RE: What the heck? Flow limitations and strange waveforms
(03-14-2020, 06:50 PM)Crimson Nape Wrote: Based on 7 to 8 hours of sleep since 2013 should but your little baby somewhere around 17900 to 20500 hours. I don't know if there are any deals in your neck of the woods, but I think I'd start keeping an eye out for another one.
I don't average anything like that unfortunately. I have severe insomnia and fibromyalgia which gets quite painful at times. My sleep is usually short and fragmented. Anyhow, it's time to start thinking about a spare in case this one does fail. But first I need to tease out if these strange flow waves are real (in which case I should probably see a pulmonogist) or an artifact of a badly-behaving machine. Steps from here:
- Trawl through the charts to identify any other strange episodes
- If there are such episodes when did they start? Can I pin it down to a particular time or event?
- See if I can hire a new machine for a few weeks and see if I'm still getting episodes.
- Decide whether to see a pulmo or look for a new machine.
Many thanks for your help and advice.
RE: What the heck? Flow limitations and strange waveforms
Not sure if you saw my post on the first page, but the bottom line is I think the sync problems mayt be related to teh age of your machine. You need a new one, and it will be easier to work out if this is a machine issue or respiratory by seeing if the anomalies are repeatable using the new machine. Let's face it, you need a backup at 20K hours. Time to shop a deal. The Resmed ASV has no settings that can resolve this, so let's hope it's the machine.
RE: What the heck? Flow limitations and strange waveforms
DeepBreathing,
I don't have much to add, just trying to give some support. As you go through your data looking for similar episodes, print those graphs out so a Pulmonologist can look at them.
It would be ideal if you could rent another machine for awhile to see if you experience anything similar to what you are seeing with your current machine.
With regards to Number 4, you should probably do both. A Pulmonologist can run other breathing tests to be sure all is well.
RE: What the heck? Flow limitations and strange waveforms
(03-14-2020, 08:45 PM)Sleeprider Wrote: Not sure if you saw my post on the first page .... The Resmed ASV has no settings that can resolve this, so let's hope it's the machine.
Yes I did, thank you SR. What's worrying me is that I don't want to go and purchase a new ASV only to find that also doesn't do the job and I should have got one of the Lumis range instead. I'll have a talk to a local supplier and find out what they can offer by way of a rental and also get Resmed's service agent to look at my S9.
OpalRose, thanks for the support- it's appreciated. And yes, I will certainly be taking Oscar with me on a laptop as well as some hard copies of specific charts.
RE: What the heck? Flow limitations and strange waveforms
I appreciate your concern whether the ASV is the best device, and that brings us back to needing a better understanding of your respiratory issues. If it is straight-forward central or complex apnea, then it probably is. If the problem involves physiology of obstruction or pulmonary resistance, than we are getting into overlap where the iVAPS might be more suitable. Certainly in the examples you posted, we can see how a set pacing (bpm) and minimum inspiratory time would make a big difference. That depends on how frequently these events occur. Logically if we can maintain a respiration rate of 12-15 bpm and specify the minimum amount of time IPAP must be applied, those double inspirations would be treated. Your settings currently only provide a PS max of 9.0, and your IPAP is ranging from 11 to 14 cm. That alone takes you near the capacity of your machine, and makes the use of ASV questionable. The iVAPS gives you more ceiling to work with and given your relatively high EPAP for ASV, I agree it is worth considering. The other consideration is your pressure support does not seem to fluctuate rapidly as we miight see with most complex apnea. Your pressure support is consistently high, and the events of concern seem to be more prevalent when PS is near the minimum.
RE: What the heck? Flow limitations and strange waveforms
OK, I've been back through every night since 1/2/20 and the episodes I posted above seem to be the only ones. I've hard-booted the machine and I'll increase available PS and MaxIP to see what transpires.
I'm not aware of any specific breathing difficulties when awake, so I don't think COPD or asthma or similar is an issue. My breath-per-minute has been around 10 +/- 0.5 for years. Trying to up that rate to 12 or 15 would be a challenge, but it's not something I can do with my current machine anyhow.
So, I'll update settings and report back in a week or so to see if there are any more of these episodes.
RE: What the heck? Flow limitations and strange waveforms
Sounds good. I was basing the breath rate on what we were seeing in the zoomed images, so a slower pace is appropriate. It's interesting that the Resmed, which I think has a default pace of 15, has done so well to work with your rate and volume for so many years. I think if there was only one additional setting the Aircurve 10 ASV should include, it would be the minimum backup rate in BPM, closely followed by a Ti Min setting to resolve the longer flow-limited inspirations we sometimes see. I would think with a Ti Min setting of 1.2, you would not see the false-start inspiration or double support on flow limitation. We have seen this in other members from time to time, and the slow inspiration with lower respiration rates is the way the machine most often loses sync. Good detective work on your part to put the issue into perspective.
