afib and sleep apnea

[poppypete]

In terms of SpO2 you're doing great.  Your AHI is not bad. The pattern of obstruction appears like positional apnea and events seem to be confined to a fairly short period(s) of time.  If you are still using the c-collar, just try to keep that positioned properly, and maybe we should expect that your AHI of 2-4 is just okay as long as you are feeling pretty good.  Your heart rate is not spiking and you no longer have O2 issues, so this treatment is helping you to heal, and we probably need to give that time.

The "answer" lies not in the numbers but how you subjectively feel.

Jason: "The mask pressure graph will show how your ASV is working to attempt to maintain the air volume and breathing rate to the last 3 minute rolling average your ASV was giving it all it had (25 cm’s of pressure)during this time but it was not sufficient. I would not worry about this low level of events, but as an education I see it as worthwhile question to ask and be answered.

I if you look at these apnea with mask pressure you will see the ASV is responding on a breath by breath basis attempting to encourage you to take a breath by boosting pressure support to the max but you do not breath yourself so an apnea is scored."

Sleeprider and Jason...

Combining the thoughts in these two replies from you both, and reflecting on my experience these past couple of months:

Last night:
I had 4hr 50min in my first session, mask on at 8.40pm...waking at 1.30am.
At 10.10pm (90min sleep), the mask pressure does reveal more...as hypopneas commence (questioning myself: have I gone over onto my back, or is this another sleep phase change happening?).
The second session commenced 5 minutes later @1.35am.
Again the mask pressure reveals change after 2.30am, but sufficient to only reveal 2H and a 17s apnea before I recall waking...but I did not rise this morning, choosing to recline and rest in lieu...until 4.4.48am.

Now given all my past experiences and to consider again the question I first raised related principally to what was happening to me back then; what occurred to me during my first oximetry reading 'test'; and what caused my hospital visit...the 'activity' I see today on my graph between 4am and 4.48am suggests strongly to me now, that the supine position (when I'm 'positional breathing' differently to when I'm on my side), gives me rise to think this may well be the final piece in my personal jigsaw.

So as Sleeprider so eloquently suggests: "The "answer" lies not in the numbers but how you subjectively feel.", my answer is that I did feel on waking, that my chest had had a workout (again)...however, far less severe than previously when I visited Emergency in concern.

When my partner later rises, I'm sure she'll add some comment to what no doubt disturbed her a little, after 4am...but in the meantime, would you two too, like to see anything more than this full graph of last night's results?

Cheers...and thanks again...poppypete

Sleeprider and Jason...

re: "as an education I see it as worthwhile question to ask and be answered."

As I'm now obviously well into positive territory, thanks to the tweeking of settings help Sleeprider you are giving me, I'd just like to grasp (if either of you can help), why my graphs show up close, what is here (attached):

Last night, 90min after mask on, in 9min, 5 hypopnea are followed by a short 13sec unclassified apnea, only one...and that only 1 of 2 only for the night.

Within that almost 7hrs session, the further 90min which followed the initial free-from-activity 90min period of slumber, was all the night's 'activity' we review and concern ourselves with, which is not countered by the machine on current settings. Then 2hrs of 'no-activity' sleep (at least none because the machine does its job).

What is this close-up telling me???

Should I expect still more improvement over more time, or be content with where I'm now at???

Is it

1. the Afib resolution;
   
2. patterns of sleep understanding; or just
   
3. time now required, over which time both myself and the machine will adjust more to each other...
   

• ...these 3 that is required for that greater improvement of lowering the AHI???
  

Thanks for your comments, as always...poppypete  

SleepyHead:
The last time you used your ResMed CS PaceWave...
was last night (on 19 June 2018)
You had an AHI of 4.45, which is considered technically "treated"
You machine was on for 6 hours, 58 minutes and 0 seconds.
You had a small but acceptable amount of major mask leakage.
Your EPAP pressure was under 12.36cmH2O for 90% of the time.
Your IPAP pressure was under 18.16cmH2O for 90% of the time.

No oximetery data has been imported yet.

On my Windows10 MedView .dat file from my ChoiceMMed MD300W314 oximetry reader, the SpO2 levels were above 90% and well up above 96% most of the time.

ResScan scored me 100% on their 4 parameters of

1. above 7hrs use;
   
2. mask seal;
   
3. less than 5 AHI; and
   
4. only 2 mask removals.
   

and send me this:

"Hello Peter,
Congratulations on earning the SILVER badge! You've earned this badge because you've used your machine for at least four hours a night for five days in a week. Using therapy consistently takes a lot of hard work and dedication.
Be proud of your accomplishment and know that using your therapy can have a significant impact on your quality of life.
Did you know:
81% of people with OSA who use CPAP for more than seven hours a night have less daytime sleepiness after three months.1
If you like you can log in to myAir now to share your accomplishment with family and friends on Facebook and Twitter.
To progress to your GOLD badge, use your machine for six hours or more each night for 21 out of 30 days.
Sleep well!
The myAir Team
myair.resmed.com
1. Antic NA, et al. The effect of CPAP in normalising daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011; Jan 1;34(1):111–19."

[Sleeprider]

Although the total number of hypopnea events are up, the UA is just about gone here. I'd like to hold off on pressure changes until I see you try the soft cervical collar/ stop snore or similar positional therapy. Most of your therapy time is quiet and uneventful, and this pattern of hypopnea and apnea events, just over one-hour in is becoming very familiar.

