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pattern of breathing
#1
pattern of breathing
I'm writing for my husband.  He's been using a Respironics System One bipap with ASV machine for idiopathic central sleep apnea since 2015, prior to that he used a different Respironics bipap ASV starting in 2012.  Since diagnosed with central sleep apnea, he's had 5 different sleep doctors and 3 sleep labs. 

I have a question about Sleepyhead results that I'm finding to be a bit troubling.  I'm hoping someone can give me some guidance or at least some input here. I have started keeping a list of the worst nights to share with his sleep doc, he doesn't see her until May. I will post a couple of screenshots from Sleepyhead from the past week, in one week there were three fairly bad nights with a funky pattern on the flow charts. He has recently, March 5th, seen his cardiologist who did a quick EKG and said things look very good.  That being said, here are a couple of screenshots. I did change the MinEpap this morning, to 9.0 from 9.5 - small changes for now.  
       
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#2
RE: pattern of breathing
Hi Dreamless.

Just so you know, SleepyHead has been superseded by OSCAR, which provides all the features you are used to, but somewhat more bug-free. There is a new release planned for a few weeks' time which will significantly improve the way the machine handles Philips Respironics data.

But to your husband's case - I think a lot of those events labelled as central apnea may in fact be obstructive - the machines are pretty good at judging the difference but they're not infallible. The way the events are clustered might indicate a large amount of positional apnea. This typically occurs when the chin gets tucked down to the chest, thus compressing and compromising the airway. If that is the case, no amount of pressure will resolve it. You need to get positioned on the pillow such that the head is very slightly tilted back and the neck is slightly extended. Many members have found the best way to achieve this is to use a soft cervical collar.

Read all about it here: http://www.apneaboard.com/wiki/index.php...onal_Apnea

and here: http://www.apneaboard.com/wiki/index.php...cal_Collar
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#3
RE: pattern of breathing
Dreamless, welcome to the forum. I think your husband's events are not related to the reactions of the ASV machine but instead come from a physical cause resulting from "chin-tucking" or a misalignment of the airway caused by his sleeping position. He is in good company with many other members here, and I'm glad to tell you there is a very easy solution. Please read our Soft Cervical Collar wiki and look at the examples of other members, including an ASV example. http://www.apneaboard.com/wiki/index.php...cal_Collar

You will see they had similarly high AHI and event types to what are in your husband's charts before using a soft cervical collar, but that they successfully eliminated most or all of those events using an inexpensive device. The whole objective in choosing a collar is to get a height that support the chin to prevent tucking, while being a comfortable fit where you can fit several finger between the collar and neck. Some people can resolve positional apnea by using smaller or different pillows, but the amazing success we have had with collars is nothing short of phenomenal.

The close-up of periodic apnea shows that these apnea are quite long and need to be resolved, however they terminate with very strong recovery breathing. This is more typical of an obstructed airway rather than a central apnea, and could show how your husband has to fully arouse to clear the positional obstruction by moving and taking a breath. No amount of pressure can break through an airway obstructed in this manner which is why he needs the soft cervical collar.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#4
RE: pattern of breathing
Thank you both for your replies.  I took the time this morning to download Oscar, very easy and looks very familiar.  
Thank you for the link DeepBreathing.    Thanks  There are a lot of incredibly thoughtful and helpful people here, I really don't know where we'd be without all of you! 

I have a question about the program and Sleepyhead.  Once in a while when downloading his card, there will be a big empty time slot on part of the charts but it shows a flow chart for the night. We also use the EncorePro to download his card for dr appointments when they want a 30 day download.  That program will show the entire night with all the pertinent info.  Example - a few nights ago, part of the charts were empty and it showed an AHI of 7.85 but EncorePro showed the whole night and gave him an AHI of 18.5   Any ideas about this? 

A few years ago, someone here told my husband about the cervical collar.  He purchased it and has used it since and it made a big difference.  I did have him read your reply last night and he thought maybe he needed to tighten the collar a bit due to his chin finding its way behind it.  We will check his card in a couple more days and see how these charts look again.  

Again, THANK YOU !!!!!  
Dreamless' wife
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#5
RE: pattern of breathing
Unfortunately Sleepyhead did not handle the more advanced Respironics machines very well and there were a lot of bugs, which were inherited by Oscar. A completely new module for handling this data has been written and is now undergoing testing. We expect a revised version of Oscar to be released in a few weeks. You should then see a lot of these problems disappear.
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#6
RE: pattern of breathing
DeepBreathing, 
Thank you for your reply. Ok, that makes sense. Still, an awesome program to have available. 
Thanks!
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