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90 day update
#11
a greater difference in inhale pressure to exhale pressure will widen the distance between I and E, will lengthen I and shorten E.  (I do not think you have any problem with your I:E ratio, but reducing the EPR would make I:E ratio lower.  increasing EPR or Flex would increase I:E.)

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#12
As you may know I'm posting to learn stuff. It would be good if you could help me. Why do you think an inverse 1:0.8 ratio is Ok when it's far from the ideal of about 1:1.5? I may have it wrong but it's what I'm reading on the net, that it is a disorder. Also, wouldn't you think it's worth bringing to the doctor's attention? Given also the reduced tidal volume for an average male.
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#13
(04-27-2017, 05:05 PM)Crimson Nape Wrote: JohnnyGobbs,
Out of curiosity, what sre the average CA duration times?


Avg is probably like 15 seconds with maybe like 5 a night going to 18-22.
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#14
(04-27-2017, 05:25 PM)quiescence at last Wrote: the wiggle wobbles in your pressure chart are places where the machine senses pre-cursors of obstructive apnea, like flow limitations.  I know this was at the beginning of the month, but if this were MY chart today I would ditch the ramp (or start at 7) and set my minimum at 8 (even if adding back EPR=1).  This follows the basic rule of having your min at the higher of (1) median pressure compared to (2) 95% pressure minus 2 cm. [7.78 vs. 7.58]= 8

all in all, though, it is nice to be under AHI of 1.0 (pressure correctable apnea).

nice job and charts all around.

QAL
Okay noted. I only use the auto ramp so I have an idea of when I fall asleep that night. This chart was older, I've since gone back to epr 1 but will consider a min pressure of 8.
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#15
As far as the inhale exhale ratio, please elaborate further. I'll look at a couple other nights of charts of mine with it.
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#16
A normal I:E ratio can vary, but 1:1.5 to 1:2 is not uncommon. Many of the people who have relatively high residual AHI on CPAP that I have observed on this forum have what is recorded as a ratio of 1:0.5 to 1: 0.9. We really don't know what gives rise to this phenomena, but if you start looking at the many charts that are posted here, you see it all the time, and the people with that issue frequently have hypopnea and centrals. it's kind of frustrating, because there isn't much you can do about it.

An interesting view is to zoom in to less than 2-minutes so you can see a high level of detail in the flow rate (be sure to right click on the right axis and add a dotted line for zero flow). On Resmed machines, include the mask pressure graph. What we normally see in these inverse I:E ratios is an abrupt exhale followed by a blip then a period of null flow before the next inhale starts. Normal respiration the exhale ends gradually and ends up near zero flow before inspiration. My theory is that most of these individuals that record inverse I:E actually have normal I:E, it's the machine that gets messed up by the abrupt end to exhale and sometimes a brief pressure drop that it records as the start of inhale. So this not only messes up the reported I:E ratio, but it means the machine is actually out of sync with that person by starting the inhale (IPAP) before exhale has ended.

Sorry for the detail here. Show a closeup of the flow rate where you can see individual breaths, include a zero dotted line and the mask pressure graph and you might find something interesting that we have no clue how to resolve other than to get rid of Flex and EPR which seems to make it worse.
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#17
Here is a rather extreme example of a flow rate that gets measured with inverse I:E, especially where it begins to enter the green shade periodic breathing event.   In this case the machine records the exhale ending at the point where flow returns to 0.0 rather than where inhale begins.  This is a Resmed, and it gets the mask pressure correct, keeping pressure at EPAP until a real inhale is detected.  Philips seems to get fooled into its Flex pressure change earlier before inhale has really been initiated.

[Image: Capture2_zps4c86e478.jpg]
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#18
So the machine can add the pause to the breathe in time by mistake, that would certainly throw the numbers out. Normal is, breathe in, breathe out, flater line pause. The pause is added to the breath out time. If the machine is seeing the breath where the green starts as an inverse breath, where it is clearly a normal ratio, it has got it wrong. You would need to look at the insp and exp time charts to confirm this.
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#19
I started out my CPAP treatment at I:E around 1:1, but noticed a distinct shift all at once a couple months in.  See my overview chart at http://imgur.com/u0JJyzq - My results seemed better after the transition to between 1:0.6 and 1:0.8.  But, I did not choose it and was surprised when it happened.

You'll notice the bulk average I:E is 1:0.7 in this later overview chart ( http://imgur.com/BZbTHGz ) and where the I:E is closer to 1:1 more events are logged.

I seem to be about I:E of 1:1 in most REM periods [ what I have interpreted as REM ] seen here: http://imgur.com/JXUvUvA - and generally at about 1:0.6 during NREM sleep seen here: http://imgur.com/jc81MhD

My normal sleep airflow:

[Image: OXBO6Er.png]

My REM sleep airflow:

[Image: EWGgTMe.png]

Cheers!

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#20
(04-27-2017, 09:55 PM)Sleeprider Wrote: A normal I:E ratio can vary, but 1:1.5 to 1:2 is not uncommon.  Many of the people who have relatively high residual AHI on CPAP that I have observed on this forum have what is recorded as a ratio of 1:0.5 to 1: 0.9.   We really don't know what gives rise to this phenomena, but if you start looking at the many charts that are posted here, you see it  all the time, and the people with that issue frequently have hypopnea and centrals.  it's kind of frustrating, because there isn't much you can do about it.  

An interesting view is to zoom in to less than 2-minutes so you can see a high level of detail in the flow rate (be sure to right click on the right axis and add a dotted line for zero flow). On Resmed machines, include the mask pressure graph.  What we normally see in these inverse I:E ratios is an abrupt exhale followed by a blip then a period of null flow before the next inhale starts.  Normal respiration the exhale ends gradually and ends up near zero flow before inspiration.  My theory is that most of these individuals that record inverse I:E actually have normal I:E, it's the machine that gets messed up by the abrupt end to exhale and sometimes a brief pressure drop that it records as the start of inhale.  So this not only messes up the reported I:E ratio, but it means the machine is actually out of sync with that person by starting the inhale (IPAP) before exhale has ended.  

Sorry for the detail here.  Show a closeup of the flow rate where you can see individual breaths, include a zero dotted line and the mask pressure graph and you might find something interesting that we have no clue how to resolve other than to get rid of Flex and EPR which seems to make it worse.
Thx man. This stuff gets deep! I just wanted to make sure nothing was totally abnormal. I tried to do a screen shot with what you asked. Not sure if I did it right or if you can interpret anything from it.

http://imgur.com/a/wmVR8
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