Bizarre exhalation patterns

[Ratchick]

OK, this isn't that important, but I found this on my last CPAP session, and I genuinely haven't seen anything like it before... 

   

Any ideas?

If it means anything, I woke up about ten minutes later with an alarm, and my pulse actually felt like it was doubled up - in that I was counting it at 140-150 bpm (which isn't uncommon for me, but is pretty rare while I sleep) but my pulse ox was measuring it half of that, and there was definitely a sensation of my heart beating harder than normal - again not uncommon for me because dysautonomia does crap like that. Settled down after a couple of minutes but yeah, that was weird, even for me!

[Gideon]

Expiratory Snoring, is that what you are referring to?

[Geer1]

That almost looks similar to what happens with cathyf, like some weird high amplitude cardiogenic oscillation that at times is even present during inhalation.

Still not sure what causes hers and if it is heart related or some other sort of muscle twitch etc. Hoping she catches it on video. Like her data it appears that it did or almost did throw your PAP out of sync with breathing.

To me it looks too slow to be expiratory snore but maybe something similar.

Short answer, not sure. If it keeps happening try and get it on video.

[Ratchick]

It definitely wasn't registering as any kind of snore, not on OSCAR and not on my phone app. Sadly it happened during my nap so I didn't turn on my camera because naps are normally pretty uneventful.

I shall definitely keep a look out for it in future.

[Geer1]

I am curious to see the same view with mask pressure below. It looks like you started getting a bit out of sync starting with the breath at 1:08:20.

Also looks like it could potentially be post arousal but I am not sure what you would have been doing even when awake to cause that flow rate.

[Ratchick]

I definitely wasn't awake - but it WAS during one of my crazy-rapid-breathing--high FL spikes that happened between clusters of CAs. And I was dreaming around that time so who knows. LOL

I also don't any obvious sign of an arousal beforehand, though it's not always easy to tell as my flow apparently goes all over the place when I'm dreaming.

   

[Sleeprider]

I have seen this pattern with several other individuals on the forum. A member "Hojo" comes to mind. I think this was the first post where I noted he has intermittent very-high respiration rate that upon closer look, was a lot like your pattern http://www.apneaboard.com/forums/Thread-...#pid223896 His symptoms completely cleared up with ASV, which you can see near the end of that thread on page 16. The very unstable expiratory pattern combined with poor inspiration flow shape seems somewhat common in CSAS, and I'm fairly certain this is the case with you. I fully expect this be be gone immediately upon your commencing ASV.

[Ratchick]

Wow nice to know. I must admit, I don't usually spend much time looking at my high resp rate periods (because generally there are very few events and my sats are pretty good) but yeah, it's entirely normal for my resp rate to triple in those periods, flow limits through the roof, horrible shaped flow... I just hadn't seen this very specific one so I thought I would ask.

I will go take a look through my ASV data and check.

[Geer1]

There is awake and "awake". The large amplitude breath at 10:08:30 is the one that looks like an arousal breath, potentially caused by the machine coming out of sync a couple breaths earlier.

That said seeing the closeup makes me believe this is just another asynchronous issue. Look at the mask pressure graph and see how the breathing completely confuses the machine and how it and your bodies breathing are fighting each other. I believe it all started at the beginning with something causing an initial out of sync breath. If you look at the beginning of this I think you will notice one breath that appears to trigger prematurely and then it snowballs from there.

[cathyf]

Ratchick, check out my http://www.apneaboard.com/forums/Thread-...-your-data thread -- I've got this all over my data and it started 6 months into therapy

These nights stick out like a sore thumb on the overview chart -- you'll show up with a MAX (really 99.5th percentile) respiration rate of something ridiculous like 45-50. (Yes I know from a huge amount of examples that a ResMed machine won't record a respiration rate of more than 50. And I've got some 50s in my data, LOL).

When you actually look at the curves it's obvious to your eye that there's only about 1/10th of the breaths that the machine is counting -- and you can tell what it's reacting to what it's counting by the way it's bouncing around the mask pressure.

Are you seeing this on your ASV or on an autoset? With my vauto I keep the trigger sensitivity set to medium. I tried a couple of experiments with setting it to "very high" and I would get runs of data where the machine was obviously completely discombobulated!

Since I spent 6 years running with EPR turned off I've got a gazillion examples of runs of this. Without any pressure support the spells are pretty frequent. EPR/PS cuts down the time I spend breathing like this, but if I DO get out of sync with the machine when it's doing pressure support and the trigger sensitivity is above medium then it will send the mask pressure on a wild ride. I can sleep right through a severe positional apnea s***show, but trigger very high plus PS of 4 woke me up feeling like somebody was shoving their fingers down my throat. It woke me up VERY awake -- I sat up, put on my glasses, put the machine into the clinical mode and set the trigger back to medium, LOL.

(My several forays into very high trigger have led me to the conclusion that EPR is hard-wired to a much higher trigger sensitivity than the vauto's "medium" default. Which is mind-boggling -- why would the ResMed engineers who designed EPR do it that way? If there are parameters that aren't configurable, then ResMed has decades of experience telling them what's the best default value. But evidently the engineers who understand pressure support don't talk to the engineers who designed EPR! )

For those deep stabby exhales with hardly any exhale, I posted about that here: http://www.apneaboard.com/forums/Thread-...k-was-THAT and the general consensus was that it was coughing. Again I think the machine is fundamentally confused -- coughing out to show up as snore or maybe leak because it's noisy and choppy.