Help with awakening problem and data interpretation

[Dannyj1981]

Hi Guys            

I really need some help in understanding whats happening during the night . I am waking up many times even with the bipap so i have been looking at my data in oscar to see if there is an explanation . My data is attached .

At these times im waking my EPAP is 12.35 my IPAP is 29.38 and pressure support is 17.53 cmH2O
However my tidal volume is 250 and my minute vent is 5.

These event are happening a lot each time i wake i switch my vent off settle down and restart so its easy to find the point when i look in oscar . 

I cant for the life of me figure out what is going on all i know is im waking multiple times per night again .

Any help will be greatly appreciated 

Danny

[sheepless]

Danny, given your list of ailments I won't be much use to you, but it might be instructive to see an F12 (in oscar) screenshot of the entire night. I think F12 now automatically arranges the graphs and removes the calendar exposing useful stats.

[Dannyj1981]

Here is a screen shot of the night     

[sheepless]

from an apnea and ahi standpoint you're doing great. your pressures are quite high and go to the max but maybe your physical condition requires it. your flow rate looks a little sketchy. while the 1 minute zoom shot may be exaggerating the flattening inspiratory 'peaks', it looks like some fairly significant flow limitations. since I don't know your machine or how your condition relates to pap therapy, I will bow out at this point and defer to more-experienced members.

[Dannyj1981]

       

Hi Guys

So today i have been looking into flow limitation , UARS etc and i have a query regarding how my machine is scoring episodes. Whilst my AHI has dropped and last night was below one , i still feel no benefit in my day time alertness , i still feel strange on waking everyday (possibly hypercapnic with headache and nausea).

I will be purchasing a CMS50F thhis week to use alongside my Bipap.

So looking at last nights screen shots i have included the first is a three minute window with a hypopnea in the middle to me its not much different to lots of other parts of the nights report .

However the second screen shot is very different there is something going on and after this event there are clear recovery breaths and when  zoomed in the flow rate shows no exhalational flow the flow rate completely flattens to 0 for 14 seconds.

what is occuring here to me it looks like an event but why did the machine not score it .

I understand that UAR events are not really counted by most sleep drs but can have a huge impact on patients symptoms?

Any ideas?

Thanks 

Danny

[sheepless]

bumping for some additional eyes here.

[Gideon]

Danny,
Add a second full night chart please. So normally these 2 full night charts, Standard and Advanced
in OSCAR click on "View" then "Reset Graphs", then "Advanced". This will show your ventilation charts which are not typically needed for Apnea.

in OSCAR click on "View" then "Reset Graphs", then "Standard". to get back to what you posted.

The flow limits you see are likely an artifact of your very high for sleep apnea PS which is likely supporting your Type 2 Respiratory failure due to mitochondrial disease causing diaphragmatic weakness. Changes here need to be cautiously made. and at this time I see none.

[Dannyj1981]

       

Hi gideon 


Thanks for your help here are the two nights chart showing the ventilation graphs.
I can see that when i am getting these flow limitations /artefacts my minute ventilation and tidal volume is extremely low from looking at the charts .

Thanks 

Danny

[Sleeprider]

Danny, we need more of the information that is in the lower left pane with the machine settings. Can you take an image of that? We need to know the mode, pressure settings, backup rate, ramp settings and other information. Your charts are very unusual for ST or AVAPS. You appear to start with a ramp range of 17/4 (IPAP/EPAP) and the machine eventually settles at 30/12.7 with every breath being triggered by the machine. We cannot see what Mask pressure is really doing because the y-axis only spans from 4.0 to 17, so any variation in IPAP pressure is lost. During ramp you appear to be extremely over-ventilated with minute vent declining from 19 L/min to about 9 L/min and eventually stabilizing after about 04:00 at 11 L/min. This suggests in important error, particularly in the ramp settings, but we can't see what those are, and the mask pressure seems decapitated in these charts. Let's try again.

[Dannyj1981]

       

hi Sleeprider

 i hope this one works i  altered the axis of the mask pressure graph to allow for the higher ipap


danny