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Opinions as to What is Occurring?
#1
My average AHI is low (19 days out of the last 28, it was 1.0 or less and averages 1.18 for the last 28 days) but occasionally spikes (2-4+). As I looked at the SleepyHead graphs for last night and for the three nights with the highest AHI, I see a pattern. That pattern is a large number of CA events, mostly concentrated between 4:00-5:30 AM. On each of those days, I woke before the alarm to either go to the bathroom or just because I felt like I'd had enough sleep. Then I stayed in bed and drifted in and out until the alarm went off. The attached graph shows I had 21 of those events (durations between 11-21 seconds) between 4:51 and 5:26 AM.

My guess is that the machine is detecting uneven breathing patterns as I drift in and out of sleep. Does that make sense? I think if I had really stopped breathing that many times in a 30 minute period, I'd have felt pretty bad and poorly rested when I woke up.
Sorry, user error occurring. Can't figure out how to get the image to attach.


Attached Files Thumbnail(s)
   
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#2
I get some of my worst O2 desaturations between 3:30am and 5am in the morning.
I suspect that I am rolling onto my back and everything is collapsing.

It's hard to tell from your graph without being able to blow it up so you only see about 1 hour at a time.
then you can examine discrete events better.
Maybe you are rolling on your back as well or just need a bit more pressure to get you through the rest of
the sleep session.
It's like being cheated out of your last hour of sleep though, I know how that feels.


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#3
this is above my pay grade. unlike obstructive events more pressure doesn't help with central events

probably you were awake during the 5 am period but not sure about the cluster at 4.10 am

show the download to your sleep physician
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#4
You need to zoom in on the problem area and look to see how long and deep the apneas are.

Some people use the term "Sleep Wake Junk" to refer to clusters of apnea as you're going to sleep or waking up.

It may or may not be that important. The consensus seems to be that it's the nightly average that matters, not short periods of time.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#5
Thanks to all for the comments; I updated the image to a zoomed in screen shot.

My doctor wasn't interested in my graphs at my last visit other than to verify my compliance and the AHI numbers. Some comment like "I'm not interested in these..." or words to that effect.
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#6
Some CAs are normal as we drift in and out of light sleep. This is from Wikipedia:



Sleep onset

Set point of ventilation is different in wakefulness and sleep. pCO2 is higher and ventilation is lower in sleep. Sleep onset in normal subjects is not immediate, but oscillates between arousal, stage I and II sleep before steady NREM sleep is obtained. So falling asleep results in decreased ventilation and a higher pCO2, above the wakefulness set point. On wakefulness, this constitutes an error signal which provokes hyperventilation until the wakefulness set point is reached. When the subject falls asleep, ventilation decreases and pCO2 rises, resulting in hypoventilation or even apnea. These oscillations continue until steady state sleep is obtained.




CAs can be normal during REM also. Contrary to what a lot of people think, REM is not "Deep Sleep" and we often awaken from REM - especially people who remember dreams vividly. This also is from Wikipedia:



Steady REM Sleep

Ventilation

Irregular breathing with sudden changes in both amplitude and frequency at times interrupted by central apneas lasting 10-30 seconds are noted in Rapid Eye Movement (REM) sleep. (These are physiologic changes and are different from abnormal breathing patterns noted in sleep disordered breathing). These breathing irregularities are not random, but correspond to bursts of eye movements. This breathing pattern is not controlled by the chemoreceptors, but is due to the activation of behavioral respiratory control system by REM sleep processes. Quantitative measure of airflow is quite variable in this sleep stage and has been shown to be increased, decreased or unchanged. Tidal volume has also been shown to be increased, decreased or unchanged by quantitative measures in REM sleep. So breathing during REM sleep is somewhat discordant.


Sleep-well
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#7
jgjones1972 - Thanks

and

Great-info
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#8
(02-07-2013, 02:59 PM)aehjr Wrote: Thanks to all for the comments; I updated the image to a zoomed in screen shot.

My doctor wasn't interested in my graphs at my last visit other than to verify my compliance and the AHI numbers. Some comment like "I'm not interested in these..." or words to that effect.

Hi aehjr,

I think your doc just flunked an important test. If you are able, I suggest dropping him and changing to a new sleep doctor. This one does not seem worth keeping. There are better ones which will want to pay attention to how long your events are lasting and will want to consider how to optimize your treatment.

I think the Flow plots you posted show the well-known Cheyne-Stokes Respiration (CSR) pattern.

The pattern of gradual increases and decreases and central apneas which is shown in the Flow plot is very even, very repetitive, which makes me think you were definitely asleep. I think the breathing pattern would be very much more varied if you were partly awake. I suppose using a Zeo might be able to confirm whether you are asleep during these episodes of CSR. I think you were.

That said, I am not sure if your CSR is a problem or not. Might not be, but would be good to investigate.

I suggest changing doctors and asking your new doc.

And in the mean time perhaps you can invest in a CMS series wrist-mounted Pulse-Ox to monitor how low your oxygen gets.

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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#9
vsheline - That pattern of flow plots and high CA count in SleepyHead have only happened twice in 29 days of monitoring the data. I'll do some reading on Cheyne-Stokes Respiration.
Rather than a Zeo, I was thinking I should get an oximeter so I can monitor the saturation when those events occur. Seems like the saturation (or lack of it) is the most important bit of info to know.
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#10
(02-09-2013, 08:13 PM)aehjr Wrote: Rather than a Zeo, I was thinking I should get an oximeter so I can monitor the saturation when those events occur. Seems like the saturation (or lack of it) is the most important bit of info to know.

Yes, I had just finished updating my post to add that suggestion when your reply was posted.

The wristwatch type exerts less pressure on the fingertip and is less uncomfortable to wear than the type where the entire unit clips onto the finger. Especially if wearing several days in a row.

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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