What are these breathing patterns?

[yrnkrn]

Machine is AirCurve 10 VAuto, min EPAP=9, max IPAP=14 PS=5 (VPAPauto mode but fixed). 

I see these pattenrs 5-10 times per hour and wonder what do they mean.

[Sleeprider]

Ever inhale sharply through the nose, then swallow, and resume breathing with an exhale? Are you aware of any post-nasal drip? That's what the first one looks like.

The second one looks like a possible arousal with flow limitation at 03:38:45. All of this is perfectly normal, and no reason you should be aware of it.

[yrnkrn]

Thanks, this makes sense. I do have post nasal drip. It's not very annoying but maybe it's time to do something about it.

With PS=5 the flow limitation is zero most of the time which is why I had not included it in the graphs.
With lower PS/EPR or straight CPAP it is significantly higher. My flow limitation is very responsive to PS/EPR.

Anyhow, should I try to minimize the 2nd one, possible arousals?

[Sleeprider]

Now that you mention it, I do see the bilevel PS. Maybe you should update your profile with your Aircurve 10 S or Vauto machine and more accurate pressure settings. Nasal "prongs" almost don't exist. You are using nasal pillows, and should have that in your machine settings. As far as changing anything, nothing I see see here gives me a clue what to suggest.

Nasal prongs:



Nasal pillows:

[yrnkrn]

I have updated the profile. 

With same settings 14/9 and mouth taped (zero leak), what do you think happens on these expirations? the windpipe closes and opens?

[Sleeprider]

There is a brief pause in the exhale that could be a swallow or just a momentary hitch in expiration. You might want to right click on the Y-Axis of the chart (left margin) and add dotted lines at zero. It makes interpretation easier as everything below the zero-line is expiration and everything above is inspiration.

[yrnkrn]

With dotted line at zero, with more context and high zoom.
I am interested to know if this may indicate higher EPAP is required.

[yrnkrn]

On this reference I found how swallow looks on the airflow (marked black solid bar). This is for infants but probably similar to adults.

[Sleeprider]

The graph in post #8 is a swallow following or during inspiration. The flow drops to zero and the esophageal pressure is increased during the swallow, and the chest and abdomen is relaxing (no respiratory effort). In post #7, the flow rate abruptly and briefly drops to zero during expiration, and the exhale continues after the interruption. There is no additional information to help determine if this "hitch' is a swallow or has another cause. It appears to be inconsequential. I don't think this pattern would be affected by EPAP pressure, higher or lower, but it's easy to find out since you have a bilevel.

How frequently does it occur?
If you experimented with EPAP pressure, does this event appear often enough you could discern a change?

[yrnkrn]

This pattern happens few times a night for about ten breaths each time, so practically it's not a problem.
I had seen it happen with EPAP=7,8,9,10,11, does not appear EPAP is a factor.
Maybe a swallow but I do wonder about the abruptness ceasing of the flow.

1 Example with 14/10:



2 With 14/11, appears to end with arousal breaths:



3 Another one with 14/11: