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My Wife Keep Waking up at Night!
RE: My Wife Keep Waking up at Night!
Pressure support enhances ventilation rate and reduces CO2 in the bloodstream. The response to this effect of pressure support (the difference between IPAP and EPAP) varies considerably from person to person, but can lead to hypocapnia, which will directly affect respiratory drive and cause CA. The effect increases at high pressure support levels, and decreases as pressure support is decreased. The effect of of a reduction of pressure support in improving CA is not completely predictable, and it is present at low levels with your wife, however that is the principle we use in suggesting lower pressure support in the presence of CA.
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RE: My Wife Keep Waking up at Night!
Hi Sleeprider,
With SH chart, what should I look for if I want to know the quality of a sleep my wife have? Does it tell me when she woke up at night?
I know the AHI showing the amount of apnea events a person have per hours, but is that also indicate the amount
of time a person woken up at night?
I have been slowly increasing the IPAP pressure on my wife's Bilevel machine, and trying out different FFM and 
soft cervical collar and managed to keep the AHI below 2!
So far so good!

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RE: My Wife Keep Waking up at Night!
I'm not sleeprider but I'll answer until he shows up. Looking at the flow chart I'd guess she woke up 3 maybe 4 times during the night. All but one not lasting very long. Now this is all a guess based on the flow rate and no chart can really say how the quality of her sleep was. The best way to know would be to ask her if she felt rested.
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RE: My Wife Keep Waking up at Night!
Walla's guess and advice is as good as mine.   Dont-know
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RE: My Wife Keep Waking up at Night!
After two months with the new Resmed Aircurve 10 vauto and wearing a soft cervical collar, my wife AHI floating between 2-3 cmH2O. The setting of the machine is EPAP=8, IPAP=16.4, PS=4.
The doctor ruled out COPD in restricting her restricted expiration.  
The quality of sleep is not great but tolerating. She keep arousing several time at night, and sometime finding hard to get back into sleep again.
He oxygen blood saturation 95%, and a great improvement from BILEVEL therapy. In 15 September 2015, when she did her first home sleep study, an oxygen nadir of 69% and a desaturation event of 18.6/hr was recorded.
I did tried to reduced the central apnea and obstructive apnea by reducing the PS=3.4. But not much has change in apnea events and the respiratory rate and tidal volume dropped a little.
My question is how can she improve her quality of sleep from here on? Is minimize the complex apnea of central apnea and obstructive apnea the way to do it? Is it worth trying the Resmed Aircuve 10 with backup rate?

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RE: My Wife Keep Waking up at Night!
Your wife's therapy looks good, and you should check if much of the AHI is short duration events as I suspect. We have discussed in the past that your wife's median respiration rate is a slow 9 breaths per minute, or 6.7 seconds per breath. Any pause of 3-seconds above her normal breathing rate can flag an apnea, but may be normal for her.

In this graph, her resp rate is approaching 12 BPM (3-breaths/15 seconds) so during CA clusters, her respiration rate does seem a little higher. The AHI is certainly within tolerable levels and I don't know that it would be helpful to pursue a more aggressive therapy like ASV as there is considerably more disturbance inherent in the varying pressure support with ASV. I'm not sure the events being flagged as centrals are particularly bad in her case, and may be caused by her sleep disturbance as opposed to being the source. Just something to consider.
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