Is this normal or my APAP is simply stupid?

[Sleeprider]

The swings in volume do appear to be related to flow limits separated by recovery breaths, and that pattern should be minimized with proper pressure support. The RERA is real. By definition, "increasing flow limitation ending in arousal". The arousal in this case is the recovery breathing. That first breath is actually a larger inspiration and breath hold.

We have seen this many times. Once you use the Vauto you are going to post you can't believe the difference and why didn't I do this sooner, kind of like this http://www.apneaboard.com/forums/Thread-...#pid355464

[fejsbukpejdz]

It is so crazy how PSG I got 1 month ago did not include anything...

They did no EEG, they did no RDI no RERAs no flow limitations.

I was awake almost entire night and they scored my breathing "okay" with AHI of 4.5


I slept like 3 hours and was awake for the next maybe 6 or 7.


They had no clue if I was awake or asleep without EEG. 

They told me you slept good.

My current doctor the one that will do PSG with  Somno HD just toay told me that they have no way of knowing I was awake nor to analyze arousals if they do not monitor EEG and flow limitations as well as accurate airflow.

HE told me his Somno HD device can not replace Esophageal pressure monitoring but he said that with nasal cannula  from somno hd and RERA as well as flow limitations are up to 90% or 95% correctly identified. So it is not gold standard, although it is the best home sleep study device he knows of.

He said he will see if it has flow limitations and how significant and he will try to get my insurance to cover the Bilevel machine.

He also told me, no need to wait for them and if I have money I should go ahed and buy it already.

[fejsbukpejdz]

also yes I have seen that post about that guy who switched from Dreamstation to ResMed...

It is amazing.

I am puzzled.

Even found more such posts in older threads.

[SarcasticDave94]

The more data and info sleep technicians and sleep doctors get just represents more data to ignore.

My sleep doc just put me down as having better sleep despite not using ASV recently and me having just told him it's not better.

[Crimson Nape]

You can contest anything that a doctor puts in your medical notes. I've had to have a doctor remove statements that I supposedly made which were totally inaccurate.

[Geer1]

A few thoughts.

1) You need to figure out a way to sync your O2 data to your CPAP data. What I do is hold my breath and remove oximeter at the same time a couple times before going to sleep. This allows me to determine time sync difference within a second or two. This is important because you need to determine if the O2 desaturation is causing the arousal or if an arousal is causing a desaturation. The latter is not uncommon as many people have false "apneas" after an arousal when they hold breath during awakening phase or changing sleep position etc.

2) Once you are able to accurately diagnose which came first you need to try and interpret the data to understand why. A series of low limited breaths, a one off apnea, just random strange breathing? All are treated differently. Some will require increase in pressure, some may require an increase in pressure support, some might even improve with lower pressure and some will not respond to any treatment.

3) You dont need to nor will you ever succeed in treating every apnea, hypopnea, rera or desaturation. Healthy people have a number of these episodes and chasing perfection is a lost cause.

4) These machines dont flag all breathing issues nor do they react to them (and in many cases they may react but not fast enough to stop the breathing issue from affecting your sleep quality). They use the 10 second definitions of apnea, hypopnea etc because everyone has breathing disturbances to some point and the common agreement is that in the majority of cases sleep disordered breathing is not a significant issue unless the defined apneas etc meet agreed upon diagnosis criteria (5 ahi etc). This causes some people to not be diagnosed/treated properly but it also is a good indicator that if your health etc still isn't good that there may be more at play than apnea.

5) I am not saying you dont have a breathing issue, I am saying you need to do more research and testing to try and figure out what the issue is. Try to learn the basics (definitions, how to interpret data, good, bad and normal etc) and then slowly adjust settings in different ways to see if they improve what you determine to be the breathing issue.

To answer your last question tidal folume is calculated from flow rate. Tidal volume is the area under the flow rate curve. A short fast breath on flow rate curve means you took in less air and therefore had a lower tidal volume. The tidal volume graph is a running average so it starts to decrease in those situations then increases as breathing normalizes again. Those examples you posted are uneven breathing but it isn't clear I'd they are a problem (not clearly causing an arousal etc). They could be a sign of rem sleep during which many people display fluctuating breathing.