[Treatment] Still fatigued, history, are these CAs real?

[Gideon]

My bad.

[Sleeprider]

The high sensitivity for trigger is something I did a couple years ago. I had similar central events flagged and that Change works great to clear it up. You have a relatively long expiration time so leave cycle sensitivity at medium. I think as you become accustomed to the Vauto you’re really going to like it. Hopefully no smoke odor this time.

[GuyScharf]

The high sensitivity for trigger is something I did a couple years ago. I had similar central events flagged and that Change works great to clear it up. You have a relatively long expiration time so leave cycle sensitivity at medium. I think as you become accustomed to the Vauto you’re really going to like it. Hopefully no smoke odor this time.

Definitely no unexpected odor this time!

I reduced pressure a little bit to 5.8/4/9.8, so still at fixed pressure.  Looks like flow limits might have increased a bit over 6/4/10 but it is difficult to know for sure with just one night of each setting.

I tried high sensitivity last night.  In statistics, the one thing that stood out was the I:E ratio -- 0.58 instead of the 0.93 that is typical.  I guess that is a result of setting trigger sensitivity to High?  I noticed a difference in breathing at the beginning of the night but immediately became used to it.

As I look over the flows for the night, I am struck by how a flow limit of just 0.02 is accompanied by a flattened-top wave pattern.  Still have some waxing and waning but less than before I started EERS testing.

Are "waxing and waning" and "oscillatory breathing" and "CO2 inspired breathing" all synonyms for one another?

[Gideon]

IMHO yes.  "Waxing and waning" and "oscillatory breathing" are a description of the waveform whereas "CO2 inspired/induced breathing" refer to a cause of that breathing pattern.

[Sleeprider]

I hate the way OSCAR calculates I:E ratio. It's based on I/E, but if you look at ResScan I:E ratio is expressed as 1 to xx for inspiration to expiration and this is accomplished by the product of E/I. I just don't like this perpetuation of the Mark Watkins error. That said, the longer expiration time is very normal and should allow better ventilation. Any change to tidal volume or minute vent?

[GuyScharf]

Tidal volume and minute vent were about the same as before I started the EERS experiments: 460 and 6.13 were values for the last two nights on the VAuto.

I see that OSCAR calculates an I:E ratio that it shows on the Overview page.  Does it show this anywhere else?  What machines does it show this for anyway?  I don't see it for the AutoSet but do see it for the VAuto.

UPDATE: Never mind.  I found your post, with a list of machines that report this, and discussion from early 2019.  What has changed in OSCAR about handling I:E ratio since then?

[Gideon]

We need to flag this as an OSCAR calc, anything that OSCAR itself calculates, perhaps a supercase "O"

[sawinglogz]

I hate the way OSCAR calculates I:E ratio.  It's based on I/E, but if you look at ResScan I:E ratio is expressed as 1 to xx for inspiration to expiration and this is accomplished by the product of E/I.  I just don't like this perpetuation of the Mark Watkins error.  That said, the longer expiration time is very normal and should allow better ventilation.  Any change to tidal volume or minute vent?

It looks like this is Resmed-specific and imported from the raw Resmed data. How is it being displayed for you?

I've seen I/E used by pulmonologists (though usually notated as Ti/Te) along with Ti/TTot.

https://www.pftforum.com/blog/what-does-...cise-mean/

If it's being labeled "I:E" we should display it as "1:N" (even if Resmed is only recording/reporting N).

If we want to keep displaying "N," we should change the label to E/I.

[GuyScharf]

ok, I now have six days of data with VAuto 6-10, PS 4, high sensitivity for trigger.  Maybe a slight improvement over the AutoSet, but still not feeling as refreshed as I would like.

I am attaching screenshots for the last two days, links to videos of 6-minute through the entire days, and spreadsheet.

What should I try next?

• Very high sensitivity?
  
• Increase PS to reduce flow limits further?
  
• ?
  

Thanks!

                   

https://www.dropbox.com/s/9cr0ut3ur06v3t...7.mp4?dl=0

https://www.dropbox.com/s/dlvqp76j2izs60...0.mp4?dl=0

[Sleeprider]

I don't see a lot of optimization opportunities remaining in this data, and it may be time to look at factors external to PAP therapy as sources for "not feeling refreshed" or fatigue. We can see therapy is fragmented into several sessions, with primary sleep separated by a 2:15 hour break on 8/11 and almost 2-hours on 8/12. Everyone has different sleep habits, but routine breaks of over 2-hours in a night would make anyone not feel particularly refreshed the next morning.

I had a really crappy sleep last night myself. I don't know what time I woke up, but I laid in bed until dawn without sleeping, and really felt it. For me it was a combination of getting that damn Shingrex vaccination and too much wine at dinner. I'll do some make-up tonight. The point is, be aware of your sleep hygiene and that it is going to impact how your feel. If you're not aware of being disrupted by your therapy, you probably aren't. It sure doesn't show in the data.

Feel free to make small changes in minimum pressure to deal with the OA events. I would stick to small changes of 0.4 or less. Changing pressure support (IPAP) may improve some ventilation, but I don't see much flow limitation at PS 4.0. Again, try small changes in EPAP first while maintaining PS, then try small changes in PS. I don't think your settings are the root problem, but it's always okay to try small changes.