Interpretation Questions - My OSCAR Data

[ApneaQuestions]

Meanwhile... back to experimenting with the Resmed Airsense S10 Autoset         (VAuto not arrived yet)

Last night's data..

What changed?  EPR fixed at 3 ("Pressure Support")  Bumped Min Pressure from 7 to 8

What's next? Will try min 9 to get me just below my median pressure of 9.46 - Makes sense?

Comments:
Notice no mask removals and this is longest uninterrupted session in months (8 hours 9 mins)
However, the previous night was sleep study #3 and (as I expected) my sleep was poor again.  
I think I accumulated some sleep debt in that study that I claimed back last night. Glad it was free.
They had a heating vent directly over my head blowing hot air at my face.  The room was 72F and I like to sleep at 65F or less.
What are these people thinking? [rhetorical]  They couldn't drop the temperature because all the other bedrooms and the techs would be dropped to 65F too. Brrrr.
I'm seriously thinking about getting an EEG if I can find something reliable at a reasonable cost that hooks well into OSCAR...  Not because I'm overly concerned.. more out of geeky interest.  Any suggestions on models?

The zoom shows a two-for-one with a Hypopnea followed in quick succession by a free RERA. Seems the recovery grunting was interpreted as "snore".

Symptoms/Subjective:
Several conscious awakenings (not stressing out about it).  Body pains non-existent.  Dry mouth, Dry nose (congested - turbinates still enlarged) , less puffy baggy sliitty eyes.
If I can maintain 8 hours I will be happy.

[ApneaQuestions]

This may be my final test with the Resmed Airsense 10 Autoset due to its max of 3 on "Pressure Support"

Last night's data..

What changed?  EPR fixed at 3 ("Pressure Support")  Bumped Min Pressure from 8 to 9 to get closer to yesterday's median pressure 9.46

What's next? Aircurve VAuto has arrived - I will use the default prescribed settings just to get some base data.

Comments:
I only ran for 3 hours and then took off the mask.  I was having some intensely vivid dreams that would make a great movie.
I've attached a couple of zooms showing..
1) More waveform flat-tops followed by a pseudo-apnea
2) Interesting periodic amplitude modulations on the Flow Rate in places. - Anyone care to comment on those?

[Plmnb]

Hey, ApneaQuestions,

I am curious, what would a GOOD or NORMAL, as normal as possible anyway...FLOW RATE graph look like?  And/or the FLOW LIMIT graph?  Actually, which one of these graphs should I be more curious/concerned with?

I Google searched what some of the graphs should/might look like and I am having difficulty comparing them to mine.

I found this, thought it was pretty nifty:


[attachment=18229]

Plmnb

[Gideon]

Flow Rate is the important one, Flow limits always show there. Flow Limits are a metric that says FL is happening, look (in Flow rate) here.

That is a good representation of flows, though normally you will see the expiration is about twice the inhalation.

[ApneaQuestions]

I am curious, what would a GOOD or NORMAL, as normal as possible anyway...FLOW RATE graph look like?  And/or the FLOW LIMIT graph?  Actually, which one of these graphs should I be more curious/concerned with?

This is the blind leading the blind!

I'll answer them in reverse order.

The flow limitations graph shows places where the machine thinks something "significant" is happening with your flow.  The bigger the spikes and the more clustered they are is a good indication that something is going on.  I just use that as a clue to zoom in and look in detail at the actual "flow rate" to see how nice and rounded my breaths are.
So basically both curves are useful.  One tells you something might be happening.. the other lets you see exactly what is happening.

In addition, I also added a couple of user flags to come up with my own "RERA-like" detection.
FIle->Preferences->CPAP  is where I set up two "Custom CPAP Uer Events"

#1 80% 10s
#2 80% 5s

I've discovered that the first flag is fairly conservative and the second flag is over-sensitive

In terms of what "normal" should look like.... Ideally the inhalation should be nice and rounded.
If it's flat or chair-shaped or some other funky shape then this suggests that the airflow is not smooth and unobstructed.
In my case, I'm increasing pressure supports to see how rounded I can get them because I suspect they may be messing up my sleep and pulling up from deeper sleep into shallower levels. (notice I say suspect).

