A NewBie with Hypopnea Concerns

I have just joined this forum and I hope for some solid information from people with experience dealing with Sleep Apnea.

During last summer I would have spells where I would feel like I was going to fall asleep while driving. My PA ordered a sleep study. I was diagnosed with Mild Sleep Apnea (AHI 6.3). A Sleep Doctor prescribed CPAP at 7% Pressure. This has reduced my symptoms by more than one half. But after 89 days with CPAP I was still having mild symptoms and I returned to the Sleep Doctor. The doctor did not understand my concern because my AHI was below 5 and in his opinion was acceptable. After reviewing my download, the only suggestions he had was to repeat the Sleep Study or change the CPAP to APAP with 20/5 pressure. He wrote a prescription and the machine was changed beginning on the night of 1/7/2015. After eleven days with APAP I feel very little change.

My Symptoms are:
31% were Irritable (along with some depression) days
52% were Headache days
37% were Tired days
54% were Foggy Head (memory issues) days
17% were Zoned Out (a feeling of being asleep with eyes open) days

I use the Sleepyhead software and I see it does provide a ton of information. I am very surprised a sleep doctor could not make sense for all of this information. Here is the Summary data from my downloaded data.

SleepyHead Usage Statistics: (98 days of CPAP Data, between Fri Oct 10 2014 and Sat Jan 17 2015)
Average Hours per Night……..……….…...9:15
AHI…………………………………………..…........ 1.98
Obstructive Index…………………………..….. 0.21
Hypopnea Index……………………………….... 1.73
Clear Airway Index……………………….….... 0.05
Flow Limitation Index…………………….…... 0.02
RERA Index……………………………………...... 1.03
% of time in Cheyne Stokes Respiration…….. 0.24%
Average Leak Rate……………………………... 0.50
90% Leak Rate…………………………...……..1.00
% of time above Leak Rate threshold…..…..0.00%
Average Pressure………………………...…..6.72
Min Pressure……………………………..……..4.00
Max Pressure…………………………..……….9.20
90% Pressure……………………………….….7.00

After reviewing the Sleephead data I see, on the average, 87% of the AHI is caused from Hypopnea and 11% from Obstructive. I am concerned about the Hypopnea because, to my limited knowledge, a pressure change will not prevent Hypopnea. I am hoping someone in this group can shed some light on this for me. I have shown the eleven days of APAP data below.

Thank you.
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Prescription Change (1/7/2015): APAP (Variable) Min 5 Max 20 (cmH2O)
…………………………………....…………............Cheyne ……………………………………………………..................…... Vibratory…………………………
……………………….....………... Periodic …....Stokes…………………………………………..................……Vibratory….Snore… Pressure…..90%....
Date.………Hours…..AHI…. Breathing …Respiration........…Obstructive...Hypopnea...RERA…Snore…....(VS2)…….Pulse……Pressure
1/7/2015…….9:23…..2.66…..1.00%........0.48%...............0.11….…...….2.45…....…0.96...…0.00……...0.21………0.64………6.5%
1/8/2015…….7:59…..1.13…..0.00%........0.00%...............0.13…....….…1.00…..…..1.00…...0.00………0.00……...0.38………6.0%
1/9/2015…….9:35…..1.15…..0.00%........0.00%...............0.10….…...….1.04…..…..0.83…...0.10………0.52……...0.31………6.5%
1/10/2015…...9:23…..1.38…..0.00%......0.00%...............0.00…....….…1.28…..…..0.75...…0.00……...0.11………0.32………6.5%
1/11/2015……9:08…..1.75…..0.00%.......0.00%...............0.11….....……1.64…..…..1.53...…0.22……...0.44………0.55………8.0%
1/12/2015……8:43…..3.09…..0.00%.......0.52%...............0.23…....…....2.75….…..0.69...…0.00……...0.11………0.57………6.0%
1/13/2015……9:00…..3.11…..0.00%.......0.34%...............0.00…....…....2.78….…..1.67...…0.00……...0.11………0.56………7.5%
1/14/2015……8:21…..0.84…..0.00%.......0.00%...............0.00…....…....0.84….…..0.48...…0.00……...0.12………0.24………6.0%
1/15/2015……8:21…..1.20…..0.00%.......0.00%...............0.24….......….0.96……...0.96...…0.00……...0.12………0.24………6.0%
1/16/2015……9:00…..1.55…..0.00%.......0.00%...............0.00….....……1.44…..…..1.22...…0.00……...0.00………0.55………6.0%
1/17/2015……8:59…..1.11…..0.00%......0.00%................0.33….....……0.78……....0.67...…0.00……...0.56………0.44………5.5%

I screwed up somewhere. In the above post, it was signed by "Guest" but it should have been by "GearBear70".

