Seeking advice on SH screenshot

[FrankNichols]

Well, after a lot of slowly testing here is where I am. The screen shot is typical of the past few days/week.

Leaks are mostly controlled but the control is painful - very tight straps on F10. The tight straps are not only painful, but I think it reduces the life expectancy of the straps by stretching them tight they lose their elasticity. I am working on a memory foam "liner" idea that I have hopes for.

OA's are mostly controlled - none last night.

I am not sure if the periods of high respiration variability are REM sleep or periods of waking - I think they are REM, but I am not sure.

One thing I was trying to do is to make sure the Pressure waveform does not flatten out on top. At lower pressures it is obvious that it "wants" to go higher because it rapidly increases up to the MAX setting then sits there for a while until dropping back down. Here it reaches the max setting quickly, and then almost at once starts drifting back down. I think that is "a good thing" - am I mistaken?

Any thoughts on further adjustments would be seriously appreciated. I am probably going to try lowering the MIN pressure a little to see if I can get the CA's down a little.

Thanks,
Frank

Edited to add a zoom in on a small section, in case that helps.

[MitchS]

Hello Frank.

I can't help you with your charts, but I would like to offer my encouragement on your battle with making CPAP therapy work for you. I have been watching your progress from the beginning of your therapy. I have to say I admire your persistence and ingenuity in solving the constant roadblocks you have encountered. Many people would have given up long ago. Keep up the good battle, we are all rooting for you here.

Mitch

[justMongo]

Your flow rate should look more like it does from 00:45 to 01:20 --- smooth.
What's with the respiratory rate jumping up to 40 - 50 per min?
And your TV falls when RR is up. (keeping your minute volume relatively the same.)

They say everyone is different; and your graphs are certainly different.
A question that pops into my head is: Are you using the best machine for the job?

[FrankNichols]

Your flow rate should look more like it does from 00:45 to 01:20 --- smooth.

That would seem to indicate peaceful sleep during that time - it would be wonderful to have that all the time (well, except for REM time).

What's with the respiratory rate jumping up to 40 - 50 per min?

I assume those are REM sleep, but it may be arousals back to being awake, but I don't recall being awake then -

And your TV falls when RR is up. (keeping your minute volume relatively the same.)

I assume that indicates rapid shallow breathing? I don't know...

They say everyone is different; and your graphs are certainly different.
A question that pops into my head is: Are you using the best machine for the job?

That is an excellent question, I have no idea, when I go back to me sleep doctor for my follow up in a couple months I will ask him that and show him what my charts look like. Maybe he can explain some of it.

Thanks,

Frank

[PoolQ]

I can only add what I would look into, not a Dr and so on. What it looks to me like is that you are taking very short breaths, in and out quite fast and then idling in between. Sometimes those idles are long enough to trigger hypopnea or central flags. I don't remember seeing such fast inhales with an even faster exhale. Not even close to CSR and not sure if it's your natural breathing pattern or your reaction to the pressure/machine.

From what I understand an ASV machine not only treats centrals, but it also enforces the breathing waveform (may be wrong here, but pretty sure I read that).

There are some on this forum that are very knowledgeable about waveforms that should be able to add something interesting.

I know my Dr would look at your central count and just go pfft, nothing there (because he did with me By event count alone you are doing fine, how do you feel? Are you just chasing perfect 0.0 or are you trying to figure out why you are not as rested as you would like?

[justMongo]

Observation: The night has flow limitation most of the time.

Narrative: PaytonA and I have the same machines (as each other); and we have both observed that a ragged flow waveform may double trigger our machine's bilevel. This also gets reported as a doubling of the respiratory rate.

Possible explanation for Frank's RR: Ragged flow waveform causing the machine to report a double or triple RR.

It begs inspection of the flow waveform where 30-45 BPMs is reported.

Franks median RR is 15 BPM; which is "average."
Suggest you zoom in Frank.

K/R

Mongo

[FrankNichols]

By event count alone you are doing fine, how do you feel? Are you just chasing perfect 0.0 or are you trying to figure out why you are not as rested as you would like?

My goal was/is to stay below 5 so, I am not interested in trying to get to 0.0. However, I am interested in using the least pressure to keep me below 5 and people here know a lot more than I do, so, I am seeking opinions and advice by people smarter than me, that is all

It begs inspection of the flow waveform where 30-45 BPMs is reported.

Franks median RR is 15 BPM; which is "average."
Suggest you zoom in Frank.

Your wish is my command: Below are three "zooms" and the flow waveform is a bit "weird" looking to me, now that you mention it.

First is a 7 minute section where the RR is around 50

Second is at the end of the 7 minutes where the RR transitions down to the 20 range

Third second zoomed in on an arbitrary section where RR is around 50

[vsheline]

Hi Frank,

Regarding "I am not sure if the periods of high respiration variability are REM sleep or periods of waking - I think they are REM, but I am not sure."

These periods are when the machine is being fooled by the roughness of the Flow waveform.

The machine distinguishes inhalation from exhalation based on zero crossings in the Flow waveform.

When the Flow crosses zero more than once between exhale and inhale the machine may be fooled into over-counting the respiration rate (RR) by a factor of 2 or higher.

The Tidal Volume is the Minute Volume divided by the RR, so if the RR is falsely high the TV will be falsely low.

Those who have bilevel machines can increase the Min Ti setting (the minimum time an inhalation needs to last to be counted in the RR) to perhaps half a second (instead of the default setting which I think is around 0.2 seconds) which would probably prevent the machine from being fooled.

[vsheline]

Hi Frank,

Regarding
"Leaks are mostly controlled but the control is painful - very tight straps on F10. The tight straps are not only painful, but I think it reduces the life expectancy of the straps by stretching them tight they lose their elasticity."

My IPAP pressure is usually 20 to 21 and occasionally reaches 24 to 25.

I copied PaulaO2 in wearing two mask liners. Really helps. I use RemZzz brand, two at once. (I am very careful to never pull on them or stretch them out, and I get at least a couple weeks use out of two.)

I also switched from the F10 (which worked well, as long as I wore a mask liner) to the SimPlus FFM, which for me works even better.

[green wings]

Hi, Frank. Amazing job on getting rid of the REM "cluster bomb" OAs! Mine are better, but not gone. I guess I'll have to stop saying "but they're not as bad as Frank's."

You're not using any EPR at all? Wow, that's amazing. It feels comfortable? Did you try using EPR and get bad results?