Rapid Breathing-Fractured Sleep-Out of Breath

[SingleH]

Hi Fixit50,

Just a quick update to say I had a look at my Dads figures yesterday, unfortunately I didnt get a chance to take a copy of them, but I can say one thing. He still had recoveries ocurring with a combination of high PS and high EPAP, but the magnitude of of the recovery was much less and much shorter. On average the waveform was much less disturbed before hand and returned to normal after occurance. I dont have any screenshots at this time.

However, what I cannot guage is whether it reduced the number of recoveries as the combination of high PS and high EPAP has resulted in extensive expiratory mouth breathing to the point as much has 50% to 75% of his sleep is constant expiratory mouth breathing almost every night. I dont know the implications of this, but I dont think its right and have started scaling back the EPAP.

As I saw his waveforms were far more disturbed at lower pressures and PS when recoveries occured, I can only assume the additional physical support that the higher pressures provide helps override any erratic and weak breathing beahaviour when it happens, thus mimising his recoveries.

[Fixit50]

Thanks for posting these observations.  I’m also making some similar observations.  Last night for example I used the chinstrap which I adjusted and even taped to make sure it stayed in position.  The result is that it did a better job of keeping my mouth closed all night.  I had a comfortable night’s sleep with zero events and low pressures.  There were scattered recoveries and probably no fewer than other nights when the machine had to do more work.  The difference as you’ve also seen, is the magnitude of these recoveries was very small. The largest reached a peak minute vent of 18.5 l/min where more typical recoveries in the past were in the high 20’s.  In general, it seems the recoveries are smaller if the breathing is more regular.  Typically, tidal volumes are somewhat reduced for a period of at least a few minutes prior to a recovery.  Occasionally, there are exceptions like the one in post #63 where VT was only mildly reduced before a moderately large recovery.  In that case however, breathing before the recovery was a bit jagged so maybe there’s a clue there. Below are some stats from last night.  
   
I plan to slowly increase PS to 5.0, and then get rid of the chin strap and see what results I can achieve with the F20 mask alone.

[SingleH]

Thanks for sharing, interesting to see you are seeing a similar effect and the chinstrap has an effect.

I am going to get my Dad to try a chinstrap instead of his collar and see what happens.

[Fixit50]

That may be a good idea.  I've tried a collar recently and several years ago with the same result.  It seems to keep my jaw in position, but for some unknown reason it has had mixed results.  At times it's worked as well as a chinstrap, but half the times I get significant numbers of OAs and bursty flow limits.  Overall, its been discouraging in my case.  The chinstrap has been very effective when properly adjusted.  I've had to customize a commercial chin strap for best results.  The commercial ones pull the chin up and slightly back which does not work as well. I attach it so that it makes a vertical loop pulling the chin straight up.  Alone that would slip forwards, since the top of my head slants forwards.  I've added a strap using Velcro which connects the top of the chinstrap with the lower F20 mask strap at the back of the neck.  This has been very effective in my case, and I also find it to be more comfortable than unmodified chinstraps.

[SingleH]

I bought the Resmed chin strap which pretty much looks like it might be doing what you suggest to avoid, in that it pulls the chin up and back.

Im just trying to visualise what you described. My dad has an F30 mask. I made quick paint drawing using the chinstrap I bought, are you saying to mount it more vertically as shown with the grey strap I have drawn, and then use the velcro strap running along the centerline at the back of the head to attached to the bottom mask strap (highlighted in blue) at the back of the neck?

   

[Fixit50]

I bought the Resmed chin strap which pretty much looks like it might be doing what you suggest to avoid, in that it pulls the chin up and back.

Im just trying to visualise what you described. My dad has an F30 mask. I made quick paint drawing using the chinstrap I bought, are you saying to mount it more vertically as shown with the grey strap I have drawn, and then use the velcro strap running along the centerline at the back of the head to attached to the bottom mask strap (highlighted in blue) at the back of the neck?

Yes, That is what I’m suggesting.  
You might be able to use the existing strap but mounted in the vertical position and then add the strap from the top center running to the back of the lower mask strap you’ve shown in blue.

[SingleH]

Thanks for confirming, the top strap of his F30 mask sits pretty much on the top of his head, so it might be possible to secure the chin strap in that location also. Will see how it goes.