Pretty easy in this case. Hypopneas are like incomplete obstructive apneas. They are very disruptive to sleep and oxygen levels, so you want to limit them. Your machine pressure is set to a minimum of 4. Go zoom in on the hypopnea events and focus on the pressures at which they occur. Move your minimum pressure above that.

My numbers were very similar to yours and so were my circumstances. I moved my minimum pressure to 7 and left my maximum at 20. I did this to eliminate any undetected UARS. It worked.

GearBear70 wrote:I screwed up somewhere. In the above post, it was signed by "Guest" but it should have been by "GearBear70".

that's what happens when you forget to log in

Sleeprider wrote:Pretty easy in this case. Hypopneas are like incomplete obstructive apneas. They are very disruptive to sleep and oxygen levels, so you want to limit them. Your machine pressure is set to a minimum of 4. Go zoom in on the hypopnea events and focus on the pressures at which they occur. Move your minimum pressure above that.

Thanks for this idea. I will go through the last few days and record the pressure at the Hypopneas.

After a quick look, I see when I was under CPAP Pressure 7 cmH2O with a Ramp of 4 cmH2O for 20 minutes, I had a lot of Hypopnea. Example on 12/5/2014: AHI = 3.65, Cheyne = 1.45%, Clear Airway = 0.20, Obstructive = 0.10, Hypopnea = 3.36, RERA = 1.09, Vibratory Snore = 0.00, Vibratory Snore (VS2) = 0.30 and Pressure Pulse = 0.79.

Another example 1/14/2015 with APAP 20 cmH2O/5 cmH2O with no ramp: AHI = 0.84, Cheyne = 0.00%, Clear Airway = 0.00, Obstructive = 0.00, Hypopnea = 0.84, RERA = 0.48, Vibratory Snore = 0.00, Vibratory Snore (VS2) = 0.12 and Pressure Pulse = 0.24. The pressure for everyone of these Hypopnea was 5 cmH2O. Raising the lower pressure maybe worth a try.

Thank you.

With an AHI of 1.98...I would not give it another thought.

LSAT wrote:With an AHI of 1.98...I would not give it another thought.

I would agree if my symptoms were not such a bother. Each day I have recorded how I have felt for that day and the AHI. To help you better understand my concerns I show my AHI and daily remarks for the month of January. My history shows when my AHI is 2.0 or higher I can have a couple of bad days trying to get over the symptoms.

Thank you for your comment.

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Date………..……AHI
1/1/2015……….0.6…….Remarks: I woke feeling rested and my head was clear. I finished the day feeling good.
1/2/2015……….1.3…….Remarks: I have had a headache since 3 am & have taken pills. My head is foggy but I otherwise I feel kind of good. My headache went away after the pills & my head cleared up before noon. In all it was a good day.
1/3/2015……….1.2……Remarks: I woke up feeling somewhat rested & with a clear head. It was a pretty good day.
1/4/2015……….2.2……Remarks: I woke feeling rested but with a slight headache. My head is a little foggy. By late evening I was tired but in all a pretty good day.
1/5/2015……….1.7……Remarks: I woke feeling some rested and with a clear head. We had 6 inches of snow & the snowblower would not start. I cleaned a lot of the driveway with a shovel & the neighbor cleaned the rest. But I was not very tired at day's end.
1/6/2015……….1.5……Remarks: I woke feeling some rested and with a clear head. I ran the snow blower again today and was not tired in the evening.
1/7/2015……….2.7……Remarks: I woke feeling tired, with a headache and somewhat foggy feeling. I had a couple zoned out periods in the afternoon but felt better that evening. Last night was the first night with the new prescription Auto-CPAP 20/5 per Dr. James Cafaro.
1/8/2015……….1.1……Remarks: I woke feeling rested but my head is a little foggy. When the day ended I felt pretty good.
1/9/2015……….1.1……Remarks: I woke feeling rested but with a slight headache and a little foggy. The headache & foggy was gone by lunch time. At the end of the day I felt good.
1/10/2015……..1.4…….Remarks: I woke feeling somewhat rested and with a clear head. The day ended good.
1/11/2015……..1.8…….Remarks: I woke feeling pretty good. By evening I was very tired.
1/12/2015……..3.1…….Remarks: I woke tired, irritable and with a foggy head. The foggy stayed with me through the afternoon. By evening I was very tired and took a nap around 6:00 pm. I woke up choking.
1/13/2015……..3.1…….Remarks: I woke tired, irritable and with a foggy head. I ended the day irritable and tired.
1/14/2015……..0.8…….Remarks: I woke somewhat rested but a little foggy. It was a pretty good day.
1/15/2015……..1.2…….Remarks: I woke with a headache, feeling foggy and a little irritable. I took pills twice to shake the headache. I had a few zoned out spells during the day. I spent the day easily irritated and depressed.
1/16/2015…….1.6……..Remarks: I woke feeling somewhat rested but with a slight headache and a little foggy.
1/17/2015…….1.1……..Remarks: I woke feeling rested and with a clear head. At the end of the day I was tired but still with a clear head.

