ittiandro

Thanks for your comment Two points

1. Yes, sleep apnea could kill you, if left untreated, for a number of pathologies it spawns (diabetes, obesity, heart diseases, etc.) but not, I believe, for a single long lasting episode., as you seem to imply.
   A breathing interruption must be 10 seconds or more to be classified as apnea. Since apneas are rated on an hourly scale, one single episode can kill either if it lasts one hour, which doesn't make sense, or, if you have 360 events of 10 secs over an hour's period, because this wouldn't leave you time to breathe, which is theoretically possible, but equally nonsensical, in addition to the fact that there is no clinical evidence.

2. Zero AHI is perhaps best, but an AHI score of 5 or less is normal in the sense that statistical studies and clinical evidence indicate that most adults do experience brief periods of breathing interruptions. What I find somewhat intriguing is that, judging retroactively from certain episodes way back in my young days ( I am 82 now) I must have had sleep apnea for my whole life without being aware and with no impact on my mental and physical conditions, except for snoring, which bothered others more than me.... When I finally decided four years ago (more out of curiosity than anything else) .to see a sleep doctor, the Sleep Apnea titration process revealed a stunning AHI score of 40 AHI's! Now they are down to under 1. To be honest, I don't feel much of a difference. If I have never been affected by 40 AHI/hr I don't think I should worry about 5, even less about dying, which will certainly happen before not too long for other causes ( natural, I hope) .

Ittiandro

Thanks, what is the high leaks threshold, roughly? Is 2.00 pc low?

Tks

Ittiandro

Can mask leaks increase AHI events, in particular obstructive apnea ? Last night my AHI score reached an all-time high of 4 , with an O.A. of 2.38. Even though the overall AHI score of 4 is well within the normal range it is still unusually high. The large leak score was 2.08. I wonder if the leaks have a bearing on the AHI score. Usually my AHI score is well below 1.

TKS

Ittiandro

Sierra yes, it is a red dotted line. Usually when I take off the mask for a break , the machine goes off automatically and all the graphs show a blank gap, except the flow rate in this case. THe break lasted for about an hour during the night session.

TKS

Ittiandro

For some reasons, possibly because of the recent pressure adjustment, I had the best AHI reading ever : ZERO !!! I think I had it once or twice before. The only odd thing is that my flow rate shows ZERO between 23:30 and 0:30 but with a dotted line in the gap. I know I have got off the bed to work on the computer for about an hour.I don't remember the exact time, but why the dotted line ? Usually, if I go off the CPAP for some time, the gap on the graphic is blank, I don't think I stopped breathing !!!.

Ittiandro

Thanks

I lowered the pressure settongs by small increment ( .02) Ill see ow it goes over the next few days . Today the AHI was .86 which is my normal.. I cxan go weeks without CSR's . I find it odd that I had them for a few days in a row.

Thanks

Currently, my EPAP-IPAP settings are 10.2-15.2 but I don’t see a correlation between these settings and the CSR, because in the past the same settings didn’t yield higher CSR’s. Should I lower hese settings? I will speak both to my sleep specialist and possibly a cardiologist.
The former doesn’t seem to pay too much attention to the CSR’s., even though they are a bit high ( up to 7%). Perhaps he should. He just goes by the number of AHI’s and for him that is enough, as long as they keep below 5 and I feel well. As to the cardiologist, I have already seen him a couple of months ago, for a follow up on my atrial fibrillation. Everything is OK. So I don’t think the CSR’s underlie a heart problem or I wouldn’t be able to run, exercise on the elliptical or shovel the of snow around the house, which is sometimes hard work... There might be some causes elsewhere, but it is like finding a needle in a hatstack. Perhaps my medication ( betablocker, and, recently, Ozempic for diabetes, now completely under control. By the way, Ozempic does wonders. I even lost 10 kg, down from 96 kg, a real bonus for the heart...

I also have a hunch that the hypersensitivity of these CPAP machines may be an issue. As helpful as these state-of-the-heart machines are, sometimes I wonder if they don’t amplify the inputs beyond measure and perhaps give false warnings. Who knows?

THanks

Ittiandro

I am 82, on the CPAP machine since 2020. My AHI's are usually low, under 1, except that over the last 7 months , I see more and more CSR's, some of them as high as 8.6, in the average around 3. Generally I sleep well, I exercise regularly . I don't know what to make about them.. The last time I spoke to my sleep doctor he didn't seem to worry too much about it, but the frequency is increasing. Any idea?

Thanks

Ittiandro

Thank you for sharing your experience. It gives me some more insight,

Ittiandro

Sierra Thank yo so much for your feedback. It is a mine of info that I’ll keep in mind while trying to sort it out with my respirologist

To put thing into perspective, though, overall these CSR episodes don’t affect me as much. I usually sleep well and feel well at wake-up.

If I wrote this post it is because I am a bit concerned that these CSR’s, albeit rare, may be a precursor of something more serious to come, given the fact that I am 81 ( still running and windsurfing, though)

My betablocker is metoprolol. It was prescribed after two occasional tachycardia episodes at rest, two years ago, which led to an atrial fibrillation diagnosis.

My GP increased the dose to 2X50 mg/day after the 2nd tachycardia/ Afb episode 2 years ago. I am also on Metformin for borderline A1C and I read that metformin can be a factor in sleep disturbances.

By reading extensively about CSR and CA, I have come to realize that perhaps the CO2 dynamics may be involved. I asked myself whether there was some degree of CO2 retention( hypercapnia, as they call it) and I wondered whether the EPAP setting needed to be adjusted . Perhaps it was too high and impeded the full CO2 evacuation

. Currently, my pressure setting was 12.4-15.8. I thought that lowering the EPAP to 10.5 , with 15.8 IPAP could facilitate the CO2 evacuation. I’ll see how it works. If I still have CSR’s I’ll try the EPR adjustment you suggested , as a 2nd venue.

Another association I made is about the Tidal Volume. I noticed that when the AHI ‘s are on the rise ( above 1, which is rather rare) , particularly when I have CSR events, the minimum tidal volume drops to 0. AS I understand it, perhaps wrongly, if the TV is 0, there is no air exchange in the lungs and the blood CO2 then may increase.

Last night, with the new adjustment, I had an almost perfect AHI score of 0.59 ( 0.23 OA’s, 0.35 H). What is interesting is that the TV reached a peak of 1500 ( 99.5), which happened only once before with an even lower AHI score of 0.25. Usually, the TV is 1200-1300 at 99.5. Perhaps the lower EPAP setting has contributed to a higher TV.

Thanks again

Ittiandro