Fluctuation in events per hour

I started using a Resmed Air Sense 10 a little over 2 weeks ago after being diagnosed with mild sleep apnea, mostly hypopnea, a little bit of OSA, 7 total events per hour during the sleep study. I'm noticing large swings in events per hour, from .3 to 13.7. I'm using a pillow type nose mask. Mask seal has been "good" except for last night. My usage hours have ranged from 7-9 hours per night. My question is what might be causing the swings in events per hour. I don't have data on how many are OSAs. Any ideas would be welcome. I want this to work. TIA.

Would you mind a curious question? Do you normally sleep on your back - and did you do so in the study?

From your report, it sounds as if you might have 'positional' apnea, the kind that almost goes away if you don't sleep on your back (and use tricks to make sure you don't). People in that category sometimes wear soft cervical collars to keep their heads up so airway stays open better and mouth closed, two things that otherwise could encourage apneas along with back sleeping, and often are able to not use Cpap once they have good habits and have had a second sleep study to confirm things.

Will wait for your comments...

Julie wrote:Would you mind a curious question? Do you normally sleep on your back - and did you do so in the study?

From your report, it sounds as if you might have 'positional' apnea, the kind that almost goes away if you don't sleep on your back (and use tricks to make sure you don't). People in that category sometimes wear soft cervical collars to keep their heads up so airway stays open better and mouth closed, two things that otherwise could encourage apneas along with back sleeping, and often are able to not use Cpap once they have good habits and have had a second sleep study to confirm things.

Will wait for your comments...

Thanks for the response. I'm a side sleeper. But there are times when I'm on my back, so it's good to know the effect on apneas. I should also add that my sleep study showed a lot of leg movements. I was offered klonopin for that, but I did not want to start down that road. I'm hoping that better sleep/oxygen levels might impact the leg movements. I probably need to tinker with mask fit, too. Resmed tells me that I'm experiencing leakage around 10l/hr., which they consider "good." I know that it's still very early in the process.

Clinical Guidelines require sleep supine various times during the study, especially titration, and tech is supposed to physically move the person to supine if they are not in compliance.

While sleeping on your back is the most likely culprit, other things can influence your event rates.

For example, for me, caffeine in any amount any time during the day not just in the evening, doubles my AHI for the night.
Surprisingly, any form of curry powder does the same thing.
Stress over outside things like your job can do the same thing.

In regards to the leg movements, one of the things that can make that worse in low blood levels of iron.
Ask your doctor to have a FERRITIN level blood test done. If that is lower than the middle of the "normal range" on the test results, perhaps increasing iron in you diet will help and your doctor can advise you of what form of iron is appropriate. Don't go off on your own in increasing your iron intake because too much can cause other medical problems.

Finally, do you have or can get the sleep lab reports for any studies leading up to your diagnosis. These reports will contain very useful information as you continue on your journey, especially a titration study that will allow you to see the event distribution based on the varying pressures they tried and on the distribution depending on your sleep position.

tedburnsIII wrote:Clinical Guidelines require sleep supine various times during the study, especially titration, and tech is supposed to physically move the person to supine if they are not in compliance.

It may be preferred for testing, but I don't think it is a requirement. I was told to sleep in any position I want. I was worse in supine, but I barely did any during my titration. They did not disturb me or suggest I sleep on my back. They simply did the best with the titration and allowed me to sleep. It seems to me that actual sleep is way more important that body position. I never reached REM sleep either. They recommended a range of pressures starting with what worked well for side sleeping in non-REM, and a range to cover REM and supine. That has worked great for me. I have only needed to change my pressure settings once, and that was when I had a bad cough and needed a higher starting pressure to assist me during that cough.

If somebody came in and tried to move me while I was sleeping, I would panic, have an adrenaline rush, and by unable to sleep for awhile. That seems like a really bad move when they need a minimum number of hours with the person asleep. So, I really doubt that the techs would be encouraged to disturb people when they are actually asleep.

why didn't you title this threads as "swings in events per hour" instead of Fluctuation...........?

Why don't you MYOB Avil!

Julie wrote:Would you mind a curious question? Do you normally sleep on your back - and did you do so in the study?

