[CPAP] Introduction

[Knitman]

Well it seems I am persona non grata. I really was looking forward to Sleeprider's response. I wasn't being sarcy. I was daft enough to worry myself over your well being. I didn't occur to me to search and discover you to be perfectly well and active. What a fool am I? (who sang that? Oh, Carly doing a standard.)

Still, I find writing therapeutic so I shall continue.

I had a good night, only waking once to painkillers. 

My machine still reports Centrals but I don't see them on the charts unless the Resmed clinician was correct and she thinks they are the same as clearways.

If anyone reads this, have a good day. I am not so nuts I shall continue from the dog house.

   

[Sleeprider]

Actually I was painting ceilings yesterday, and while I saw your chart, I thought I'd let it settle for a day. I mentioned several times that when CA is present, it's consistently inconsistent. Your results today are back to a much more encouraging level. Something that would help interpret what is going on is if you can post some zoomed graphs of the flow rate at about a 3-minute resolution. That makes the individual respiratory waves visible and much can be learned from their shape and variation or lack thereof.

Clear Airway and Central are the same thing, but the use of the term clear airway is not diagnostic. Both are a pause in breathing of at least 10 seconds. Without going into the events tab on your daily chart, we don't know their durations. You are currently at 11-20 with EPR 2. Normally we expect to see a reduction of CA events may correspond to a reduction of EPR, however, the resulting flow limits will cause your pressure to rise more as you can see in the 6:30 to 7:30 timeframe. If you cut back on EPR, I recommend you also reduce maximum pressure, perhaps as low as 14-15 cm. I don't know that the pressures above that range are helpful, and at this point we are not seeing obstructive apnea or hypopnea.

[Knitman]

I just had a nap, 90 mins after getting up. I slept 2 hrs 10min and myt AHI was 0.00 and my av pressure was 16 something. I forgot to re-insert the card so no card reading.(Juts realised that with DS I can re insert card and it will put the data on. All the resmed did was out the o AHI and the the time of sleep but no charts, no poressures, no anything.)
   


Is this helpful? If not I can make it wider but over a much shorter time. I did notice that for most of the night, the appeared to be 0 flow limit.

Why is FL important?

BTW I do not joke about being brain damaged. I am. My memory is appalling. Tho I do not have dementia. I am more 'punch drunk' if that is an expression used in America.  I mention because it because a few times now you have mentioned that you have written something before. I woulnd't necessarily recall that. I mkight the same questions a few times. I know it's annoying. It's annoying to me. I have sevral copies of the same CD or Blu-ray UHD, DVD or BluRay because I don't recall buying it. 

I have blackouts which others wouldn't notice. If you drive I am sure you have the experience of having driven a long way through lights, roundabouts etc but have no recollection of it at all? 

I also dissociate right in front of you sometimes which those who have seen it happen say is spooky but they were smart enough to not do anything but wait for me to come back.(You could say in this case 'the lights are on but no one is at home'.)



In the UK we have several expressions, none are PC, but one could say I am not the full ticket, am a sandwich short of a picnic, 2 spanners short of a tool box, not the full pack of cookies, not playing with a full deck-

Anyway, why does it matter that the machine goes up high in pressure? Isn't that why it's an auto? Would it do something that is detrimental?

If it is of any consequence to you, you have helped reduce my anxiety over my condition and the treatment more than anyone else has.

[Sleeprider]

Detailed data is only recorded with the SD card in place during therapy.  Summary data is written to the card if you insert it after the session.   This is the same for both Philips and Resmed, however, the Resmed is much higher detail with data written at 25-times per second, vs Philips at 5 times per second.  I think that you posted the flow limit chart around 07:00. I'm looking for something like the chart below. Yours will look different, but this is a zoom of the respiratory flow rate, and includes mask pressure. I am mostly interested in flow rate at this point.

[Knitman]

   

[Sleeprider]

That is acute flow limitation, and since the Autoset relies on spontaneous effort to move from EPAP to IPAP pressure, we can see the pressure support is flat-lined at about 14.5 pressure. Respiratory rate here is about 12 bpm but flow is severely curtailed. We knew this segment of your sleep would show high flow limitation, and this is what it looks like. I'd like to compare this to a more normal part of the night like around 05:30 and see what things look like there.

In the new zoom chart, I want you to make some changes to the Y-axis. If you right-click next to the title at the left chart margin, a context menu will be displayed. I want you to choose the Y-Axis options, change Auto to Override, and change the minimum to -100 and maximum to +100. Then do it again and select Dotted Line, and select zero. This will give us much better resolution and put a line at the zero-flow crossover between inhale and exhale.

On the mask pressure graph, change the Y-axis to minimum 10, maximum 20. This is the scale you are actually using and will again help us see what the machine is doing.

[Knitman]

Sorry Sleeprider, I changed the chart a few times not thinking you'd answer so quickly. After looking at this one, do you still want me to do as you have asked?

[Sleeprider]

Chart looks better because lines are thinner. I still want to look at a period of lower flow limitation for comparison, and work with the scales, if you can figure it out. I'll say one thing about that chart, it is disappointing how little pressure support you are getting. This kind of obstruction / flow limit can arise from chin tucking.

[Knitman]

   

[Knitman]

I have posted a new chart which I think is what you want.

I don't think I chin tuck. The Dr Dakota neck thing keep my gob shot. I would have to force it open by pressing chin into the memory foam collar. I can't do it. My neck has 'lack of lordosis' which means instead of curved it is str8.

I am still laying on my side. The inflammation of my intercostal muscles seems to have calmed down on it's own by me not giving in to it. So I am sleeping better too.

I don't understand what you mean by I am lacking pressure support. There are two different pressure graphs. Which one do you mean? Or do you mean both?

I have been especially tired this last few days but it is more likely due to the trauma to my jaw and the abscess and infection. Despite going back to sleep for 2 hours I am still nodding off. Whilst I have been writing this.

One thing I am very surprised by is how quiet this machine is and how I am unaware of the air to the point I wonder if it is blowing. Taking mak off whilst it is blowing certainly shows me it is working but I am astonished by the fiorce which I don't feel whilst it is onm.