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Not all CAs look alike
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cpdaniel Offline

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Post: #1
Not all CAs look alike
   

This image shows detail from the Sleepyhead flow rate graph for 3 CA events that I had a couple nights ago. There's nothing remarkable about there being 3 events.

I can't help wonder, when looking at these three graphs, if these are really all the same type of event.

The top one, I suspect, is from me rolling over in my sleep given the steady breathing beforehand, then a moment of chaotic breathing, then settling right back down to steady breathing. It might also have been from coughing in my sleep.

The second one, from a couple hours later into the night, looks like a typical obstructive event to me - definitely looks different than the first.

The third, based on what I've interpreted from some of the posts I've read on this forum, looks like the start of a section of periodic breathing, but it lasts for less than 60 seconds, so I'm not concerned about it.

In all three cases, the pressure was at or near my minimum of 9.6 EPAP/13.6 IPAP.

I'm curious about tiny differences like this because, while I typically have an AHI of below 1 (it was 0.41 on this night), I'm still tired most days - but some are better than others so I'm looking for insight into what's different on those nights when I wake up feeling more rested.

Thoughts? Barking up the wrong tree? Seeing information where there's really just noise?

-cd
(This post was last modified: 02-08-2016 12:22 AM by cpdaniel.)
02-08-2016 12:17 AM
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Sleeprider Online
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Post: #2
RE: Not all CAs look alike
Your breathing pattern in all three events shows signs of flow limitation leading up to the apnea. That suggests OA rather than CA. The machines rely on flow sensors using the FOT to determine if a breathing pause is clear or obstructed. It's not a perfect system because it can't measure respiratory effort against flow. None are serious in length, and there is no recovery breathing following any of them. I think your ideas are plausible, if not likely true. The third one does not really look like PB. A large complete breath followed by two smaller ones and a pause barely long enough to cause a flag.

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02-08-2016 12:00 PM
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PaytonA Offline
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Post: #3
RE: Not all CAs look alike
None of the graphs show the gasp for breath at the end of the apnea which seems to be typical of OAs. The second graph looks like a typical CA to me as do the others. That is just my opinion.

Best Regards,

PaytonA
02-08-2016 12:30 PM
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EuroGuy Offline

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Post: #4
RE: Not all CAs look alike
I believe only the second event is genuine. The other two you are either waking up or moving.

youtu.be/1OQFESwNXm0?t=3m14s

youtu.be/xallwxPCg84?t=2m35s
02-08-2016 01:37 PM
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richb Offline

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Post: #5
RE: Not all CAs look alike
(02-08-2016 01:37 PM)EuroGuy Wrote:  I believe only the second event is genuine. The other two you are either waking up or moving.

youtu.be/1OQFESwNXm0?t=3m14s

youtu.be/xallwxPCg84?t=2m35s

Sleep Docs don't like to use machine data because without EEG data you can't tell for sure if someone is actually sleeping. I for one feel that machine data can provide significant additional data so that reasonable inferences can be made which suggest therapy regimes. If you are only having a few events such as you posted, there is not much to go on to suggest a change in therapy. The suggestion above is that only one of the events is a true CA. You would need a significant pattern of CAs to suggest a change in therapy.

Rich B
02-08-2016 04:55 PM
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PoolQ Offline

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Post: #6
RE: Not all CAs look alike
"I'm curious about tiny differences like this because, while I typically have an AHI of below 1 (it was 0.41 on this night), I'm still tired most days - but some are better than others so I'm looking for insight into what's different on those nights when I wake up feeling more rested"

This was me a few months ago. Except that while my numbers were good, I would have nights that I was not happy about but could live with and then I would have bad nights. I was doing the exact same thing as you-looking for some reason why! My breathing was a mess, ugly, CA's all over the place. It got so I was yet again waking up every 30-60 minutes.

I say all this because for me the periodic breathing and CA's were not the problem. My breathing is just ugly, no idea if it's age, apnea, or what.

What changed was the Doctor asking me to put aside all the sleephead graphs I had with me and told me to just talk with him about my sleeping.
At one point I said that my apnea seemed to start just after I laid down, before I was asleep. A heaviness in my chest.

He sent me to a pulmonologist Who agreed with my Doctor that it was not COPD, because I had almost none of the symptoms. Gave me a full work up and behold I have moderate COPD just without the symptoms-ala unspecified moderate COPD.

I am not suggesting you have COPD, but include more possibilities in your search for your solution. I don't think crappy waveforms is the main cause.
02-08-2016 08:27 PM
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richb Offline

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Post: #7
RE: Not all CAs look alike
(02-08-2016 08:27 PM)PoolQ Wrote:  "I'm curious about tiny differences like this because, while I typically have an AHI of below 1 (it was 0.41 on this night), I'm still tired most days - but some are better than others so I'm looking for insight into what's different on those nights when I wake up feeling more rested"

This was me a few months ago. Except that while my numbers were good, I would have nights that I was not happy about but could live with and then I would have bad nights. I was doing the exact same thing as you-looking for some reason why! My breathing was a mess, ugly, CA's all over the place. It got so I was yet again waking up every 30-60 minutes.

I say all this because for me the periodic breathing and CA's were not the problem. My breathing is just ugly, no idea if it's age, apnea, or what.

What changed was the Doctor asking me to put aside all the sleephead graphs I had with me and told me to just talk with him about my sleeping.
At one point I said that my apnea seemed to start just after I laid down, before I was asleep. A heaviness in my chest.

He sent me to a pulmonologist Who agreed with my Doctor that it was not COPD, because I had almost none of the symptoms. Gave me a full work up and behold I have moderate COPD just without the symptoms-ala unspecified moderate COPD.

I am not suggesting you have COPD, but include more possibilities in your search for your solution. I don't think crappy waveforms is the main cause.

This is a very good point. Poor sleep quality can have multiple causes and treatment of one or more of them might not solve the issue of poor sleep quality. Many Docs call themselves Sleep Specialists when in reality they are only good at treating Obstructive Sleep Apnea.

RichB
02-08-2016 09:02 PM
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wolson Offline

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Post: #8
RE: Not all CAs look alike
(02-08-2016 09:02 PM)richb Wrote:  This is a very good point. Poor sleep quality can have multiple causes and treatment of one or more of them might not solve the issue of poor sleep quality. Many Docs call themselves Sleep Specialists when in reality they are only good at treating Obstructive Sleep Apnea.

RichB

I absolutely agree with this statement. This is especially true the farther away that you get from the research centers and the big cities. The doctors in the small towns and in the boondocks are doing their best but they are often in these places because they are not the best. (I know of one case where the person claimed to be a doctor, had a license, but on investigation was found to have failed out of medical school! It happens!)

What causes problems is that some of them have egos that will not allow them to tell the patient to get a seond opinion when they don't know what is causing the apneas.

Walt

Walter W. Olson, Ph.D., P.E.
Professor Emeritus
02-09-2016 10:36 AM
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cpdaniel Offline

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Location: Central California, USA

Post: #9
RE: Not all CAs look alike
Thanks for the comments, everyone. Sorry for the late reply - I was away on a business trip for the past week - my first significant road trip with the machine. I actually got a couple of my best night's sleep since getting the machine while I was on the road - trying to figure out if there was anything about the sleeping conditions that actually made it better, or if it was just coincidental.
02-15-2016 09:03 AM
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