GearBear70 wrote:

Sleeprider wrote:Pretty easy in this case. Hypopneas are like incomplete obstructive apneas. They are very disruptive to sleep and oxygen levels, so you want to limit them. Your machine pressure is set to a minimum of 4. Go zoom in on the hypopnea events and focus on the pressures at which they occur. Move your minimum pressure above that.

Thanks for this idea. I will go through the last few days and record the pressure at the Hypopneas.

After a quick look, I see when I was under CPAP Pressure 7.0 cmH2O with a Ramp of 4 cmH2O for 20 minutes, I had a lot of Hypopnea. Example on 12/5/2014: AHI = 3.65, Cheyne = 1.45%, Clear Airway = 0.20, Obstructive = 0.10, Hypopnea = 3.36, RERA = 1.09, Vibratory Snore = 0.00, Vibratory Snore (VS2) = 0.30 and Pressure Pulse = 0.79.

Another example 1/14/2015 with APAP 20 cmH2O/5 cmH2O with no ramp: AHI = 0.84, Cheyne = 0.00%, Clear Airway = 0.00, Obstructive = 0.00, Hypopnea = 0.84, RERA = 0.48, Vibratory Snore = 0.00, Vibratory Snore (VS2) = 0.12 and Pressure Pulse = 0.24. The pressure for everyone of these Hypopnea was 5 cmH2O. Raising the lower pressure maybe worth a try.

Thank you.

I have edited your post to show correct terminology. Pressure is in cmH2O water not percent. The results of your data review show a clear path to improvement. All hypopnea (and I bet most RERA) is at 5 cmH2O pressure or nearly that. Raise the minimum pressure to 6.0. Keep the ramp function OFF. If that doesn't erase the hypopnea and RERA, continue to increase minimum pressure in 0.5 cmH2O increments. Good luck!

Thank you 'Sleeprider'. I can use all kinds of help.

Without being able to look at your reports, I'm also going to suggest that your "symptoms" are the result of inadequate minimum pressure. But, along with that, I also suspect that they're a result of your pressures changing all the time during the night. When you enter a deep sleep stage or REM, your breathing can change.......that may trigger a pressure increase and bump you out of that needed sleep stage and into a lighter one......and leave you feeling unrested. If that's happening all night long, it's no wonder you're having those symptoms. You ain't getting any sound sleep!


Den

.

Agree, but would suggest you raise the low pressure even more - 6 is about as 'bare minimum' a pressure as anyone can really breathe at, and I'd go for at least 8 and see how you feel after a few days (one is not enough). You can always lower it again if it's higher than you're comfortable with, but for the record, most of us seem to end up closer to 10 than otherwise.

Sleeprider wrote:

GearBear70 wrote:

Sleeprider wrote:Pretty easy in this case. Hypopneas are like incomplete obstructive apneas. They are very disruptive to sleep and oxygen levels, so you want to limit them. Your machine pressure is set to a minimum of 4. Go zoom in on the hypopnea events and focus on the pressures at which they occur. Move your minimum pressure above that.

