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+--- Thread: PLM pattern or RERA spikes? (/Thread-PLM-pattern-or-RERA-spikes)
PLM pattern or RERA spikes? - permabear - 08-07-2023
My flow rate shows these periods of a waxing and waning amplitude. It's CSR like (but it is not CSR), probably driven by CO2 levels in the blood.
But what does this have to say?
Is it harmfull (in a sense of disrupting sleep, like FL do?)
And if so, what adjustment should I make in my pressure settings? I assume my PS might be a bit to high, am I correct here?
Thank you for your insights!
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RE: What does this CSR like pattern have to say? - permabear - 08-07-2023
And here are two more screenshots:
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RE: What does this CSR like pattern have to say? - Gideon - 08-07-2023
How do you feel? And be critical.
It's hard to argue about your AHI fo it now becomes more about how you feel, comfort is king.
In general higher PS Causes deeper breathing and more gas exchange. This includes reducing CO2 levels. Which could be resulting in the waxing waning pattern you see. You can reduce your PS or not, you are in the no harm, no foul stage.
Why are you limiting your max IPAP pressure? Any increase in pressure should be minimal in your case.
RE: What does this CSR like pattern have to say? - permabear - 08-07-2023
Thanks for the reply Gideon.
In the morning my head is a bit foggy and I'm having difficulties with concentration. In the afternoon I have this energy dips and after some physical effort I'm totally worn out.
So yes, there's definitely room for improvement.
I use a fixed pressure while I'm not doing well on the pressure changes of the APAP mode.
So am I understanding correctly that this waxing waning pattern in itself is not something to worry about/ go after?
RE: What does this CSR like pattern have to say? - Gideon - 08-07-2023
It's not a problem until a significant number of central result
Fatigue: increase your min to 7, see if that helps.
On the max, my preference is to limit theax by better managing your events to prevent pressure increases. Try max IPAP of 2 cmw higher than min EPAP + PS. This gives some room but limits excursions.
RE: What does this CSR like pattern have to say? - Sleeprider - 08-07-2023
Permabear, in addition to what Gideon suggested, the oscillation of respiratory volume is typically the result of a feedback loop for CO2. When you breathe more deeply, more CO2 is expired and the lower CO2 suppresses respiration resulting in shallower breaths. This period of shallower breathing can increase CO2 and the loop feeds on itself and continues until respiration stabilizes. There is nothing wrong or abnormal, and this feedback is hard-wired into our spontaneous autonomic respiration. This pattern is often induced by pressure support, and can be mitigated by using a lower PS. You are currently using PS 4.4. Was this problem present at PS 4.0 or lower?
You have separated your therapy between many threads with different questions, and it is a lot easier when you keep your therapy together so changes can be compared and history reviewed. Please keep your stuff together.
RE: What does this CSR like pattern have to say? - permabear - 08-07-2023
Thanks for the response Sleeprider.
At PS 4.0 I have far less oscillations indeed. On the other hand, when I tried PS 6.0 they were practically the same as I have now at PS 4.4 (not much worse as I'd expect).
Thanks for the suggestion to keep all questions in just one post, during the whole therapy journey. I just never realized this would be handy. Maybe this might be included in the Forum rules?
RE: What does this CSR like pattern have to say? - permabear - 08-07-2023
Thanks again Gideon. I've never tried EPAP higher than 5.2 (because of the absence of OA/Hypopneas) so I'm happy to give it a shot.
So tonight's settings will be EPAP 7.0, PS4.0 and IPAP13.0 (VAuto mode).
RE: What does this CSR like pattern have to say? - permabear - 08-11-2023
Please find attached the charts with EPAP 7.0 PS 4.0 IPAP 13.0
First of all, I'm not so sure if this is a major leap forward regarding how I feel. I still needed an afternoon nap for a few days. However, in the morning I was rather sharp and focussed while at work. My morninghead feels a bit more 'full' than usual, but I might need to get accustomed to this higher EPAP (went from 4.4 to 7.0).
Looking at my charts I see pressure running up when FL occur (no OA/H at all). This oscillation what I was asking about is less present with the reduced PS of 4.0.
Could you please take a look at my charts.
I'm not sure if the algorithm is really effective when it raises pressure. So I'm questioning myself if I should raise my minimum EPAP some more or it's the PS that's just a tad to low for me.
Obviously I don't need an EPAP higher than 4.0-4.5 in order to prevent OA/H. (However, I still have some user flags present, measuring a 70% flow during 10sec).
Could it be that someone feels better at an higher EPAP regardless any low AHI? Or is it the PS I have to aim for (probably resulting in some more oscillations).
Thanks again for your insights. Much appreciated!
RE: What does this CSR like pattern have to say? - permabear - 08-11-2023
And two more charts.