Are isolated "gasps" arousals?

[obob]

       
I have noticed almost from the beginning of my 9 month experience with CPAP that I have a fairly large, persistent number of "spikes" in my Sleepyhead/OSCAR Flow Rate graphs, and that these correspond with "spikes" in the Tidal Volume (TV) graphs.  Many (or most) of these spikes correspond to a single inspiratory event, but none are significant enough to change the Respiration Rate much (15-17 bpm.)  A convenient way to score them is to count the TV "spikes" that reach above the 95% level:  in my case an average of 15 little gasps per hour.

For all I know this is a common occurrence.  Can anyone tell me if these spikes/gasps might be arousals that might have bearing on how crappy I feel most of the time.  (AHI high one day, low another.  On and off quite congested.  Extreme fatigue far exceeding quotidian lassitude.  For a while felt I was getting a handle on my "sleep problem" but not lately.)

Any thoughts much appreciated,

obob

[Sleeprider]

Your close-up graph shows the classic condition for RERA which is an increasing flow limitation followed by a recovery breath or increased flow rate. While we don't have EEG to show sleep stage, it is safe to say this is very likely an arousal. The Dreamstation CPAP does not offer much help for this pattern, and a bilevel or Resmed Airsense 10 Autoset with EPR is a more effective tool as flow limitation is better treated by pressure support than higher pressure. You would really like an Aircurve 10 Vauto.

[ApneaQuestions]

Not wanting to make light of your question.... I can't offer any answers.... but as I tried to imagine what you are describing, I couldn't help but think of a Norwegian colleague I once worked with.  (Lovely people).  Is this video getting close to the inhalation you are referring to?

https://www.youtube.com/watch?v=nutMYpTqLe4

Or is it more of a "Sigh breath"
https://www.youtube.com/watch?v=3xzew29MBwo

[Gideon]

Your detail shows a series of Flow Limits followed by a Recovery Breath/arousal, the definition of a RERA. These need to be managed,

It looks like your Flex is set to 1,, Try Flex =2 or 3 if you are comfortable with it. You would do better with a BiLevel with a higher level of pressure support.

[Gideon]

Hope you don't mind a PM

I was fascinated by your answer here..  http://www.apneaboard.com/forums/Thread-...#pid323333

I'm still trying to learn how to interpret these graphs.

Am I right in thinking the "series of flow limitations" is represented by the "flattened tops" of the flow rate curve?

If not.. what is it you are seeing that tells you that?

Actually yes.
1. AB has a policy of answering therapy questions in the forum.  Exceptions are very rare and would include extremely private personal information.
2. This allows others with the same question to learn
3. And other members will offer corrections if I am wrong, thus providing you with better info.

   

[2SleepBetta]

 ApneaQuestion Is this video getting close to the inhalation you are referring to? pid='323332' dateline='1576111575']
https://www.youtube.com/watch?v=nutMYpTqLe4               Yes, this seems right for me.

Or is it more of a "Sigh breath"
https://www.youtube.com/watch?v=3xzew29MBwo                No, not for me

Those OP spikes occur almost regularly for me at 10-15 minute intervals. They are spaced at nearly the same intervals like telephone poles along a country road. They are rarely associated with any nearby FL. I include an example below and am pleased to see the OP because I have long wondered what explains the spikes. 

[attachment=17929]

[obob]

Not wanting to make light of your question.... I can't offer any answers.... but as I tried to imagine what you are describing, I couldn't help but think of a Norwegian colleague I once worked with.  (Lovely people).  Is this video getting close to the inhalation you are referring to?

https://www.youtube.com/watch?v=nutMYpTqLe4

Or is it more of a "Sigh breath"
https://www.youtube.com/watch?v=3xzew29MBwo

Yes, yes! now that you suggest it the Scandinavian inspired "affirmative hhh" is exactly as I imagine these events sound.  I, of course, am asleep when they occur so I can't be sure, but that is what they look like.  I'd add that it is the more astonished/shocked rapid inspire version in the video.  In the FR graph the gasp is only a little longer than the surrounding sleep-breaths yet in this example 1150 ml of air were inspired (assuming the accuracy of the Respironics machine & OSCAR.)

Thank you so very much for youtube clip!  Strangely, I only recollect Scandinavian women using this affirmative, an impression that is reinforced by the Norwegian woman in the youtube.  But then my limited sampling may have been influenced by two Danish sisters-in-law, sadly both deceased.  Perhaps Scandinavian men use this affirmative but less emphatically???? 

obob

[obob]

Your close-up graph shows the classic condition for RERA which is an increasing flow limitation followed by a recovery breath or increased flow rate.  While we don't have EEG to show sleep stage, it is safe to say this is very likely an arousal.  The Dreamstation CPAP does not offer much help for this pattern, and a bilevel or Resmed Airsense 10 Autoset with EPR is a more effective tool as flow limitation is better treated by pressure support than higher pressure.  You would really like an Aircurve 10 Vauto.

Thank you Sleeprider, for your reinforcement of my suspicion that these events have significance.  Next month, after a year on the PR APAP machine (mostly), my sleep clinic doctor has suggested we do an in-clinic sleep test.  I have twice conveyed my conviction to him that I suffer mostly from upper airway flow limitation.   He amiably disagrees; based on a take-home sleep test performed over a year ago he has concluded I have obstructive apnea, but he does make hints that I might do better on a bilevel machine*.  I suppose more to get me out of his office (already 30 minutes over his 15 minute allotment) he suggested the in-clinic test.  

• Will this test change his mind?  
  
• What will he have to do to convince Medicare that I need a bilevel machine?
  
• What can I do to change his mind?
  

obob

* I do, in fact, have a ResMed AirCurve 10 VAuto machine thanks to much help from members here at AB, and yes, I do like it over the PR APAP.  However, there are several problems.  Briefly:

•  I'd like to keep getting Medicare support for CPAP, only for the VAUTO instead of the PR APAP, 
  
•  It has been difficult to get it fine-tuned while meeting compliance for my PR machine,
  
•  For the past 6 months I've suffered increasingly from nasal congestion and am not sure VAuto will be any better than my PR APAP without first successfully addressing that problem????
  

[sheepless]

I see just one spike in the recent screenshots. if these are repetitive w fairly uniform intervals, consider the possibility of periodic limb movements.

[Sleeprider]

obob, if you have a Vauto and would like to immediately prove your doctor wrong, then let's do a trial on the Vauto and compare. I can give you setting that should be able to give you all the proof you need in less than one week. Read this thread by Car54 and let me know. http://www.apneaboard.com/forums/Thread-...curve-auto