soft cervical collar replaces cpap?

[christian4870]

when you get the large leaks your tidal volume drops off, 

This is correct, it is nearly always like this at my sleepyhead records. is it normal = large leaks mean less tidal volume?
see details of last night: http://imgur.com/a/NBcOm
titrated = you mean, how long a have the apnoe? since 40 days I use a mask now, a view weeks before I have been at a sleeping laboratory, where they made my settings. I do not have a special doctor, my next visit to the sleeping laboratory (hospital) will be in November

[ajack]

when you are large leaking, every data point is suspect and not to be trusted. I guess it would be normal to not get quite as much air in your lungs from a pressure drop, or the machine to misread it.

Do some zoom in sections on when you are breathing fast and the forum can help you see if they are being counted right. choose a 3 minute section when you are asleep and not leaking.
Best would be to get the leaks sorted, so you are getting true readings, then reevaluate. It's still quite possible for your numbers to come good and the machine is messing up.

It's not critical and still falls within the normal limits. November would be ok, I'd hope the forum could help you sort it by then. If you are still having trouble, they may have some ideas and fit you with masks that fit better.

If you are still having trouble. Depending how much out of pocket you are, if you do the titration sleep test using a cpap and bipap/bilevel. You can see what is what.
...IF the data is accurate and at this stage we really don't know this 100%... I would want to lower my respiration rate by increasing my tidal volume. The 7-10 minute ventilation rate would stay about the same. It's just a different way of getting there. lots of smaller breaths or fewer larger breaths. A bipap/bilevel machine can help do this.

[christian4870]

Do some zoom in sections on when you are breathing fast and the forum can help you see if they are being counted right. choose a 3 minute section when you are asleep and not leaking......

If you are still having trouble. Depending how much out of pocket you are, if you do the titration sleep test using a cpap and bipap/bilevel. You can see what is what.
 A bipap/bilevel machine can help do this....

how do I see, where/when i am breathing fast? which data should I provide? flow-rate, resp.rate, AZV, Leckrate, what else?

In Austria nearly everybody has a good common insurance (we do not pay for doctors...or only very low), the problem is, they will not try out bipap/bilevel if they see, that my data are not very bad, they where satisfied, even if i showed them my leckages and AHI more than 10, they say it is o.k. and you have waiting times of 6 month or more for the next date in a sleeping laboratory

[ajack]

It's not urgent in any way. Bring it to your doctor's attention and see what he says?
I was just surprised that the tidal volume didn't come up with the FFM that wasn't leaking that much. I was expecting it to. 500 would be a typical number.

we don't know that the data is right. machines are pretty dumb and can miscount respiration rate by counting a hiccup in the wave as a breath.

Med is for median, where half are lower than this amount and half are higher. It's not quite an average, but close enough. you can get the weighted average by right clicking on azv for example.

tidal volume can be miscounted by leaks with mouth breathing with a nasal mask, or out the sides of a full face mask.. azv is the tidal volume. the amount of air you breathe each breath.

your breathing rate or respiration rate chart is called 'resp rate' I think for sleeping typical rates are average 8-14, but acceptable is under 20, which is the top end of normal going by google.

you zoomed in on the section of leak, you need to zoom in on a non leak area and the respiration is high and have a 2 or 3 minute section, so we can count each exhale and see the shape of the breath. To see if there is something that looks odd, I'm not as good at this bit, there are better guys at reading breaths and they will voice their opinion.

[christian4870]

you mean it this way?:
http://imgur.com/a/J5pvG

[ajack]

I think that it counting 18 breaths right. 1:53:40 to 1:54:40 ..you aren't maxing out on your 16cm pressure, so I don't know if raising the pressure may help. The section just after that with the M shaped breath is what can be counted as 2 breaths and that little bit could respond to more pressure, but I doubt the first section would. but there are better guys that read breaths than me.

I'd take or mail the SD card to your doctor. That breath rate and the tidal volume of 416, with no leaks, should be enough for a review.
I'd send the picture with it, but they tend to respect resscan more, I don't know why, both are just reading the card data. at least it time stamps the bit you want him to look at.

[robysue]

Just a few comments since ajack is suggesting that you keep looking at tidal volume numbers, but I can't see why that's of any great interest.

Calculated tidal volume should take into account the height, weight, and gender of of the person.  But the standard "short cut" formula for estimating what the tidal volume during wake breathing should be for young, healthy adults is

Tv =  (7 mL/kg of body mass)*(weight in kg)

This means that a male weighing around 71.4 Kg (157 lb) would have a theoretical Tv = 500.

However, a large number of things factor into the measured tidal volume, and it's known that in sleep, the tidal volume is usually less for a person than their resting, wake tidal volume is.   But in general tracking tidal volume numbers are typically important for those with known daytime respiratory problems such as COPD, emphysema, and asthma. And getting the target tidal volume for VAPS ventilation and invasive ventilation correct is a critical part of setting up a vent for a patient who cannot breathe on their own.

But it's not clear whether tidal volume is a critical factor to follow in OSA patients who use CPAP and who do NOT have respiratory problems beyond the OSA.  In other words, if the apnea is managed and a sleep study has shown that the O2 levels do not drop while on CPAP, there doesn't seem to be any real significance in the variation of sleep tidal volume as compared to the normal wake tidal volume.

To get back to my point:

What is the problem that christian4870, the OP is trying to solve?  

Is there any reason to believe that trying to "fix" the tidal volume number is going to help christian4870 solve his real problem?

If so, how will dial wingin' in an effort to increase the median tidal volume to 500 help?

[ajack]

There is no reason to continue wearing yourself out at 18 to 48 at 95% breaths per minute, with low lung volume. (if the data is right) When there is a simple answer to fix it. If you increase the lung volume and function, you don't have to breath as often, Is that a reason for it to be a great interest?

[Sleeprider]

I have generally tried not to focus on respiration rate and tidal volume on this forum unless things are truly abnormal and contributing to other problems. In this case I agree with Robysue that we may be trying to fix something with CPAP that is not really a problem, and certainly not targeted by CPAP capabilities. Christian4870 is very successful in that AHI is hovering around 1.0. The respiratory flow pattern is normal and the respiration rate is within normal range. Considering what we are trying to accomplish with CPAP in the treatment of sleep disordered breathing, these additional setting changes are really not a priority. I think the objective here needs to be to get comfortable and effective with therapy. Once the user is very experienced and has clearly accomplished these objectives, then experiments with tidal volume, respiration rate and making graphs "pretty" might be something he may want to try...or not. The point is there really is only theoretical application of using EPR or pressure support with this kind of auto CPAP to influence tidal volume or RR rate. I have never seen pressure support that is limited to 3 cm achieve significant changes in these parameters.

[ajack]

There isn't much you can do for tidal volume, breath rate and minute vent with a cpap, other than a little bit by getting the pressure right and as you say a EPR of 3.
I don't think a cpap will fix it and is why I'm suggesting going back to doctor and a possible switch to bipap. There isn't much discussion of these data points on the forums and I had to go to google to get any idea and experiment with my ST to see the effect.