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[ASV] Timed breaths and Patient Triggered Breaths
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FrankNichols Offline

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Post: #11
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-07-2016 08:47 AM)justMongo Wrote:  Thanks we do have one!

Well, true, but those do not accumulate. Smile

I am not a Medical professional and I don't play one on the internet.
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04-07-2016 08:58 AM
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richb Online

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Post: #12
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-07-2016 08:03 AM)tmoody Wrote:  First, I want to thank both of you for these explanations. I wish we had a "thank" button.

Second, I need to learn more about this overshoot/undershoot phenomenon. I don't really understand it. I take it we're talking about CO2 and not CO, and the centrals are somehow caused by some kind of blood gas homeostasis failure. That's all news to me, and I hope I can learn more about it.

Concerning Timed Breaths... I've noticed that the number of TBs reported by SH tends to track the AHI, though not perfectly. My AHI last night was 1.7, one of my lowest yet, and the number of TBs was the second lowest ever. Zero centrals and only 14 hypos for the night. If the TBs are the machine preventing events, I'd expect to see higher TB counts with lower event counts, but that's not what I see, as a general thing.

Hi tmoody,
I have attached an image of periodic breathing (Hypopneas) that I obtained using a straight low pressure of 5 cm H20. The pressure was low enough to not convert most of the Hypopneas to Centrals. An ASV machine would intervene for all of these events so they wouldn’t show up. Noticr the rising and falling pattern of breathing. Also notice that breathing doesn't cease during the Hypopneas as it does during Central events. You can read about the role of the Carotid Body in controlling breathing (especially during sleep) to get an understanding of the causes of idiopathic central apnea. One more point is that you may be experiencing Obstructive events along with the Periodic breathing. Your initial settings might have to be fine tuned to correct this. Post some 10 minute screen shots so that you can get some more opinions from people on this Board.

Rich


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04-07-2016 11:52 AM
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tmoody Offline

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Post: #13
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-07-2016 11:52 AM)richb Wrote:  Hi tmoody,
I have attached an image of periodic breathing (Hypopneas) that I obtained using a straight low pressure of 5 cm H20. The pressure was low enough to not convert most of the Hypopneas to Centrals. An ASV machine would intervene for all of these events so they wouldn’t show up. Noticr the rising and falling pattern of breathing. Also notice that breathing doesn't cease during the Hypopneas as it does during Central events. You can read about the role of the Carotid Body in controlling breathing (especially during sleep) to get an understanding of the causes of idiopathic central apnea. One more point is that you may be experiencing Obstructive events along with the Periodic breathing. Your initial settings might have to be fine tuned to correct this. Post some 10 minute screen shots so that you can get some more opinions from people on this Board.

Rich

Thank you. I found this: http://www.hindawi.com/journals/mi/2014/354279/, which will take me a while to get my head around.

Here's a brief screenshot from last night, that shows some periodic breathing with a hypo in the middle:

[Image: ztmBq2tm.png]
04-07-2016 12:24 PM
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richb Online

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Post: #14
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-07-2016 12:24 PM)tmoody Wrote:  
(04-07-2016 11:52 AM)richb Wrote:  Hi tmoody,
I have attached an image of periodic breathing (Hypopneas) that I obtained using a straight low pressure of 5 cm H20. The pressure was low enough to not convert most of the Hypopneas to Centrals. An ASV machine would intervene for all of these events so they wouldn’t show up. Noticr the rising and falling pattern of breathing. Also notice that breathing doesn't cease during the Hypopneas as it does during Central events. You can read about the role of the Carotid Body in controlling breathing (especially during sleep) to get an understanding of the causes of idiopathic central apnea. One more point is that you may be experiencing Obstructive events along with the Periodic breathing. Your initial settings might have to be fine tuned to correct this. Post some 10 minute screen shots so that you can get some more opinions from people on this Board.

Rich

Thank you. I found this: http://www.hindawi.com/journals/mi/2014/354279/, which will take me a while to get my head around.

Here's a brief screenshot from last night, that shows some periodic breathing with a hypo in the middle:

[Image: ztmBq2tm.png]

The article you linked to suggests a disease process affecting the carotid body. I believe that in most cases and at normal altitudes the carotid body can be simply maladjusted causing periodic breathing.

Rich
04-07-2016 01:56 PM
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palerider Offline

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Post: #15
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-07-2016 08:47 AM)justMongo Wrote:  Thanks we do have one!

I believe they're talking about the feature on some forums where there's a button labeled "thanks" that doesn't create another post, but does up a tally of people that found the information useful. sometimes you'll see on those forums that a post has dozens, or hundreds of 'thanks'.
04-07-2016 04:35 PM
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tmoody Offline

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Post: #16
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-07-2016 01:56 PM)richb Wrote:  The article you linked to suggests a disease process affecting the carotid body. I believe that in most cases and at normal altitudes the carotid body can be simply maladjusted causing periodic breathing.

Rich

Yes, that's right. I just wanted to get some ideas about what the carotid body does. I'd never heard of it before. There's also this conjecture: http://www.ncbi.nlm.nih.gov/pubmed/16125867. There's a strong association between apnea, metabolic syndrome, obesity, hypertension, etc. These authors conjecture carotid body dysfunction as a common cause, but as far as I can tell there's been no followup work on this.