From your report, it sounds as if you might have 'positional' apnea, the kind that almost goes away if you don't sleep on your back (and use tricks to make sure you don't). People in that category sometimes wear soft cervical collars to keep their heads up so airway stays open better and mouth closed, two things that otherwise could encourage apneas along with back sleeping, and often are able to not use Cpap once they have good habits and have had a second sleep study to confirm things.

Will wait for your comments...

I just got the report from my titration study and it did note that the apneas/hypopneas occurred mostly while supine. My AHI was 12.5, with 10.5 being hypopneas. So it seems that your suggestion that I might not need the APAP in the long run is correct. Periodic limb movements were very high, almost 50/hour, with 18 resulting arousals per hour. I only slept 2 hours and 23 minutes. I'm reluctant to take klonopin for the PLMs. I go back in mid August for follow up. In the meantime, my psychiatrist gave me a script for Provigil. Filled it today, will try it tomorrow. Thanks for listening.

cyclist56 wrote:I'm reluctant to take klonopin for the PLMs.

That's smart, but I am not sure your doctor is smart. There are other drugs that are successful. It's a matter of trial and error because individuals react differently.

I have a friend who is receiving excellent relief using gabapentin. But again, each individual has to go through trial and error to see what works.

cyclist56 wrote: my psychiatrist gave me a script for Provigil.

The problem with Provigil is the off switch - it doesn't have one. It can be very difficult to find the dose that keeps you alert during the day and has no lingering effect at bedtime.

I think you know that getting your CPAP therapy to work well is a priority. I recommend Sleepyhead software to help with the process.

A fair # of people are on klonipin with fairly good results, not sure why you don't want to try it. And once the PLMD is under control you'll have a better idea whether or not you need Cpap or not.

[quote="Julie"]A fair # of people are on klonipin with fairly good results, not sure why you don't want to try it. And once the PLMD is under control you'll have a better idea whether or not you need Cpap or not.[/quote
I'm just leery of drugs that are addictive.

Julie wrote:A fair # of people are on klonipin with fairly good results, not sure why you don't want to try it.

Go read the psych forums where people are trying to taper off clonazepam and other benzos and then come back and babble that.

cyclist56 wrote: My AHI was 12.5, with 10.5 being hypopneas. So it seems that your suggestion that I might not need the APAP in the long run is correct. Periodic limb movements were very high, almost 50/hour, with 18 resulting arousals per hour. I only slept 2 hours and 23 minutes. I'm reluctant to take klonopin for the PLMs. I go back in mid August for follow up. In the meantime, my psychiatrist gave me a script for Provigil. Filled it today, will try it tomorrow.

Those were periodic limb movements not related to respiration, right? If so, then I hate to be the party pooper here, but now that you mention the number of limb movements in your study, and particularly the ones with arousal, I'm suspect that your apnea may not be as mild as your report indicates. If your report says your movements were related to breathing then just skip the rest of this. It is not unusual for periodic limb movements and apnea events to mask each other. Your limb movements may actually be worse too. When both sleep apnea and periodic limb movements are present, they vie for prominence. When either is resolved, there's a possibility of the unresolved sleep disorder worsening as it is able to more fully manifest when not constantly disrupted by the other. As to your proposed medication route, that makes me a bit concerned. It is a slippery slope of sedatives to sleep and stimulants to wake up. If it turns out you must, then you must. But since you are already concerned about taking meds, I would suggest you try to address any possible contributors to your leg movements and then see what you are left with. A ferritin level was already mentioned. Current thinking is it should be near 100, not simply in the "normal" range. Also have them test any levels that might pertain to muscle and nerve function, like magnesium and Vitamin D levels, and some B vitamins are important to nerve function. There are plenty of DIY tips to try to help mitigate the symptoms. Not everyone must be medicated. But some do, just do it with an abundance of knowledge.

During my initial testing I had periodic leg movement. When my primary care Doctor found out he had me tested for B-12. My B-12 was very low. I had to take shots for awhile and now 1/2 a pill each day.
I didn't have it prior to the test and haven't had it since. Low B-12 also makes you feel run down and tired just like untreated sleep apnea.The taking of B-12 and becoming a hose head worked.