Relationship of Pressure adj to CAs

Relationship of Pressure adj to CAs - Printable Version

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RE: Relationship of Pressure adj to CAs - SaldusMiegas - 05-27-2015

Thanks to everyone for your thoughts and ideas.

I'm gonna roll with the plan for a while and see what happens.

I appreciate the insights you all have shared.

Saldus Miegas

RE: Relationship of Pressure adj to CAs - Sleeprider - 05-27-2015

(05-26-2015, 12:59 AM)SaldusMiegas Wrote: .
Thanks everyone for the thoughtful feedback!

Here is a montage of sleepyhead screenshots of a typical night illustrating the CAs occurring above 15cm pressure.

btw, there must be a good way of adding in SH screen shots. I have seen them in other threads but a search for how-to came up empty. So I futzed around in GIMP for nearly an hour in the middle of the night combining graphics until I got one scaled below 500K max atch file size. Hope it is even readable. Any pointers to how this is properly done would be much appreciated.

Based on this report (and another day or two showing similar) I scaled back the auto upper limit from 20 to 14 which was below all of the CAs.

The left side of the graphics show the event detail for the CAs and hypops with durations and time stamps.

thanks for your interest and time,

Saldus Miegas

p.s. doing much better on reducing leaks since this snapshot was taken.

Saldus, the statement I made regarding CA was specific to the person's data it was directed at. Sporatic clear apnea that occurs randomly is not a concern, and may reflect an arousal, movement or just a normal holding of breath that meets the 10 second threshold to record the event.

What my comment cannot be applied to is clusters of CA, particularly when it is associated with periodic breathing patterns and hypopneas. Your last chart shows some of these latter issues, and I would not ignore pressure as a possible factor in your AHI and CA events. I don't think your events correlate particularly well with just pressure, and you are mixing CA and OA in the same event, which I think is actually mostly obstructive apnea. You are showing events in pretty defined clusters, and this is more typical of sleep stage or supine sleeping; but it's hard to say with what we have here.

There's some interesting stuff in the closeup of the waveform you posted, but really not enough data in the closeups to make conclusions about the therapy overall or correlate the events to pressure. Maybe a shot of the entire period with events, flow, pressure and maybe snores and flow limitations.

RE: Relationship of Pressure adj to CAs - SaldusMiegas - 05-28-2015

(05-27-2015, 09:21 PM)Sleeprider Wrote: Maybe a shot of the entire period with events, flow, pressure and maybe snores and flow limitations.

Thanks Sleeprider. I appreciate your review and feedback on the data. I'm sure my earlier conclusion about the CAs was flawed because lately I am still seeing the CAs even with top pressure of 14.6.

I will provide an update of an entire period including all the data you suggest.

Doing the first upload took me well over an hour and how I did it can't be the best process (wait until after midnight when I'm good and groggy, manually snap multiple screen shots, edit them together in powerpoint, paste into GIMP then scale down multiple times to obtain a single PNG image file of less than 600K board limit, and finally post it as an attachment). I fell asleep at the keyboard in the middle of the night last night trying to do it all over again.

I have seen other posts where people add multiple screen shots, and I think I saw a how-to blurb somewhere in a post but I can't seem to find it now with search.

Is there a best practice for posting screen shots of sleepyhead data?

will try to do this tonight after work.

Saldus Miegas

RE: Relationship of Pressure adj to CAs - Sleeprider - 05-28-2015

I would suggest following this method to post images: http://www.apneaboard.com/wiki/index.php?title=Attaching_Images_and_Files_on_Apnea_Board

Posting a large thumbnail from Imgur gives much better detail and is a lot faster. Here is an example from my own. Notice, I too have some CA, but without clusters or other patterns, it is not a concern. For me, the bigger issue is my OA is consistently near zero and RERA is very low.

RE: Relationship of Pressure adj to CAs - SaldusMiegas - 05-28-2015

Sleeprider,

here is a recent night's data (May 26) for your review... this was taken after limiting the top pressure down to 14.6cm. The CAs persist. There are also significant leaks I am still wrestling with which might make this data less interesting.

This is not the same date I posted earlier, it's more current. The past few nights have been erratic with bed times, wake times, AHI like a roller coaster, and lots of large leaks. Trying to get that stabilized again. One thing I need to do is go to bed on purpose at a reasonable time (versus falling asleep at the keyboard and then hitting the rack with PAP machine around 2-3AM). Still working on that. Let me know if the data is useless until I stabilize again. I don't want to waste your time.

thanks,

Saldus Miegas

Note: this night was split with an afternoon nap then night sleep. I zoomed in on the night sleep which has the majority of incidents.

RE: Relationship of Pressure adj to CAs - quiescence at last - 05-28-2015

If this were my decision, and the past 3 or 4 nights seemed similar to this, I would reduce the upper level again slightly to 14, and increase the min pressure gradually. Up 0.5 every 4 nights to reach about 10. I would also change the EPR to 1.

I would also do something unspeakable to reduce the washout of CO2, not saying because I don't make those suggestions out loud and will only say look up PEEP DECREASED ELIMINATION.

Your score of 5 and change is not ultra bad, though, and you don't need to hurry at making adjustments.

And, I think your leaks are not because of pressure, but some form of disruption of the seal. I would look at some form of thin cloth liner, and this may even out to low leakage instead of the rapid fire seal loss (probably between the mask and face.)

QAL

RE: Relationship of Pressure adj to CAs - Sleeprider - 05-29-2015

The AHI is just over 5, but is about 60% CA and 25% H. Not sure why RERA is getting thrown into the pie chart, but it is high enough to keep you from feeling great. I agree with trying to narrow the range of pressure. With OA pretty much controlled, lowering the max pressure is okay. You can reduce max pressure until you see the proportion of OA increase noticeably. Hopefully the lower pressure will help reduce CA.

As far as increasing minimum pressure, it appears your effective minimum is about 9.5 and the median is around 11.5. It could be a coincidence, but you have very few events when your pressure is below 12 CM. A range of 10-13 looks pretty good at this point. The leaks are a mess, and you have some work to do to control that. Which mask were you using?

RE: Relationship of Pressure adj to CAs - SaldusMiegas - 05-29-2015

Thanks QAL and Sleeprider.

I'm using the F-10 mask.

Interesting that your advice is leading me toward the Rx Of constant 10 with a narrow band of variation.

Thought I had the leaks handled but that must have been a lucky couple of days or natural variation because it sure hasn't been consistent.

Will continue to play with mask fit and sleeping positions (love my side hate supine) and make the adjustments toward 10-13.

I really appreciate you guys taking the time to review my data and weigh in with good advice.

Saldus Miegas