwink

Your machine is probably registering a bunch of CAs when you are having trouble sleeping after waking up in the middle of the night. Our respiration is unstable during sleep onset. The machine has no way of knowing if you are truly asleep so its logging a 10 second pause in breathing as an apnea event. I suspect that a lot of those are during sleep onset. They are not worrisome.

Since you mentioned that your AHI doesn't go up if you have no trouble getting back to sleep right away, I strongly suspect that sleep onset instability is at work when you do have trouble falling asleep.

My 2 cents. I am sure some more more experienced PAPers will chime in soon.

Also, since you are an IT DB kinda guy, you should totally have an APAP machine with all bells and whistles.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#13
(02-09-2015, 06:05 PM)mwarshofsk Wrote: How do you treat untreated CAs? Thinking-about

Are my expectations too high to want an AHI < 5 ALL the time?

As its been only two months, might I need a bit more time to adjust to the therapy? Dont-know

Lastly, am I better off going to an APAP at some point?

Thanks so much for your thoughtful responses! Bigwink



Central Apneas --- real ones --- happen when your brain forgets to stimulate the breathing process. OSA happens because of obstruction in the airway, but you can clear all the obstructions (splint the airway with a cpap) and if you have a CA it won't help. Reading on, it sounds like your "CA"s are the variety that can be disregarded... only happening when you are not really asleep, and therefore are not sleep disordered breathing, but normal sighs and yawns and restlessness. I would guess that you need a higher dose of air sometimes to splint your airway. An autopap is really nice, because then you don't have to have that higher pressure all the time, just when you are needing it. (like during REM @ 3am) The ones that also report RERA are nice (I covet one - being a data gal myself)


oh, and wanting to be < 5 all the time is not too far out there.! seems like many who only have OSA and not CA or mixed are able to squelch it down there... Mine is nearly always < 1 and hasn't been over 2 any time I was using the APAP. I do think it is more likely to be that low when using auto, fewer events can escape. Too high of a pressure is to be avoided; there are tradeoffs.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#14
mwarshofsk,
Welcome to the Forum.
Is it possible, since you don't yet own your current machine until your 2 months is up, that you can ask your Doc. to write a script for an Auto CPAP and switch it out. This way you can download Sleepyhead software and really start to see what is going on while you sleep. Plus your pressure doesn't have to stay at a constant number. You can set a range and let the Auto CPAP machine take care of the events as needed.
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#15
Again, thank you for the responses! Thanks

Quie, the ResScan software shows me detailed data from my machine. Your illustration is similar to my experience in that, I may have 3 - 5 events in the first 1.5 hours then I get into a zone of 0 - 1 for 3 or 4 hours. The last 2.5 hours of sleep is where I experience the most events that bump my average AHI. I like the discussion on RERAs ... it makes sense ... and I believe as I am adjusting more to the therapy they are decreasing. Will keep data digging ... thanks for the input!

Ash, I think you nailed it as well. My O2 saturation was falling to 70% prior to CPAP treatment. As I understand it ... now that my body is getting so much more O2 during the course of the night my brain doesn't think I need to breath as much at times. That too is improving rapidly with time.

Daria, thanks for the follow-up comments regarding CAs and APAPs! From one data geek to another ... "Data is knowledge and power!".

ALL, In your experience, why is my sleep doc hesitant to prescribe an APAP for me??? ... They seem to be a little sensitive to the fact that they are losing some control of some of their clients ... cuz we don't treat them like gods and we advocate for the best sleep we can get. Thinking-about I was told that it is more difficult to adjust to a range of pressure than one pressure ... Any thoughts?

Just called my sleep clinician. She can quickly download the data from my machine. The last 30 days I have averaged an AHI of 4.3 ... It was 5.2 the first 30 days. I like the trend. With time I expect that my body will continue to adjust to the therapy to where I am below 3 AHI consistently, but if I can remain even lower with the right pressure over time or an APAP with the right range ... Well, I want that! Smile
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#16
mwarshofsk,
I'm not sure why Sleep Doctors are hesitant to prescribe an APAP. There may be some conspiracy
between Doctors, Sleep Clinics, and DME's to keep the patient dependent on them, rather than be knowledgable about your treatment.
And I don't believe it is harder to adapt to a range of pressures compared to a single set pressure.
Remember an APAP can be set to Auto APAP mode or straight CPAP mode. With a CPAP machine, you only have the choice of a straight pressure setting.
OpalRose.
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#17
(02-09-2015, 06:05 PM)mwarshofsk Wrote: Sgear, I wondered if while I was trying to get back to sleep if I was having false CA's. Honestly, I am still not clear on exactly what a CA is.

A CA is called either a central or clear airway event(Depends on CPAP manufacturer). It is the CPAP sensing that you haven't taken a breath 10 seconds or longer. A CA vs an OA is determined by the machine sending a pulse of air, FOT (wave pulse) in a Resmed, to see if it detects any back pressure. No back pressure means no obstruction detected so it must be a CA, your brain is not telling your body to breathe. If back pressure is detected, then you have an OA, such as your tongue blocking your airway. A CA can also be the body's response to a sudden atmospheric pressure increase, such as when you first turn on the CPAP or sticking your head out of a car window while traveling down a highway. The actual technology to determine an event is a lot more sophisticated than my description, but it should be good enough for government work.
Statistics prove that people who have more birthdays live longer.
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#18
(02-09-2015, 04:46 PM)sgearhart Wrote: These events could be false positives. If you are tossing and turning or takes you awhile to get back to sleep, and on the other end, you are waking up but just lying there. Usually they will be reported as CA's because our breathing while awake is sporadic as opposed to our patterns while asleep.

Thanks for clarifying that. I sleep intermittently throughout the night, waking up several times. Usually by the time I wake up around 4-ish, I'm usually awake for good. But in the recent past, I've kept my mask on during that period in case I'm able to catch a few zzzz's before getting up at 6. However, looking at my data, it appears that my highest number of "events" happens during that time, whether or not I am awake. And I have found that it really skews my numbers up. Today I took the mask off at 4:30 am for good and my AHI was a bit lower.

Of course, this also defeats the purpose a bit. I try never to sleep without the mask on, so if I'm sleeping during that period, it's probably more important to keep the mask on rather than try to drive my AHI down.
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#19
(02-10-2015, 01:39 PM)novatom Wrote: I try never to sleep without the mask on, so if I'm sleeping during that period, it's probably more important to keep the mask on rather than try to drive my AHI down.

While analyzing the data to tweak the CPAP to hit that sweet spot is good, target fixation is the downside. I'm guilty of worrying about the AHI number and not the quality of sleep therapy and I have to take a step back. Low AHI's are good but not at the expense of your treatment. A higher AHI from false positives is better than not using CPAP therapy to avoid a higher AHI value.
Statistics prove that people who have more birthdays live longer.
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#20
Yah, I guess you got me on that thought ... I am a little AHI target fixated, but I have also noticed extra increased energy and focus during the days following my lowest AHI values ... maybe a psychosomatic response to seeing the wonderful AHI value, but I'll take that too! Big Grin
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