In early posts on my thread I gave a couple of easy-to-understand pictures describing how these waveforms may look and why they may be worth optimizing.
If the limitations are followed by a "Recovery Breath" then you can be fairly certain that it affected your sleep and that would officially be a RERA.
The "A" in RERA means Arousal.
Here is that post http://www.apneaboard.com/forums/Thread-...#pid323859
scroll down from that post and you'll see I found the paper that did an interesting study showing that apparently healthy people have these waveforms.
However... I put a different spin on that... maybe those apparently healthy people might benefit from some pressure support too!
After all... how do we define "apparently healthy"?.

I'm working on the assumption that RERA-like waveforms "may" also affect sleep even though no explicit recovery breath is visible.
Without an EEG machine I can't say that with any certainty.  However, flow limitations certainly can't help.
So I am using a suck-it-and-see approach to try to get my waveforms as rounded as possible and see if I feel any benefit.

At some point, I may not be able to get them any better because my turbinates are enlarged and maybe no amount of tweaking will get air through them without flow limitations.
I wish I could tell when I am mouth-breathing versus nose-breathing to separate the two. Maybe that's what the flattened waveforms are actually telling me. maybe.

Oh yes.. one other curve to check is the Respiratory Rate.  I've noticed that it's easy to spot poor waveforms as follows..

1) If the Flow Limitations look noisey
2) If the Respiratory rate looks noisey
3) If User flag 1 triggers
4) If the Flow rate looks flattened
5) and of course... if the RERA flag triggers

Hope this helps

[Plmnb]

Thank you bonjour and ApneaQuestions.

I definitely need to soak this info in for a while.

I'm sure I'll have more questions after I digest it all.

[ApneaQuestions]

There's also another thing to consider which I believe is a real and probably testable hypothesis...

If someone is actively proactive in pursuing remedies and has a belief or a suspicion that what they are doing might work... this puts them into the psychological state of being receptive to the placebo effect!  So if I feel better it may be caused by wanting to feel better and expecting that I might feel better.

It's tough to do a double-blind placebo study when you are the patient AND the doctor at the same time and therefore you can't possibly be blind!

It would be a fun trial to take two sets of people and tell them  "I am going to tweak your pressures and this should make you feel better".
However, on a randomized basis you tweak only half of them and leave the control group un-tweaked.  That would help eliminate the placebo effect.
It would be very fascinating if the un-tweaked group felt better too!

Essentially, CBT techniques can have a large impact on sleep quality but I notice that this forum tends not to talk about such things.
Partly because it's an Apnea forum and partly because people have a reluctance to recognize that their thoughts and beliefs can and do affect so many aspects of life.
I guess there's still residual stigma related to being considered somehow "weak" or "defective" or "broken" when psychological issues are discussed.
To me.. it's just another treatment modality that can and does work for a large group of people.

Anyway.. I digress.. but I think I can safely do so on my own thread.  ;-)


By the way.. I'm going to do an extra couple of nights tweaking the Autoset before switching to the Aircurve because I think there are more benefits to be gained from this machine by bumping my pressures up a little higher.  I'm treating this as a bit of a research topic on myself to see how good I can get the results.  If you see me floating down the street in the next Thanksgiving Day Parade.. I probably took it a bit too far.  ;-)

[ApneaQuestions]

...I found this, thought it was pretty nifty:...

Yes that is nifty!  Thanks for sharing it.  It fits in very nicely with my interest in waveforms.
I'll go hunt down your thread and take a peek at some of your graphs to see if you are doing the same type of zooms that I'm doing once you start on the BIPAP.
It's an interesting subject isn't it?

[ApneaQuestions]

I am curious, what would a GOOD or NORMAL, as normal as possible anyway...FLOW RATE graph look like?

I'm not talking directly to Plmnb here... I'm just quoting your question.

One word of warning here... if you can look at  these waveforms and have a calm dispassionate approach then that's great and may be interesting and fun.

However, there may be a tendency for some personalities to over-analyze and start freaking out every time they see something that's not exactly sinusoidal and smooth.

I'm in the former group.. if anyone reading this suspects you might be in the latter group.... chill out and watch a movie instead.

Not every chest pain is a heart attack. Not every waveform needs to be "fixed".  But you knew that... right?

[JoeyWallaby]

I posted some stuff on flow waves here
http://www.apneaboard.com/forums/Thread-...#pid320050