Bad breathing pattern and high respiration rate

[manganCPAP]

Following this thread with interest as I have the same issue with periods of extremely wobbly breaths with 4/5 peaks in a full breath (mine come with much stronger exhale spikes than inhale).

[elliotg]

I have now been using an EPR of 3 for over a week and can say that this has made a marked improvement. I am still getting some periods with a high RR but these periods are less than 10% of my total sleep time. And the RR is lower than previously seen even in these "bad" periods. I have not found it necessary to increase my minimum pressure - I dropped this back to my previous level (8) after a few days and this did not have a negative effect. So the larger EPR seems to have done the trick, though I am uncertain about why!

[hegel]

Elliot: have you considered monitoring your oxygen levels through the night? I mean, heightened breathing suggests that you're trying to get more O2.

Atrial fibrillation might cause higher breathing rates.

A simple pulse oximeter worn on your finger during the night will track O2 and heart rate.

[Geer1]

They aren't actually higher breathing rates, they are just incorrectly calculated breathing rates due to the flow rates crossing 0 line multiple times during each breath.

Elliot based on now seeing this multiple times and the solution always being the same as well as seeing a research study commenting on paradoxical breathing being caused by restrictive/obstructive breathing I believe what causes it in some people is their inability to breath out effectively against pressure causing muscles to start acting out of sync. This then makes things even worse because the machine stops supplying pressure increases/EPR effectively (because breath flow rate keeps dropping below 0) making it even harder to exhale. The increased pressure support (EPR in this case) improves ability to exhale avoiding the creation of this situation.

You can't do anything more with this machine but if/when you upgrade you could consider a vauto (if paid for by insurance might be tricky to talk them or your doctor into it though) which will allow more PS and probably avoid those odd times where this still happens.

[SarcasticDave94]

Adding to the info from Geer1, if you consider pursuit of a BPAP like VAuto, consider making it a case of needing more PS than 3 that EPR 3 represents. So you'll likely need to include a lack of comfort somehow.

[Geer1]

Yeah the only way you are potentially going to convince a doctor is by saying you were having poor sleep quality so you reached out online and found out you were having periods of what is believed to be paradoxical flow that improved upon recommendations to use higher EPR. Say this made noticeable improvement but you still have some periods of this issue remaining and are not able to increase EPR further to deal with it so need a bilevel with ability to use more pressure support.

Probably would have trouble getting a doctor to agree with this (heck its a relatively new find even on these forums) but if you share some images from your data maybe could convince him it is real and improves with PS.

[elliotg]

Adding to the info from Geer1, if you consider pursuit of a BPAP like VAuto, consider making it a case of needing more PS than 3 that EPR 3 represents. So you'll likely need to include a lack of comfort somehow.

Makes sense.  But I would have to pay for it as I am in Australia and the support for Sleep Apnea equipment is less than ideal.  I do have private medical insurance, but I think I get about $400 (AU) back no matter what the actual device costs.  So I would have to convince myself that it is worth it!

[elliotg]

And I have just discovered that the AirCurve 10 VAuto* is not sold in Australia!  They do have an ASV machine, but I gather that this is for central apnea sufferers.

* made in Australia but not sold here!  If anyone from Resmed reads this forum, perhaps that could be explained!

[elliotg]

Elliot based on now seeing this multiple times and the solution always being the same as well as seeing a research study commenting on paradoxical breathing being caused by restrictive/obstructive breathing I believe what causes it in some people is their inability to breath out effectively against pressure causing muscles to start acting out of sync. This then makes things even worse because the machine stops supplying pressure increases/EPR effectively (because breath flow rate keeps dropping below 0) making it even harder to exhale. The increased pressure support (EPR in this case) improves ability to exhale avoiding the creation of this situation.

Thanks for this  information! But I am still having my trouble getting my mind wrapped around this! This is what my breathing flow looks like when I am getting the high RR. 
   

Now my understanding is that the period when lower than zero is when I am exhaling and the period above zero is when I am inhaling (this is certainly how it is shown on the apnea board Wiki). If this is correct it means that when I am having my problem is during the transition from exhaling to inhaling. This would suggest that my problems are about making this transition - that is at the start of inhaling. And here it is that things start bouncing about.

Or is it that my exhalation is not yet finished when it reaches zero and my lungs are still trying to finish exhaling when the machine decides it is time to start inhaling (and raises the pressure). I guess that would make sense and explain why the higher EPR helps - which it certainly does.

[Geer1]

Inhalation uses multiple muscles, paradoxical breathing is when these muscles don't act in sync.

Just found this from a random website and it makes sense to me why this can occur due to obstruction/restriction.

Paradoxical ‘see-saw’ movement of the abdomen and chest will occur due to inspiratory effort against a closed airway. Normally, when you breathe, the chest moves outwards, and synchronously the abdomen moves outwards due to the downward movement of the diaphragm. In paradoxical breathing, the abdomen moves outwards as the diaphragm moves downwards but the negative pressure generated against the obstructed airway draws the chest inwards. This paradoxical pattern can occur with increasing partial airway obstruction and is a sign that measures should be taken to open the airway. Patients attempting to breathe against an obstruction may also be using accessory muscles of breathing and there may be intercostal and subcostal recession and a tracheal tug.

The theory would be that EPR helps keep the muscles in sync by relieving the pressure issue that causes the asynchronicity.