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Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
#11
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Oh okay, thank you. 

Is this the only possibility? I'm concerned how serious they will take me. The sleep specialist doctor didn't think that my sleep apnea was relevant - that it could not be the cause of my fatigue. She didn't think it was necessary, but still allowed me to try the treatment. My own assigned doctor disagreed and said that I absolutely should take on the offer. 

My concerns: When I'm awake the CPAP gives me high numbers of 10-15 AHI - all centrals. Can there be something in the way I breath that confuses the machine? When my girlfriend tried it for a few minutes, it showed 0 AHI. Although subjectively I feel like I'm mostly sleeping throughout the night. I have also heard that movement can trigger false centrals. Can that be the case here? Considering I'm a really restless sleeper.

I'm also concerned that they don't have an ASV machine to offer here in Finland - that it either isn't used as a treatment here or that the doctor thinks it's not necessary for me to use one. In that case am I doomed? 

I still don't have a copy of the sleep study, but the report said the following: AHI 7, no positional dependancy, average saturation 95%, saturated under 90% only 1% of the time. Some amount of partial upper airway obstruction, might be caused by a stuffed nose. Patient moved a lot during the night. Short-term series of periodic breathing and the scored breath events are mainly related to such periods of movement or change of position, in which case it is open to interpretation whether these should be included in the index at all.
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#12
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
I reinstalled OSCAR and when I reinput last nights data, it dropped from 23 to 12.45. I am so confused. When I deselect the last two hours which felt borderline awake at times and I was really restless, the AHI drops to 9.96. 

           
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#13
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
We should look at some close-ups of your respiration and these events to see if we can better identify what is going on. A zoom of about 3-mimutes is ideal. There is a section of the Organizing Your Oscar Charts wiki that deals with that (link in my signature).

I'm sure Finland has the capability to treat central and complex apnea as well as other pulmonary problems that result in the need for advanced positive pressure therapy. Your Oscar results are unambiguous that your AHI is much higher using this therapy than suggested by the initial test. It would still be useful to see the test results rather than rely on the summary. Movement can cause events and irregular breathing to be recorded, and there are conditions like "restless leg syndrome" or "periodic leg movement" that are real sleep disorders and are often treated medically. The zoomed views may offer more help in understanding.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Okay, here you go. 

           
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#15
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
In addittion, one last sentence the sleep study written report showed was: ''no definite periodic leg movement''.
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#16
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Most of the CA events zoomed seem to be representative of a movement in sleep. Instead of smoothly diminishing respiration into a CA event with a gradual resumption of breathing, I see large intakes of air, occasional breath-holds and a ragged flow rate that usually accompanies movement. While I saw an event over 15 seconds, most are minimal events of 10 seconds. I think the reason we didn't see an improvement with the fixed pressure and EPR off is because central apnea that is not the source of the events. Another member Sheepless seems good at spotting this pattern, and I asked him to stop in.

Something we can try is going back to your old settings, but use EPR at 3. Normally that would be bad for central apnea, but I think the EPR actually makes you more comfortable, and we know it helps reduce flow limitations and stabilizes pressure. If you want to try, that will be pressure 7 to 15 with EPR 3.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#17
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
"Patient moved a lot during the night. Short-term series of periodic breathing and the scored breath events are mainly related to such periods of movement or change of position, in which case it is open to interpretation whether these should be included in the index at all."


movement can trigger apnea and apnea can trigger movement. besides the difficulty of understanding the extent to which movement is in play, the hard part is figuring out which is cause and which is effect.  your sleep study ahi was 7 I think, which is barely notable. as they imply above, your problem may not be apnea so much as movement causing apnea (and restlessness, fatigue, feeling lousy...)

some of us make some weird noises in sleep. I have recordings of myself from before treatment that are painfully cringe-worthy. moans, groans, grunts, talk, complaints, swearing, eerily long (long!) vocalized exhalations... much associated with apnea, some  - especially grunts and groans - turns out to be associated with my periodic limb movement. 

despite a diagnosis of central apnea more than 30 years ago, and nearly equal numbers of obstructive and central apnea in my last test 4 years ago, I don't get many ca anymore. that could be due to finally reaching optimal settings with the right machine but I think it's in large part because I've gotten partial relief from plm with prescribed meds. in retrospect, I wonder a bit if my ca has been a consequence of my plm all along.

you/we don't know the character of your movement. you can ask your girlfriend to pay attention occasionally through several nights, maybe audio / video recording what she witnesses. you can use a phone app with a sound activated noise recorder and/or video yourself to try to determine what's going on. also look closely at your full sleep study report (not just the summary) if you have one, to see if plm was indicated or if they otherwise characterized the movements they noted. 

I've attached a screenshot of my typical plm pattern for you to compare to your own flow rate waveform (most visible at a 10 minute view scale). my pattern varies sometimes to be more sinusoidal and other folks have other variations as well. the key factor is uniformity / periodicity. for me, most episodes occur in the beginning hours of the night but can be seen sporadically throughout the night. for me, plm always follows pre-bed restless legs but I can have plm without the waking rls.  my episodes last from a few kicks to an hour or so. within each episode, the intervals between kicks (as seen in the flow rate by inhale spikes) are very consistent. the duration of those intervals may vary from episode to episode. for me they're typically about 9 to 30 seconds apart (i.e., 9 in one episode, 30 in another).

IF plm is an issue for you, pap won't help and in fact can respond with runaway pressure, which is disturbing to sleep in itself.


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#18
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Hey, thanks for the input. 

I asked my girlfriend and this is what she has noticed: Most noticeably I turn around a lot and throw my hands and legs over her quite hard. Apparently I also move my head around quite a lot, which she said often is connected to the weird sounds I make. She said the sounds I make are this throat rattle, which sounds like I'm choking, smacking and clicking my mouth and sometimes but more rarely groans or snoring. These sounds usually follow an abrupt period of me being unusually silent. She said that after I have started the treatment, the movement has slowed down a lot and that she has no longer heard me making any sounds almost at all (which might be covered by the sound of the CPAP).

So would my next step be trying the EPR at level 3? Is the pressure of 7-15 otherwise ok, or is there something that could be done to reduce the amount of pressure fluctuations? I also have a Garmin Venu smart watch which tracks my sleep (including pulse oxymetry, breathing and movement). I know it's not guaranteed to be very accurate, but is there any way to move the data to OSCAR?

Last night was my personal best when it comes to AHI, 5,99 (centrals 4.66). I had a lot of leaks and woke up a few times, but I (think) i feel a little lest exhausted than usually. Here is the Oscar data from last night in case it tells anything. 

       
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#19
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Another thing I forgot to ask. My deviated septum is quite bad. There is almost no air going through the left nostril. When I'm laying down on my left side, it gets blocked all together. When I'm laying down on my right side a little air goes through, but also my right nostril gets blocked. Only position in which I can comfortably sleep is on my back. So I'm wondering if the awful feeling in my nose can cause me to try and find a better position (to move around a lot). And since I can only breath out through my mouth, it could explain the smacking etc. sounds since I always wake up throat dry as a desert (long before the CPAP). Is it possible that my symptoms and apnea could be improved after the surgery?

The ENT also said my tonsils are quite large, and that a surgery on them could fix my apnea. She said that for many people it is not the fix, but since I'm young, healthy and normal weight, it very well could be. Should I consider that as an option?
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#20
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Tonsillectomy and deviated septum are tough surgeries, but people survive them with some improvement. For most, it does not remove the need for CPAP, but your case was so mild to begin with, it may well resolve any obstructive issues. Whether it resolves the other problems is anyone's best guess, because it's not CPAP doing it.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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