Thanks for this idea. I will go through the last few days and record the pressure at the Hypopneas.

After a quick look, I see when I was under CPAP Pressure 7.0 cmH2O with a Ramp of 4 cmH2O for 20 minutes, I had a lot of Hypopnea. Example on 12/5/2014: AHI = 3.65, Cheyne = 1.45%, Clear Airway = 0.20, Obstructive = 0.10, Hypopnea = 3.36, RERA = 1.09, Vibratory Snore = 0.00, Vibratory Snore (VS2) = 0.30 and Pressure Pulse = 0.79.

Another example 1/14/2015 with APAP 20 cmH2O/5 cmH2O with no ramp: AHI = 0.84, Cheyne = 0.00%, Clear Airway = 0.00, Obstructive = 0.00, Hypopnea = 0.84, RERA = 0.48, Vibratory Snore = 0.00, Vibratory Snore (VS2) = 0.12 and Pressure Pulse = 0.24. The pressure for everyone of these Hypopnea was 5 cmH2O. Raising the lower pressure maybe worth a try.

Thank you.

I have edited your post to show correct terminology. Pressure is in cmH2O water not percent. The results of your data review show a clear path to improvement. All hypopnea (and I bet most RERA) is at 5 cmH2O pressure or nearly that. Raise the minimum pressure to 6.0. Keep the ramp function OFF. If that doesn't erase the hypopnea and RERA, continue to increase minimum pressure in 0.5 cmH2O increments. Good luck!

I have completed my analysis of the Pressure during a Hypopnea for the time I have been on the APAP. I recorded the Date, the Current Hypopnea, a calculated New Hypopnea based on only counting those Pressures greater than 7 cmH2O, the Current AHI and a New AHI (assuming all of the other elements that make up the AHI stay the same).

For me this is an encouraging exercise. After leaving the sleep doctor's office I was very very discouraged. But after reading everyone's comments here I have hope for a better night's sleep. I will find a way to get either the sleep doctor or my Physician's Assistant to write a new prescription for APAP 20 cmH2O / 7 cmH2O with no Ramp. I will try the 20 cmH2O / 7 cmH2O for a period of time and if no improvement I will ask for the lower 7 cmH2O to be increased.

Thank you Everyone for your help.

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………………..Current….…New…………Current….New
Date…………Hypopnea…Hypopnea…….AHI…..…AHI
1/7/2015……….2.45…..….0.11………….2.66….....0.32
1/8/2015……….1.00……...0.00………….1.13…..…0.13
1/9/2015……….1.04……...0.10………….1.15…..…0.21
1/10/2015……...1.28……..0.11………….1.38…..…0.21
1/11/2015………1.64…….0.66…………..1.75…..…0.77
1/12/2015………2.75…….0.00…………..3.09…..…0.34
1/13/2015………2.78…….0.33…………..3.11…..…0.66
1/14/2015………0.84…….0.00…………..0.84…..…0.00
1/15/2015..……0.96….….0.00…………..1.20…..…0.24
1/16/2015…..…1.44….….0.00…………..1.55…..…0.11
1/17/2015…..…0.78….….0.00…………..1.11…..…0.33
1/18/2015……..1.58….….0.00…………..1.81……..0.23

GearBear70 wrote: I will find a way to get either the sleep doctor or my Physician's Assistant to write a new prescription for APAP 20 cmH2O / 7 cmH2O with no Ramp. I will try the 20 cmH2O / 7 cmH2O for a period of time and if no improvement I will ask for the lower 7 cmH2O to be increased.

I won't pretend that I know what your results mean... but I will point out that you can, should you choose to, change the pressures of your own machine in just a few minutes, should you choose to do so. instructions are readily available, just check the bottom of one of sleepriders posts

Wulfman... wrote:Without being able to look at your reports, I'm also going to suggest that your "symptoms" are the result of inadequate minimum pressure. But, along with that, I also suspect that they're a result of your pressures changing all the time during the night. When you enter a deep sleep stage or REM, your breathing can change.......that may trigger a pressure increase and bump you out of that needed sleep stage and into a lighter one......and leave you feeling unrested. If that's happening all night long, it's no wonder you're having those symptoms. You ain't getting any sound sleep!


Den

.

Please help me to understand what you mean by "reports" and how would I get that to you. I may be able to learn how to do this.

Thank you for your comment.