Lucky7's therapy thread

[Lucky7]

So, just happened to to be looking at the respiratory rate graph and I noticed that every time the machine raises pressures, there is a spike in respiratory rate. a BIG spike.

What's going on here?

EPR is ON and set to 3.

Thanks crew...

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Better screenshot without junk in the way.

[Sleeprider]

Show the other graphs, especially flow. Increased resp rate could be a reaction not a cause.

[Lucky7]

Thanks for the reply

Here we go:

[Lucky7]

Here's one of the high Respiratory Rate's zoomed in so you can see what's going on.

Flow goes from round top waves to flat, breathing becomes restricted, and then the RR jumps up to 45!

[Sleeprider]

Pressure is rising in response to each of these obstructive events. If you zoom in, I'm sure you will see flow limits that lead to the RERA or hypopnea. You are already using EPR 3, so we either need more pressure, or look into the possibility that the flow limitation is positional. It seems periodic, so it looks to me like as you relax and fall into deeper stages of sleep, your chin drops and restricts flow. Each event marks an arousal with increased respiration volume, and the pattern repeats in 20 minute intervals.

[Lucky7]

Thanks

"so it looks to me like as you relax and fall into deeper stages of sleep, your chin drops and restricts flow."

You are good, I gotta say. It's supine and flagged as "deep sleep" by Fitbit.

One suggestion I heard is to raise the min pressure. That seems reasonable to me. 

I don't think I could hack a cervical collar, so maybe Knight's Bridge eh?

Cheers! Appreciate it.

[Lucky7]

"and the pattern repeats in 20 minute intervals"

You know what? I didn't catch that! How interesting! I'll look at some other nights and see if it's periodic. Far out.

What's the physiology behind the periodicity (if any)?

[Sleeprider]

I don't think you need to go to a soft cervical collar, but do consider your pillows and sleep position as tools to improve this.

[Sleeprider]

Classic RERA.  Increasing flow limitation with increased respiratory effort leading to arousal.  I believe that is pretty close to the definition.  It results in a shift in position that frees your airway, and recovery breathing flow slowly returns to normal.  The interesting part of this is that flow limitation goes on for quite a while without a response from the machine which just begins to increase at 01:21:00 then accelerates pressure increase until 01:21:15. The machine is designed to detect increases in flow limitation, but in your case, the onset is so gradual it fails to respond until the flow limitation is acute.  You should include the flow limit chart in your posts to see where the machine actually detects the flow limit.  This is an important point, the Resmed auto PAP devices respond strongly to increases in flow limitation, not to actual flow limitation which was not counted, and allowed this event to evolve.

[Sleeprider]

Classic RERA.  Increasing flow limitation with increased respiratory effort leading to arousal.  I believe that is pretty close to the definition.  It results in a shift in position that frees your airway, and recovery breathing flow slowly returns to normal.  The interesting part of this is that flow limitation goes on for quite a while without a response from the machine which just begins to increase at 01:21:00 then accelerates pressure increase until 01:21:15. The machine is designed to detect increases in flow limitation, but in your case, the onset is so gradual it fails to respond until the flow limitation is acute.  You should include the flow limit chart in your posts to see where the machine actually detects the flow limit.  This is an important point, the Resmed auto PAP devices respond strongly to increases in flow limitation, not to actual flow limitation which was not counted, and allowed this event to evolve. If not for the positional element at play, a higher pressure would help, but as long as you gradually settle into increasing physical obstruction by sleep-position, it may not be as effective.