09-20-2016, 05:47 PM
RE: cpap therapy still tired
Hi wyu177. Looks like the second image's window precedes the first by about 70 minutes. The respiration rate is roughly the same for each. But the earlier one is more regular than the later one, with less of a "zero flow tail" on the exhale. I'll bet the I:E ratio is higher for the later one - not that it would have any particular diagnostic significance. But in general, the later pattern looks more disturbed. That OA may be a false positive, since there's a hyper breath just before it. (Don't know about Resmed, but the resperonics algorithm for OA doesn't require a "probe" of the airway with a pressure pulse. At least, I don't see them on my traces.) I'm not familiar with Resmed output. Both traces are squigly, but the later window moreso, consistent with more disturbed sleep. (The squigly trace could be reflective of a phenomenon called ballistocardiograpy - basically, a modulation of breath flow by the heartbeat - but that's a whole other discussion. It could also indicate snoring or a leak, so check for those.) Check to see what your last sleep study discloses about non OSA-related conditions.
The tired feeling despite good AHI is certainly something to discuss with the doc. However, based on my own experience, it's hard to get the docs to focus on stuff once the OSA is "treated" and stable. But there are things you can do to strengthen your case. Look at windows like the ones you posted for many different nights at different times. After a while, you'll gain confidence in spotting when you really are asleep vs. the "sleep-wake" intervals. You can calibrate using the period just after you retire when you're pretty sure you've transitioned to sleep. Check respiration rate there as well. If you have a recording pulse oximeter, and are one of the lucky ones who can sync the oximetry with the SH flow trace, you'll have an important additional data axis. If you dream, and can identify where on the flow trace the dreams are - for example mine frequently precede a complete wakeup - then you can determine what your respiration rate does while dreaming. Mine goes up dramatically, but I've read that for some it goes down, for others, doesn't change at all. But if it's pronounced, you can determine REM stages from the respiration profile. If you can do that, you can determine whether the machine flags more or fewer events during REM. The common wisdom is there should be more, but in my case there are almost none, even when there are clusters near to the REM stage. The reason I think this is significant is that it is now believed that our musculature is paralyzed during REM sleep. To me, the implication is that if apneas increase during REM, then they are caused by the autonomic nervous system - ie. CPAP tweaking is called for. But if they decrease, the probability in increased that non-REM events are caused by factors unrelated to, or peripherally related to, OSA, hence not treatable by CPAP. Just my working theory.
Lotsa stuff, but in nutshell: the more you learn about your own flow patterns, the sharper will be the discussion with the docs.
Tip for posting more revealing SH charts: Add dotted lines to show zero flow, etc. Leave the cursor on the chart - as you did for the earlier window - to display current value for each parameter. (Maybe can't be done when you clone like that, dunno. Nice use of clone, btw.) Turn off the calendar and the pie chart, and show the data in the left column under Details.
HTH more than confuses. -Ron
The tired feeling despite good AHI is certainly something to discuss with the doc. However, based on my own experience, it's hard to get the docs to focus on stuff once the OSA is "treated" and stable. But there are things you can do to strengthen your case. Look at windows like the ones you posted for many different nights at different times. After a while, you'll gain confidence in spotting when you really are asleep vs. the "sleep-wake" intervals. You can calibrate using the period just after you retire when you're pretty sure you've transitioned to sleep. Check respiration rate there as well. If you have a recording pulse oximeter, and are one of the lucky ones who can sync the oximetry with the SH flow trace, you'll have an important additional data axis. If you dream, and can identify where on the flow trace the dreams are - for example mine frequently precede a complete wakeup - then you can determine what your respiration rate does while dreaming. Mine goes up dramatically, but I've read that for some it goes down, for others, doesn't change at all. But if it's pronounced, you can determine REM stages from the respiration profile. If you can do that, you can determine whether the machine flags more or fewer events during REM. The common wisdom is there should be more, but in my case there are almost none, even when there are clusters near to the REM stage. The reason I think this is significant is that it is now believed that our musculature is paralyzed during REM sleep. To me, the implication is that if apneas increase during REM, then they are caused by the autonomic nervous system - ie. CPAP tweaking is called for. But if they decrease, the probability in increased that non-REM events are caused by factors unrelated to, or peripherally related to, OSA, hence not treatable by CPAP. Just my working theory.
Lotsa stuff, but in nutshell: the more you learn about your own flow patterns, the sharper will be the discussion with the docs.
Tip for posting more revealing SH charts: Add dotted lines to show zero flow, etc. Leave the cursor on the chart - as you did for the earlier window - to display current value for each parameter. (Maybe can't be done when you clone like that, dunno. Nice use of clone, btw.) Turn off the calendar and the pie chart, and show the data in the left column under Details.
HTH more than confuses. -Ron
We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
As dreams are made on, and our little life
Is rounded with a sleep.
