Therapy using Lumis 150 ST

[StuartC]

Three charts attached:

1. Desat in the middle of the night
   
2. First REM, longer time frame, just for some context
   
3. First REM, tighter time frame
   

I will also post a chart with the leaks but will need to post separately.

<EDIT: I will need to check clock time of Lumis vs. ring. The SpO2 chart may be lagging the flow chart, possibly by about 1 minute (?)>

[StuartC]

I decided to produce 3 charts related to the leaks:

1. Whole night
   
2. First REM
   
3. Second REM with desat
   

The shape of the leak during the first REM is somewhat similar to mask leaks that I used to have with my Eson 2, so I will check fitting again tonight, just in case.

[Geer1]

For the zoomed shots make flow rate chart larger and zoom to around 4 min duration so we can see individual breath details. Also good to include mask pressure graph.

It looks like your breaths were smaller for some reason at that time but not zoomed in enough to understand what is going on.

[StuartC]

Three charts attached with a 4 minute window.  There is one chart from each of the REM periods from 23 April, the one that has the Hypopnea is the start of the desaturation.

[StuartC]

Sunday night's charts.  Whole night plus 3 charts with 4 minute windows, one from the first REM and one from the start of the second.


Even though SpO2 is perfect, I have woken feeling "puffed".  I have been very aware of my breathing all morning.

RR is very responsive to IPAP of 14.  Is this actually too high?

Thanks.

[Geer1]

Those desaturations have significant flow limitation and probably would have been obstructive apnea without the significant ventilation assistance the machine provided. It was probably a moment of positional type apnea where you were sleeping on edge of pillow with neck kinked etc.

The other rem periods show paused breaths being the cause of respiratory depression. Increasing target RR will kick in the backup rate sooner and help support that breathing. I would start with increasing to 12 then maybe 13 at some point.

I don't understand what feeling "puffed" means.

[StuartC]

Okay, I will increase RR to 12.  Do I need to adjust volumes accordingly?  Keep VT at 480 ml?

I don't quite know how to describe "puffed".  I am not actually short of breath, nor am I breathing heavily.  My resting SpO2 and pulse are actually quite good (for me at least, 97%+ and < 80 bpm).  I am simply aware of the effort of breathing in.  It is a bit like the feeling of getting your breath back after exercise except (subjectively) fairly typical RR and volume.  I think longer time for inhalation.  Quick exhalation - and perhaps that is the origin of the term. I am puffing air out, it is audible.

It is as though I "worked" quite hard last night.

As I write that, I appreciate that it is possibly a good description of a restrictive lung condition, which has been mentioned here a few times, even if not yet in any doctor's offices.  Kick-off appointments have been made.

Thanks.

[Geer1]

Leave Va the same. MV is what matters and you don't want to target TV with this machine.

RR 11 and Va 4.0 before gave a target MV of 5.32. Increasing RR to 12 increases target MV to 5.44 so the machine will already provide more MV/PS. If you targeted TV of 480 along with the RR increase the new MV target would be 5.74 which might still be ok but is getting closer to causing more machine intervention.

Your issue isn't a lack of TV/MV, it is a depressed RR that causes your reduced MV. Imo it makes the most sense to fine tune BR to maintain RR as possible, this will reduce the mount MV drops to begin with and the work the machine has to do to maintain target MV.

I wonder if your "puffed" feeling is the feeling of getting used to breathing spontaneously again. We still have some tweaking to do and will see how you feel once things are dialed in.

[StuartC]

I wonder if your "puffed" feeling is the feeling of getting used to breathing spontaneously again. We still have some tweaking to do and will see how you feel once things are dialed in.

Yes, it could be fatigue since spontaneous trigger was 98% and RR was relatively high at times. Post exertion fatigue is consistent with my experience over the years and I am "feeling" my ribs today.

PTR is set to 12 for tonight, which sets the lower BR limit (the trigger value) to 8.

[Geer1]

If it is truly just spontaneous breathing that creates this feeling then I would have hesitations in trying to treat it. The more work you get a machine to do for you the less your body will do and the worse things will get.

If this is caused by settings hopefully it will become less of an issue as we get things dialed in.

Another thing worth looking at now is timing controls and how in sync your breathing appears to be with machine operation. If your body is fighting the machine like say trying to exhale while machine holds pressure or supplying pressure before you are ready for it then that can also cause fatigue. Best way to do this is look at your detailed breathing on flow rate chart and compare it to mask pressure chart. If breaths all look normal the good, if things look weird post some examples so we can try to determine why.