[Health] Interpreting sleep study results, EERS enhanced expiratory rebreathing space

[mper6794]

Hi, slowriter

_Apologies, yes, you alright, most of the thread is on EERS, and, maybe, now, also on REM-dependent CA's in a context of untreated UARS.
_ERRS may, indeed, be an alternative way to go and resume on it, from the point Joey stoped.
_Let us hear his Joey's opinion and questions, as well as others.

Please, no irony here. I quite often mess up with non-native English.

all the best for everyone

[JoeyWallaby]

I think the very significant leakage is making the data pretty worthless... I'm going to try using bilevel and EERS tonight, I've tried to fix my broken mask a little... hopefully that reduces the leaks. New mask in mail.

thanks, Joey, 
charts pretty much there...apologies, but still need some more blow up; RR (10 to 20), TV (200 to 800/1000)...but need data on the left
thanks

....and, please, also, charts, whatever Full night or windows, should have also the same waveforms.
.... I would prefer Full night + some 5 ten-minute windows, to start with.
....with overlays of flagged events.

Many thanks

Don't know what you mean?

Hi, joey
For the chart on nov, 22th..
I am afraid we went on PS:4.0 and EPAP: 8.0/20, as per  your chart.

It was a great blow up on expiration. It looks a great beginning.
Because I am already here, I think I could add some suggestions.
_your CA appears to be dominantly concentrate in REM stages, some misflagged as such, maybe, in the interval 9:12/9:24, for instance. In the interval 13:06/13:18, fake CA would be likely associated with arousal/awakening – sleep transition 
_in the interval 8;49/8;54 would be true CA within REM
_ in the interval of larger leaks, 11;50/12;45, event would have been triggered by instabilities of the leakings themselves; I am very familiar with this;

Hope others could shed lights as well.

Kept thinking/brain storming with myself, on the REM dependent-CA's, like this:  What you think?
_ CA essentially associated with REM phases
_you leak a lot on REM stages, and maybe coincides with time you take off mask recurrently..
_acting out leads on leakings, or just intensification of RR?
_would you be acting out, quasi-awakening, holding breaths (fake CA) and back to sleep?
_remember, except for atony, REM is pretty much awake. REM is unstable as per its own
nature.
_CA in REM could eventually disappear with time faster and easier than in NREM's, once
RRV (respiratory rate variability) become smoother with the BPAP; If not, other alternatives should be studied, including using the EERRS.
_sleep studies indicated any possibility of RDB?
_REM-dependent should be given same concern as the NREM’s?
_would they respond the same way? To PS?, because much higher RRV?
_Another sleep study and talking to your doctor? Some approach for REM-dependent CA may involve some medication?
_Respiratory Effort within REM  leads to  OA/H (or quasi < 10s) and recoveries, which lead to leaks; leaks lead to more instability and RRV (and eventually fake CA’s). 
What to tackle first: slow down respiratory effort, RRV,  by getting your fine tuned parameters!

Starting out with lower pressures and pressure support may be a good idea. When awake with CPAP on, I feel better breathing with EERS vs without. I don't know how much value there is in interpreting this data considering how much leakage (from my broken mask) is damaging it. I think I'll just do whatever with the settings until I get the new mask, then go to a lower EPAP min and PS.


This is the data from last night, short duration because I took off the mask in my sleep.







Sleep study results (because images in OP were deleted)

[mper6794]

--yes, it is hard to go through charts indeed....Let us wait
_attached might be an example for chartr (full night and ten-minute windows)

all the best

[mper6794]

yes, it is hard to go through charts indeed....Let us wait

Joey, this might be misleading: yes, It is hard to Go through your data, under current situation of anomalous short periods, leak-mask off, etc.
Gl

[mper6794]

Hi, Joey,

having in mind your sleep study, and a revision on all posts, just to save time, I would have these observations

Together with your sleep study, and revising all posts here, I would have the following observations, interpretations and suggestions (just in case you decide to for starting all over again, on much lower pressures, after finishing the experience with the EERS):

_your sleep study came in line with my suspicion: because so many arousals/supine position 100%, you did not have REM in the sleep study, and, in consequence, pretty much no CA. Therefore, your CA’s (fake and true) would be concentrated in REM. Therefore, for now, also, there would be no way to know whether you would be acting out or not during REM;

_your leaks appear concentrate in REM, likewise. For both, monitoring leaks and acting out or not, I would suggest you, the soonest as you can, you camera-record/better (or just audio-record, as I sometimes did with very low highly sensitive device) your sleep.

_I suspect your leaks would be occurring on account of chin retraction/tucking (loosing mask stripes), when you enter atony/relax deep, while entering in REM. One post you said you tighten the mask and leaks subside. You may perform one experiment and prove increasing leaks, laying down and chin-retracting/stretching head;

_are your in benzo’s or similar sedating’s anytime? (this detonate leaks, from recurrent experience, when I used it);

_you said you would have been a side-sleeper. You would have to assure this; may have great implications on EPAPmin and CA’s. Part of CA’s and quasi-H/H may be provoked by instability during leaks (I experiment this many sometimes);

_a trick for forcing sleep on your back (I used it sometimes), if camera suggest, would be sawing one or two tennis ball on a sleep-shirt;

_and for the chin move, of course, the soft collar, could help a lot (I started use 1 month ago and appears has been adding something on residual RERA I had);
 
Because all of this, once you take measures for leaks, chin retraction, and assure side position, I would suggest you started with even lower EPAPmin: just 5.6, P.S: zero.
 
All the best.

[JoeyWallaby]

Last night with EERS, cervical collar, chin strap and mouth taped

Woke up because hose disconnected

[JoeyWallaby]

Inspiration is like a spike at some points. IPAP too high?

[JoeyWallaby]

I just took some nasal spray, my nose and sinuses are feeling way clearer than usual. 

Maybe I've had mild rhinitis this entire time? 

[mper6794]

Hi, Joey

Nice chunk, with few arousals/awakenings and fake things in general! This means success for UARS people like you.

Big shot with the PS:5.0, Collar and chin strap, both preventing you from chin receding (and consequent leakings, and consequent REM/leak-driven fake CA's).
The new setting and measures have stabilized your REM periods (around 5:30 to 6:05....7:00 to 7:45, and 8:39 to end session), in which fake CA's ocurred.

You have gotten absolute zero on FLmax! In my opinion, for UARS people, FL flagged would have to be chased to the very last spike on FLmax column.
This is very good, not only because it tells you are very close your tailored EPAPmin and P.S, but also it  correspond to more stable waveform in general, with less unflagged RERA's and less quasi-H/H.

I have the impression your MV would have boost too much, on 10, on account of higher RR and TV. I suspect you could get even better results with fine-tuned EPAPmin and PS; but you may want to go on this way. Let us wait for more complete sessions an see.

Not sure about influence or not of EERS; however, my first hyphotesis you perfectely go on without it. 
It would be invaluable hearing our other fellows involved in your case, and has more expertise than me on this tool.

all the best.

[JoeyWallaby]

Thank you very much!