Something you probably didn't notice is your I:E ratio is in the normal range with longer expiratory time. All hypopnea in your last chart are marked as 10 second, which is the minimum for Resmed to flag hypopnea, and may be due to the larger flows that precede them. Resmed flags hypopnea based on a 30% reduction in flow for at least 10 seconds as compared to the 120 seconds prior to the event. While I'd like to see your respiration smooth out, what I'm saying is that these hypopnea may be non-events.

[poppypete]

Although the total number of hypopnea events are up, the UA is just about gone here.  I'd like to hold off on pressure changes until I see you try the soft cervical collar/ stop snore or similar positional therapy.  Most of your therapy time is quiet and uneventful, and this pattern of hypopnea and apnea events, just over one-hour in is becoming very familiar.

Something you probably didn't notice is your I:E ratio is in the normal range with longer expiratory time.  All hypopnea in your last chart are marked as 10 second, which is the minimum for Resmed to flag hypopnea, and may be due to the larger flows that precede them.  Resmed flags hypopnea based on a 30% reduction in flow for at least 10 seconds as compared to the 120 seconds prior to the event.  While I'd like to see  your respiration smooth out, what I'm saying is that these hypopnea may be non-events.

Sleeprider...

Before I go back to bed at this, my early hour time, having had my camomile and downloading this excellent result (keeping my c-collar on still, which tends to force me to nose breathe)...I only this early morning note your edit addition of yesterday (2nd para above).

Consequently, I've attached the graph to show you again the I:E ratio data of last night's 2 sessions (so far)...for your further consideration and comment.

The possibility that "these hypopnea may be non-events" and the (seemingly) immediate success of the effect of the c-collar is quite exciting (at least to me!).

Mate (as us Aussies call a friend)..."you are a genius!!!"

Cheers...poppypete  

[poppypete]

Sleeprider...

I was able to doze off, in spite of feeling refreshed and euphoric, for this further result (attached)...to conclude my night's sleepy-time.

Cheers...       poppypete.

[Sleeprider]

Well I was beginning to doubt we'd ever see the day! Congrats on the great results. This is what we were shooting for. Sorry it took so long.

[poppypete]

Well I was beginning to doubt we'd ever see the day!  Congrats on the great results.  This is what we were shooting for.  Sorry it took so long.

Sleeprider...

This 'great result' continues for another night, thank you once again:
1st session 
4hr 37min
0.00 AHI

2nd session
1hr 37min
1.38 AHI (2H)

3rd session (resting before rising, fully refreshed...to watch Argintina vs Croata)
43min
1.39 AHI (1H)

Average overall .44 AHI (<.5 = <point 5, not just <5)

Oximetry data showing up very well too...high levels of SpO2% and a more resting, less volatile heartbeat in spite of the Afib still.

Very healing feelings, thank you Tom. 

Cheers...poppypete 

[Sleeprider]

Mate, you're killing it! What a great outcome for you. Has your doctor had a comment?

What amazes me, is the breakthrough was just a small increase in EPAP min.

[poppypete]

Mate, you're killing it!  What a great outcome for you.  Has your doctor had a comment?

What amazes me, is the breakthrough was just a small increase in EPAP min.

Sleeprider...

re: "Has your doctor had a comment?"

Not yet...I thought I'd drop him a note today.

As a matter for your comment, I got the impression when I last consulted with him, that with the eventual resolution of the Afib, he's not totally convinced I'm finished with a CPAP auto machine as against this ASV trial which is obviously working...as is the c-collar!!! In light of latest outcomes, what do you think???

Early days, as I'm only in the first week of Warfarin now at the optimum level to dissolve any potential clot.

Yes, it is a great outcome and a huge relief after some months of struggle. I can't stress enough however, how great it was to have someone like you working almost daily with me though, so it's a great result for both of us.

Cheers...    poppypete

[Sleeprider]

How you feel counts. Are you seriously considering a return to CPAP? Your choice if you choose to mention the use of the C-collar, but maybe sometime in the future, it's something to talk about so he knows it might help his other patients...they don't teach this stuff in school.

If I was in your place, they would have to pry my asv from my cold dead hands. There is no comparison.

[poppypete]

How you feel counts. Are you seriously considering a return to CPAP?  Your choice if you choose to mention the use of the C-collar, but maybe sometime in the future, it's something to talk about so he knows it might help his other patients...they don't teach this stuff in school.

If I was in your place, they would have to pry my asv from my cold dead hands.  There is no comparison.

Sleeprider...

re: "Are you seriously considering a return to CPAP?"

No...but I was interested in your thoughts on the impression I gained from him...at my last consultation.

Your latest thoughts will help me frame my communication to him, as I'm probably going to have to make a decision on buying an ASV before the cardioversion...

...as my current machine is merely on loan from CPAP.

re: "Your choice if you choose to mention the use of the C-collar, but maybe sometime in the future, it's something to talk about so he knows it might help his other patients...they don't teach this stuff in school."

I'll do that (mention its success), and with the CPAP folk and my sleep test helper too.

re: "How you feel counts."

That's the point, isn't it? My doctor sees that too, so he'll support that view...as he too says, "it's not just about the numbers"...it is about how I'm feeling during the day.

Cheers...   poppypete.