What do we think about really long events?

[cathyf]

One of the characteristics of my relationship with the Air11 is that I'm getting some really long apneas, which are associated with deep desaturations. I've noticed events longer than 50 seconds. Since it's only one event that doesn't count any more than a 10-second event, so from an AHI point of view it's trivial. This was last night -- 53-second apnea, sent my saturation to 78%.


Here's from a month ago, my first night on the new Airsense11:

Other times that this has happened I felt pretty crappy the next day, while last night's deep dive didn't seem to bother me much at all.

Also the cpap algorithm didn't really react by raising pressure much, and when it's an isolated event I guess pressure isn't going to help.

I'm curious about whether these were going on over the last 7-1/2 years with either the Air10 or the vauto, but I don't see that OSCAR flags unusually long apneas (other than putting the time in seconds in parentheses after the event timestamp in the events list). So I would need to look through the event lists day by day.

Anyway, do other people with experiences of very long apneas have thoughts?

[GuyScharf]

In both cases, all of the graphs agree you weren't breathing for about a minute--flow graph, mask pressure, dropping SpO2, respiratory rate, etc. It looks to me in both charts like there is an arousal before the apnea. Which makes me wonder if you were changing positions; we often hold our breath for a while when rolling over.

Do you have many of these long apneas during the night, and are they all preceded by some irregularity in your breathing pattern?

Have you ever tried video recording your sleep? If you did, you could see if anything else was happening at that time. Sleep stage might also be interesting, but I don't know how to deduce that reliably from an OSCAR graph.

[mesenteria]

It looks like an arousal evinced by the more jagged verticals just prior to the stoppage.  You turned, or just adjusted, whatever, and you sagged back into sleep quickly.  But, you were probably just experiencing Ye Olde Sleep Onsette Centralle Apnea.  Yes, it was long, and yes, you desatted pretty darned solid, but it seems to have been a one off, or maybe twice a night, so no biggie. Your AHI record sez you're being well handled.  I would worry about these more when you gasp yourself awake, and that's it for at least an hour of blinking at the lights coming through the blinds.  You don't want to be awakened.

[Dormeo]

Both events are flagged as obstructive rather than central, and both are preceded by exhalation, rather than the inhalation that would be typical for breath-holding. That said, I'm not sure what to make of the arousal-type breathing just before the events, or, for that matter, the recovery breathing afterwards.

Given how infrequent these events are, I guess the big question is whether the desats are harmful. Can you run that question by your doctor?

[cathyf]

To focus on my Airsense11 first night, I'm thinking I'm not buying a 59-second "hold my breath while moving" scenario. A minute is a freaking long time to be not breathing! Here's another view of the same event, a little more zoomed out (20 minutes rather than 17), and taken on the big monitor so it shows more graphs.



Without the tooltip you can see that it starts on the exhale not inhale. That was well into the night. Here's how I started -- about two hours in, here are the first 21 events:

I put the event list in the left sidebar to show the lengths. This is a totally typical massive cluster of positional apnea. I dumped the data out into a spreadsheet, and showed time breathing vs time in apnea:

Code:

    Obstructive    10s
breathing    24s
Obstructive    43s
breathing    23s
Obstructive    54s
breathing    31s
Obstructive    38s
breathing    18s
Obstructive    25s
breathing    24s
Obstructive    14s
breathing    20s
Obstructive    14s
breathing    4s
Obstructive    15s
breathing    32s
Obstructive    13s
breathing    30s
Obstructive    25s
breathing    35s
Obstructive    20s
breathing    28s
Obstructive    16s
breathing    19s
Obstructive    38s
breathing    26s
Obstructive    16s
breathing    18s
Obstructive    32s
breathing    26s
Obstructive    32s
breathing    24s
Obstructive    13s
breathing    0ms
Obstructive    11s
breathing    23s
Obstructive    43s
breathing    45s
   RERA    0ms
breathing    8s
Obstructive    25s
breathing    11s
Obstructive    12s

grand totals -- 7 minutes 49 seconds breathing, 8 minutes 29 seconds in obstructive apnea!

I see the movement before and the movement afterwards as being me moving into the position where my airway is kinked and then me moving out of that position.

I think that the singleton later in the night was ALSO positional apnea, just that it's a "cluster of one" where I got into the position, had a minute-long apnea caused by chin tucking, and then I untucked my chin.

I think that I was asleep through all of it, with just microarousals at the movement. I'm even pretty dubious about the single scored RERA -- it doesn't really look any more awake than any of the other recovery breathing.

[Dormeo]

Yes, I meant to be differing with Guy Scharf about holding your breath and with Mesenteria about central apneas.

Apologies: I didn't notice that you had O2 graphs included in your screen shots. Given the amount of time you were in apnea during that 16-minute period, your desats look surprisingly modest.

I can't think how this might be related to the ResMed 11 machine. What I do wonder is whether you are doing some chin-tucking or back-sleeping that is producing clusters like this one. Have you tried a soft cervical collar? Good entry on that subject in the wiki.