If ischemia in the carotid body can cause type 2 diabetes, it can perhaps cause apnea, especially central apnea, as well. In another thread there's a discussion of whether prolonged CPAP treatment can cause centrals to emerge, or whether their emergence is just a consequence of aging. The conjecture here suggests the latter, with gradual calcification of the arteries as a causal mechanism.

This also suggests a possible way to reverse it, if the conjecture is correct. See, for example, http://jeffreydachmd.com/how-to-reverse-...ium-score/. Note the point that arterial forks are especially vulnerable. Coincidentally, I've been reading about the use of vitamin K2 to reverse arterial calcification, which is controversial, but also very interesting: http://www.ncbi.nlm.nih.gov/pubmed?term=...ogy%202008.
04-08-2016 07:54 AM
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richb Online

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Post: #17
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-08-2016 07:54 AM)tmoody Wrote:  
(04-07-2016 01:56 PM)richb Wrote:  The article you linked to suggests a disease process affecting the carotid body. I believe that in most cases and at normal altitudes the carotid body can be simply maladjusted causing periodic breathing.

Rich

Yes, that's right. I just wanted to get some ideas about what the carotid body does. I'd never heard of it before. There's also this conjecture: http://www.ncbi.nlm.nih.gov/pubmed/16125867. There's a strong association between apnea, metabolic syndrome, obesity, hypertension, etc. These authors conjecture carotid body dysfunction as a common cause, but as far as I can tell there's been no followup work on this.

If ischemia in the carotid body can cause type 2 diabetes, it can perhaps cause apnea, especially central apnea, as well. In another thread there's a discussion of whether prolonged CPAP treatment can cause centrals to emerge, or whether their emergence is just a consequence of aging. The conjecture here suggests the latter, with gradual calcification of the arteries as a causal mechanism.

This also suggests a possible way to reverse it, if the conjecture is correct. See, for example, http://jeffreydachmd.com/how-to-reverse-...ium-score/. Note the point that arterial forks are especially vulnerable. Coincidentally, I've been reading about the use of vitamin K2 to reverse arterial calcification, which is controversial, but also very interesting: http://www.ncbi.nlm.nih.gov/pubmed?term=...ogy%202008.

Yes a very interesting subject. And yes, most of the articles suggest further study and also often cite names of researchers who you will see again and again. Further you will see a great deal of study related to the connection between Congestive Heart Failure and Chain Stokes breathing. I also have been intrigued by the possibility of a cure for Carotid Body malfunction.

Rich
04-08-2016 08:33 AM
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tmoody Offline

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Post: #18
RE: [ASV] Timed breaths and Patient Triggered Breaths
On the subject of Timed Breaths (TBs), which I guess could also be called "Ventilation Events," I've been looking over my ASV data for the two weeks that I've been using it. I notice a fair number of nights when the TBs are clustered in the early "ramp" stage, when I'm either awake or in light sleep. I currently have a 20 minute ramp. Last night, there were 60 TBs in the first 20 minutes. When I'm just going to bed, I notice them, since they're mildly annoying. On some nights--"good" nights--almost all TBs occur when I'm falling asleep and when I'm waking up.

Even though the TBs are the machine doing its job, I believe in biofeedback; by monitoring something you can slowly learn to change it. My goal is to make the machine work less.
04-13-2016 01:52 PM
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richb Online

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Post: #19
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-13-2016 01:52 PM)tmoody Wrote:  On the subject of Timed Breaths (TBs), which I guess could also be called "Ventilation Events," I've been looking over my ASV data for the two weeks that I've been using it. I notice a fair number of nights when the TBs are clustered in the early "ramp" stage, when I'm either awake or in light sleep. I currently have a 20 minute ramp. Last night, there were 60 TBs in the first 20 minutes. When I'm just going to bed, I notice them, since they're mildly annoying. On some nights--"good" nights--almost all TBs occur when I'm falling asleep and when I'm waking up.

Even though the TBs are the machine doing its job, I believe in biofeedback; by monitoring something you can slowly learn to change it. My goal is to make the machine work less.
Disregard this request. I can see the data in your other thread.
Please put up an image of the first hour of machine use for the night. I would like to see what is going on during your ramp time. The reason I ask is that my machine which is a ResMed) does not provide "timed breaths" during ramp time. When I had ramp time set my machine would score CAs and Hypos when not providing "timed Breaths". The machine can't use its algorithm to diagnose CAs when it is working to provide "timed breaths" in ASV mode.

Rich
(This post was last modified: 04-14-2016 07:39 AM by richb.)
04-14-2016 07:29 AM
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tmoody Offline

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Post: #20
RE: [ASV] Timed breaths and Patient Triggered Breaths
(04-14-2016 07:29 AM)richb Wrote:  Disregard this request. I can see the data in your other thread.
Please put up an image of the first hour of machine use for the night. I would like to see what is going on during your ramp time. The reason I ask is that my machine which is a ResMed) does not provide "timed breaths" during ramp time. When I had ramp time set my machine would score CAs and Hypos when not providing "timed Breaths". The machine can't use its algorithm to diagnose CAs when it is working to provide "timed breaths" in ASV mode.

Sorry, this is less than an hour; I misread your request. Maybe it's helpful anyway.

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04-14-2016 07:41 AM
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