1 year and still tired!

[robysue]

Scott post the full night as well.

Scott already posted the full night. See post #127.

I asked him to zoom in on this part of the night.

[DavePaulson]

Opps I missed it.

Thank you,

Dave

[robysue]

robysue here is the zoomed in chart. I taped 4 nights in a row. Can we compare 4 nights on to 4 nights off? I hate to have to start over. I was getting used to the tape really no problem sleeping with it. Just wanted to see if there was a big difference without the tape last night. Kept the collar on though. 

Sure, let's use the last four nights as the baseline for what happens when you tape. So starting tonight, no taping for four nights.

As for the cervical collar: How many of the last four nights have you used it? If you used it for all four nights, why don't we try four nights with the collar and no taping.

Thanks for the zoomed in screen shot.  At this scale it looks like the machine is tracking your breaths ok, although it may be under reporting the size of the inhalations and exhalations a bit. Can you do a few more things for me?

1) I'd like to see four more zoomed in shots:
Shot 1: Zoom in from 4:15 to 4:20. This captures the beginning of the leak.
Shot 2: Zoom in from 4:25 to 4:30. This should be a pretty "typical" example of what is going on during most of the leak.
Shot 3: Zoom in from 4:50 to 4:55. This shot should capture the end of the leak, what looks like an arousal at the end of the leak, and an event or two that immediately follows the end of the leak.
Shot 4: Zoom in from 23:10 to 23:15. This shot should capture what your normal sleep breathing looks like when there is no excess leaking going on. I want to compare Shot 2 to this one.  

2) When you have a 5 minute "window" scroll through that whole leak and if there's anything that looks different than what you see between 4:25 and 4:30, let me see that as well.

[ajack]

If it were my chart. I think it's time to raise the pressure to 11, to tidy up some remaining oa/h. I wouldn't think 10 is really the best pressure. Or are you leaving it for now and intend to go back to auto? Sorting all the mouthbreathing out on 10, may end in tears when you need 11 or from your auto charts, possibly 12?

[Scott C.]

"Thanks for the zoomed in screen shot.  At this scale it looks like the machine is tracking your breaths ok, although it may be under reporting the size of the inhalations and exhalations a bit. Can you do a few more things for me?"

Wore collar last night and no tape. So is last night day 1? And yes I wore the collar for the 4 nights before. So to be clear I will be wearing the collar and no tape for 3 more nights to compare. For a total of 4 nights.

Shot 1: Zoom in from 4:15 to 4:20. This captures the beginning of the leak.


Shot 2: Zoom in from 4:25 to 4:30. This should be a pretty "typical" example of what is going on during most of the leak.


Shot 3: Zoom in from 4:50 to 4:55. This shot should capture the end of the leak, what looks like an arousal at the end of the leak, and an event or two that immediately follows the end of the leak.



Shot 4: Zoom in from 23:10 to 23:15. This shot should capture what your normal sleep breathing looks like when there is no excess leaking going on. I want to compare Shot 2 to this one.  



2) When you have a 5 minute "window" scroll through that whole leak and if there's anything that looks different than what you see between 4:25 and 4:30, let me see that as well.
( sorry robysue not sure what you are asking for. Do you want me to go through the whole leak graph from start to finish?)

[Scott C.]

If it were my chart. I think it's time to raise the pressure to 11, to tidy up some remaining oa/h. I wouldn't think 10 is really the best pressure. Or are you leaving it for now and intend to go back to auto? Sorting all the mouthbreathing out on 10, may end in tears when you need 11 or from your auto charts, possibly 12?

Thanks ajack, yes I'm testing a theory out. Probably going back to to a tight pressure range in a few days. Trying to get a good baseline. Last night was a bad night. But it was just 1 night.

[robysue]

Scott,

Thanks for posting those images. I saw pretty much what I was expecting to see.

First of all lets look at the image of your normal sleep breathing when there is no large leak:

The main things that I want to make note of here are the size of the bumps: The peaks are at roughly 32.5 L/min and the troughs are at roughly -32.5 L/min. And the RR is pretty constant at about 12.5 bpm in this stretch of breathing, as it should be.

