Forum · Questions about types of apnea,, CPAP settings and all that

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[-] Nannygoat +2 points · over 1 year ago

Several months ago, I started falling asleep while driving. Have had two sleep studies since then; the second one yielded sleep apnea diagnosis. Took a while to get set up with CPAP, finally received one and began to use it at end of April. I've pretty much gotten used to it except sometimes I feel like there's a tornado going through my head. My mouth gets pushed open, wind pours out of it - overall it does not help me sleep. There must be some setting that's off. And I've no idea how to fix it.

The results that show up about my sleep also seem weird. At least I think they're inconsistent, and they make no sense to me. In the morning, I can send information to my computer about what happened the night before. It shows three types of 'events:' clear apneas, obstructed apneas and hypopneas. I now have very few obstructed apneas, but high numbers in both of the other types. Some nights have had as many as 35 to 40 clear apneas, and 32 to 37 hypopneas. But I have only a handful of obstructed apneas, maybe 2 to 4. Couple of times had none at all. My overall AHI generally is 4 to 8, though it's worse on the really bad nights.

I'm confused about the exact difference between clear apneas and hypopneas. They both seem to involve not breathing. Is it possible that the CPAP increases its airflow when it senses I'm not breathing, and that causes the tornado effect? That's my husband's theory, and it's plausible, I suppose.

But if that's the case, what can I do about it? Is there anything? I have a Dreammapper machine and a tiny little Dreamware pillow mask. I also have a.number of other health issues, which I'm learning can be connected with apnea, including chronic pain from a deteriorating spine (have had three neck surgeries and one lower back one); in addition, have high blood pressure and recently developed high blood sugar, approaching diabetes level. I'm thin, at least. Am in early 70's, and still work.

Didn't mean to be so long winded, but had a lot to cover. Would really appreciate any suggestions, comments, and whatever else.

Many thanks,

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[-] DanM +0 points · over 1 year ago Sleep Enthusiast

Hi @Nannygoat. A definition of the event types can be found at the following link under the "Common AHI Definitions" section: https://www.mysleepmapper.com/Help/Faq#. A hypopnea event is when the system detects a 40% reduction in airflow lasting at least 10 seconds followed by a recovery breath. A clear airway apnea is when the device detects an 80% reduction in airflow for at least 10 seconds and a pressure test pulse can generate a significant amount of flow (meaning the pressure test does not meet resistance of the airflow). Depending on your machine settings, the device may increase airflow if it senses you are having respiratory events. If your machine is set to adjust the airflow, then you are probably on APAP. If your machine is set at a fixed pressure, then you are on CPAP. For patients who breath through the mouth, the addition of a chin strap may be helpful. For patients who do not respond to a chin strap because they mouth breath too much, switching to a full face mask may be the better option. I encourage you to contact your equipment provider and discuss these issues, as they should be able to help assess the situation and possibly correct the problem. Hope this information helps, and best wishes!

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[-] wiredgeorge +2 points · over 1 year ago Sleep Enthusiast

Nannygoat, Hopefully someone with some medical background will chime in here. I was curious about the term "clear apnea" and could only find techno-gibberish and no clear definition by hypopnea doesn't seem to involve NOT breathing as obstructive apnea does. Hypopnea seems to mean very shallow breathing that probably, like OA, results in poor restorative sleep and poor O2 intake. I only suffer from OA and use a BIPAP machine as the pressure needed to un-obstruct is particularly high. My O2 levels during sleep without treatment fall into the LOW 70s which in the long term damage organs (read heart and brain). My therapy has resolved low O2 levels very favorably. Using my machine, my AHI dropped from pre-treatment levels in the mid-teens to usually less than 1.

The important thing you noticed is that sleep is definitely related to other issues. Unlike you, I am a bit; well not skinny (hate using the word chubby) and have a family history on both sides of diabetes. I am diabetic and sleep therapy has helped my A1C (long term sugar level) drop considerably. I don't have many other health related issues but I did notice that when on my machine, I seldom sleep more than 5.5 hours per night and sleep like a rock. When sleeping with a mask, I just don't move around so I was getting some really bad back pain and that was mitigated by propping on a couple pillows.

Last, your CPAP if it is a CPAP DOES NOT change pressures. It is at a constant pressure that your doc prescribed as necessary to keep your airway open (solves the OA problem). A BIPAP machine is needed for people like me that require 25 (can't recall units of measure) to keep obstruction from happening but drops to 20 to allow you to exhale a bit more comfortably. The sleep study allow the numbers to be prescribed and I think they must have been accurate. The APAP machine varies as needed and I am not sure how that technology works exactly but if you have a CPAP, it just blows away at a given pressure. Can't comment on the tornado effect as I haven't experienced it except while machine is in mask seal check mode and the mask doesn't seal and it feels that pressure is 10 times higher than as normal after ramp-up time is complete in normal operating mode. When this happens, I take off my mask (full face) and adjust and start the mask seal check all over. You didn't mention your prescribed pressure so no guess if the mask you are using is appropriate for that pressure; over a certain pressure, a pillow mask becomes problematic. Masks do have pressure ratings and that is why I can't use pillow type masks.

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[-] DanM +1 point · over 1 year ago Sleep Enthusiast

Hi @wiredgeorge. A hypopnea is a decrease in airflow, and an obstructive apnea is an obstruction that results in no airflow. In both instances, there is continued respiratory effort as the patient tries to breathe. The "clear apnea" term is something I have only seen used with this specific system, meaning a pressure pulse of air from the machine meets no resistance. An example of an apnea type that might be a clear apnea is a central apnea. The machine does not detect breathing, so it sends a pulse of air through the tubing and mask. If the air pressure meets no resistance, then the device assumes the airway is open or clear. Since PAP devices do not actually measure respiratory effort via movement of the chest/abdominal wall, they cannot truly detect central apnea.

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[-] FriendlyLavenderAardvark3719 +0 points · over 1 year ago

I have sleep apnea also and I am having a hard time getting a sleep study done, and I am on oxygen because my 02 level keeps dropping to 88 I keep getting a shortness of breath in motion if I am sitting down doing nothing I am fine. I am also in physical therapy , I am so frustrated because I can't sleep through the night then it's hot so that sucks, I just want to go back to being normal again.

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[-] DanM +0 points · over 1 year ago Sleep Enthusiast

Hi @FriendlyLavenderAardvard3719. I'm sorry to hear you are having a hard time getting a sleep study done. Has your doctor told you why this is so difficult? Oxygen is helpful for keeping your O2 at better levels, but treatment for sleep apnea may help you get better sleep. Best wishes!

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