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+--- Thread: [Diagnosis] Small breaths? (/Thread-Diagnosis-Small-breaths)
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RE: Small breaths? - Macka - 09-14-2024
Set Oscar up to view and calculate deep sleep in the bi-level modes.
rRMVFluctuation signal set to max of 1.5 shows it. When that signal drops below 1.5, it means you have achieved a level of stability in respiratory rate and tidal volume that is present only in deep sleep. So any parts you can see when you set max at 1.5 is deep sleep.
I track changes and learn the idiosyncrasies of each mode, by carefully tracking changes in the notes. I just re-paste the settings into each night and make bold anything that is changed from the night before. Otherwise, with all the variables on these machines, it gets very hard to remember what you have tried and its effect.
[attachment=69595]
RE: Small breaths? - Crimson Nape - 09-14-2024
Good job! Were you the one that added that to the Wiki?
https://www.apneaboard.com/wiki/index.php?title=Lowenstein_PrismaLine_optimization#Extra_Settings_for_Prisma_Bi-Level_Devices
- Red
RE: Small breaths? - Michael2 - 09-14-2024
(09-14-2024, 08:52 AM)Macka Wrote: Set Oscar up to view and calculate deep sleep in the bi-level modes.
rRMVFluctuation signal set to max of 1.5 shows it. When that signal drops below 1.5, it means you have achieved a level of stability in respiratory rate and tidal volume that is present only in deep sleep. So any parts you can see when you set max at 1.5 is deep sleep.
I track changes and learn the idiosyncrasies of each mode, by carefully tracking changes in the notes. I just re-paste the settings into each night and make bold anything that is changed from the night before. Otherwise, with all the variables on these machines, it gets very hard to remember what you have tried and its effect.
In the prismaTS [Ver: 5.13.0.13] software, I don't see a chart for rRMVFluctuation in either the BiLevel/NIV or Sleep therapy views, but I do see a chart for Respiratory instability. Is Respiratory instability equivalent to rRMVFluctuation?
RE: Small breaths? - Macka - 09-15-2024
(09-14-2024, 10:35 AM)Crimson Nape Wrote: Were you the one that added that to the Wiki?
Yes that was all my mad scribblings!
(09-14-2024, 03:43 PM)Michael2 Wrote: In the prismaTS [Ver: 5.13.0.13] software, I don't see a chart for rRMVFluctuation in either the BiLevel/NIV or Sleep therapy views, but I do see a chart for Respiratory instability. Is Respiratory instability equivalent to rRMVFluctuation?
Yes that is the signal Loewenstein is using to determine deep sleep. They set it against in-lab polysomnography according to their information on the function.
In the bi-level machines, I think they are very cleverly using different terminology and displaying different signals, to limit distressing information presented to users with conditions that will not produce good figures.
So for e.g. they drop the deep sleep indicator on the bi-level range as many of the conditions these modes are aimed at, are not going to produce nice regular sleep patterns. But the therapy is life saving. Some modes don't even display AHI prominently, you have to go looking for it! They display and reward duration on the machine, minute volume, tidal volume and leakage.
The 20A displays deep sleep and it appears in oscar as can be seen below in the blue overlay. Using that I determined where they set the marker for deep sleep in the stability signal.
[attachment=69667]
It is the most useful indicator of sleep quality there is imo. It will often correlate with arousal spikes fragmenting sleep and position changes if using Torena or Somnopose. You can then look at the preceding conditions and determine if it was a natural end to the stage or breathing dissorder that likely led to it. If is breathing then you must keep working to eliminate it. If you have a close look at the second, large deep sleep chunk above, you can see it is fragmented into 3 peices. Two arousal spikes prominant in the fragmentation, with the third waking me entirely.
Now, on its own, that may be quite acceptable and nothing to overly concern yourself with, but if there was a flow limitation that was lowering tidal volumes gradually leading up to it, then I know I have to solve that.