Cyclical pattern of BPM with FF

[CB91710]

I'm seeing an interesting pattern on my respiration rate and tidal volume and am wondering if this is cause for concern, or if this is simply a side effect of my REM patterns.

Some night are "worse" than others...  some I only peak out at 35bpm, some I'll hit 50 briefly, and others I'll seem to hit 50 quite a bit, but only for these very short periods.
The interesting thing is that this primarily happens only with a full face mask.  I can occasionally see a hint of the pattern when on the P10, but it is generally pretty flat.

I had some episodes before getting on CPAP, as well as a couple while on the Nasal mask where I would wake up feeling out of breath, and in some cases as soon as I'd lie down I would get the feeling.   Went to the ER for it twice and all blood work and monitoring came back normal other than elevated HR and BP (from the anxiety).


Overall, therapy is going well...  I rarely exceed 1.5 and don't think I've seen anything above 2 (my sleep study was borderline at 12, but my snoring was actually damaging mine and my wife's hearing at over 100db!)

I really like the P10, but congestion has been a problem, and I've been having issues with both mouth and mask leaks, so I've been spending most of the last month or so on the Airtouch F20.

[DavePaulson]

Well, I think everything looks pretty good. I have a similar pattern. Even though your machine is set pretty wide open it is still kicking the obstructive events butt. Looks to me like once yu fall asleep you are never below 8.5 cm.

Dave

[CB91710]

Absolutely. Even though Sleepyhead is showing some snores, my wife reports that I am no longer snoring.
Once in a great while, I'll wake myself up with a snore. I think some of the snores early in the session are from when I am still or barely awake and snorting.

Just got back from a road trip (first one since being on therapy) and the difference in having zero issues staying awake while driving is incredible.

[ajack]

If it was my chart, I'd move the min to 11 or 12, nearer the median and leave the 18 max.
I get those wiggles in the tidal volume too. They run a regular time and I think in my case, they are rem sleep breathing.
from what I've read,,,The tidal breathing median of 560 is good and the minute vent under 8 means your health isn't too bad. I'd be happy with that chart

[CB91710]

I did reduce my EPR from 3 to 1 a while back.
Tried disabling it completely but it was just a bit too much exhalation effort right at the start.
Min at 11 without EPR would definitely be uncomfortable with the ramp disabled.

[ajack]

There is no urgency to do anything. Your AHI is good, the 11 was to try and tweak for the H.
Your chart is showing EPR is on and set at 1, I see no reason why you can't use EPR, at 1 or even at 3, you don't have clear airways apnea.
If you do change pressure. Turn on the ramp if it helps you get to sleep for now, you probably won't need it later.

[CB91710]

Reducing the EPR was because I was getting occasional CA events... nothing major, and perhaps related to a slight arousal from an obstructive event.
I reduced the EPR at the same time I pulled my max down to 18... of course, my machine came from Kaiser set wide open, 4-20.

But I'm probably going to go back to the P10 now that I'm home from vacation... will leave everything else as-is and see if the pattern continues, or levels out.

[ajack]

If you are seeing a sizeable difference from the nasal mask. I would guess that you might mouthleak a bit and the FFM is giving a fuller picture. I wouldn't be concerned with the pattern, I think it would be part of one of your 4 sleep stages. If you zoomed in, it may look a bit like a PB oscillation, mine do.

[CB91710]

Ya, mouth leaks have been a major problem the last few months. I don't know why, the P10 worked wonderfully for several months, I only needed the FFM on nights that I was congested, but moving into the summer I was having more and more problems with the P10.

Tried it again last night and had quite a few leaks (as well as waking up with dry mouth).
The respiration pattern seemed to flatten a bit, but the tidal volume pattern was still there, maybe a bit more subdued.
CA events made a return, but my overall was still below 1.0 (barely).