Night 8, it's already Love - Hate. So glad I found you guys!

[FE350]

OK, I realize you needed better resolution...I'm a slow learner.... Here are a couple of messy looking times.  Thoughts?

[FE350]

Two more.

[Sleeprider]

It's really interesting that most of those charts show a normal respiration rate in the 12 to 15 BPM range.  This one below is much lower with 6.5 BPM, but it looks like there is an unsupported inspiration between each cycle that would have resulted in a breath rate of 14 bpm if it had been supported. This is a curious pattern and I don't know how to interpret it.  None of your images shows the double and triple tap we saw during the hypopnea, so I'll consider that a good thing.  For the most part your therapy looks excellent, but that one hypopnea cluster was badly out of sync.  It's good to see the rest of these graphs that look like very good results and a generally higher respiration rate.

Tom

[FE350]

Thank you Tom!  So, nothing to worry too much about the breathing rate?  Phew.  How about settings changes to deal with the hypopnea's?  Any ideas?  It had been suggested that I consider increasing the pressure support.

[Sleeprider]

I'd like to see a re-do of that hypopnea chart, I'm considering forwarding it to Resmed as an example of potentially incorrect response by the ASV, and the zero line would help. 

The question is whether higher PS min might help to hypopnea, and in general, that is the correct response based on titration protocols.  I think it's worth a try at PS min 4.0 and see how you feel and respond.

I don't think it will change the events we saw in the image below.  In this image we see the first hypopnea is preceded by several large pressure support spikes, so the PS min is probably not a factor here. The second event is preceded by a 3 cm PS and two larger ones. Higher PS min may have improved that first small inspiration, but the next two breaths are supported by 8 and 11 cm respectively and it doesn't seem to make much difference. For the third through 5th hypopnea, between 04:10:00 and 04:13:00, there are only 10 major breaths in 3 minute and the machine is hammering you with multiple pressure pulses. Clearly PS min does not come into play here.  It was a relief to see the more normal breathing in all your other examples, but this image still has my jaw dropping.  

[sheepless]

that looks a lot like my plm pattern.

[Sleeprider]

that looks a lot like my plm pattern.

I hadn't though of periodic limb movement. You could be correct. FE350 will have to confirm if he has a bed partner, video or study to confirm or refute.

[FE350]

Hi,
Thanks for this feedback Tom and Sleepless. I’ll ask my wife to help me note anything curious. I’m not aware of leg movements, and my sleep studies confirmed that was not an issue. I’ve had 4 in-lab studies. 

A thought, I’m often awakened in the night, and my hands are asleep. I’m also dealing with peripheral neuropathy in my feet. I’ve wondered if circulation issues could be the culprit. Can this be at all related? Evidentiary?

Tom, following up on your curiosity about that funny hypopnea sequence, did you want to see more views around that timeframe, this was for your submission to Resmed?

Thanks a ton all,

[Sleeprider]

I would be happier if we didn't repeat that sequence or perhaps associate it with PLM or whatever. It's not one I have previously seen and don't really know that there is anything to be done about it.