At the peak of the large leak, your breathing looks like this:

This screen shot is over a 12 minute period. That's why the breaths look like they are closer together.  They're really not closer together: The RR is still just about 12.5 bpm, although there is a bit more variability here.  But note that the peaks and the troughs of the Flow Rate curve are no longer at +/- 32.5 L/min. Instead they're smaller---at about 16.25 L/min.  It's worth noting that this stretch is not labeled as a "hypopnea" because the running baseline inhalation rate is now 16.5 L/min, not 32.5 L/min.  Now it could be that you really are just breathing much  more shallowly (for a very long period of time). Or, more likely, the large leak is interfering with the machine's ability to accurately measure the airflow's magnitude.  However, the machine is capable (during this leak) of accurately tracking each of the inhalations and exhalations and their (rough) shape.  And to my eyes, it looks like you were breathing normally, but the machine just underestimated the size of your inhalations. In other words, it looks like your machine was capable of compensating for this leak.

Now lets look at the beginning of the leak:

Note that there are three "funny breaths" right at the beginning of the leak (look at 4:15:30). This may be a micro arousal. Perhaps you moved around in bed and jarred the mask a bit. Or perhaps this represents you attempting to open your mouth or opening your lips. The second and third breaths do show some "flow limited" shapes, but that could be from an attempt to breath through the microtape.  At any rate, immediately following those breaths, normal sleep breathing resumes, but the leak continues to grow for the next 4 minutes. And note that there is a subtle decrease in the size of the bumps on Flow Rate graph as the leak grows.

The end of the leak is much more interesting:

Note the big breaths that occur before the OA that was scored at 4:51:30.  These probably represent an arousal, most likely caused by the leak.  My guess is that the OA and the Hs scored after it represent wake breathing as you were trying to figure out (a) what was causing the leak and (b) what to do to fix the leak.  (When you are half awake, it may take some effort to realize that you need to close your mouth.  Or it could be that the leak was caused by the mask seal being broken and you were working on reseating the mask. It's hard to say)  At any rate, you'd figured out what to do to fix the leak by

"Thanks for the zoomed in screen shot.  At this scale it looks like the machine is tracking your breaths ok, although it may be under reporting the size of the inhalations and exhalations a bit. Can you do a few more things for me?"

Wore collar last night and no tape. So is last night day 1? And yes I wore the collar for the 4 nights before. So to be clear I will be wearing the collar and no tape for 3 more nights to compare. For a total of 4 nights.

Yep. That's exactly what I want you to do.

Depending on what the data show, the next thing to explore may be whether the collar makes a difference.  But we want to change only one variable at a time.

2) When you have a 5 minute "window" scroll through that whole leak and if there's anything that looks different than what you see between 4:25 and 4:30, let me see that as well.
( sorry robysue not sure what you are asking for. Do you want me to go through the whole leak graph from start to finish?)

No, I want you to scroll through the Flow Rate graph with a 5 minute window concentrating on the period between 4:15 and 4:55 to see if there are any places where the breaths look different than they do between 4:25 and 4:30. You're looking for whether there are spots where the Flow Rate appears to drop to 0 (or close to 0) that are not flagged as an apnea or hypopnea.

[Scott C.]

"robysue" This is from July 3rd.

"No, I want you to scroll through the Flow Rate graph with a 5 minute window concentrating on the period between 4:15 and 4:55 to see if there are any places where the breaths look different than they do between 4:25 and 4:30. You're looking for whether there are spots where the Flow Rate appears to drop to 0 (or close to 0) that are not flagged as an apnea or hypopnea."

Is this what you are looking for robysue ?


"This screen shot is over a 12 minute period. That's why the breaths look like they are closer together. They're really not closer together: "

Sorry about the 12 minute window, don't know why I did that.

[Scott C.]

Here is last nights chart. July 4th. Another bad night. AHI doubled! And some RERA's A lot of dry mouth awakenings . Did not have this issue at the lower Auto pressure 4-20.

6 nights on the newest settings. Min=Max=10 and Flex 1 plus Collar. No tape.

[Scott C.]

Sorry robysue posted wrong section. I am tired today.

Here is a flow rate almost 0