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[CPAP] Strange (to me anyway) flow rate data
#11
Sure.

Here is a plot of a recent dreamy REM period.
[Image: BTjeo2e.png]

A closer look shows the transition from normal NREM sleep to REM sleep at 23:15:55.
[Image: yHOoZ0C.png]

Then transition back, this night seems I had wakening 23:43:40 and possibly re-position 23:44:00.
[Image: QgSSalq.png]




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
(05-19-2015, 05:49 PM)gbesq1 Wrote: I am a long-time (since 2007) but intermittent CPAP user. I have just acquired a data-capable APAP machine (Remstar System One A-Flex 550p). After some experimentation, it appears that I do best on CPAP at 10L/min, although I may need to tweak the setting (advice welcome). However, on Sleepyhead I get several instances of the attached screenshot. Can anyone explain what's going on with the flow rate here?

Hi gbesq1,

The data you posted in your original post looks to me like all obstructive stuff. The raggedness and stop-and-go character of the Flow pretty much everywhere in the zoomed-in period shows there is obstruction in the airway which is barely allowing any breathing to occur except with varying degrees of arousal.

In some places you were able to inhale but not exhale, and I suppose this may have been the result of using C-Flex+ exhalation pressure relief, which reduces the pressure by 2 cmH2O during exhalation. (Using C-Flex+ is fine, but I think the Pressure setting was just too low.)

I think the flat segments with zero Flow were times when all Flow stopped because the airway was obstructed because the pressure was too low.

To me the data all says the Pressure was at least 2 cmH2O too low.

I see no indication of central apnea during the zoomed-in period.

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#13
(05-19-2015, 10:27 PM)gbesq1 Wrote: Here is my situation.

I was intermittent but no longer. I know I need CPAP and have been using it every night for several months and will continue. My 2007 Remstar recently conked out and I replaced it a week ago with the 550.

I tried APAP (8-20L/min) and got AHIs from 16 to 29 (the high ones using a nasal mask, the lower using a nasal pillow). Obviously no good. Since I was originally prescribed 8L/min CPAP with a recommendation of 10L/min if I could tolerate it (which I can), I switched to 10L/min on my new machine and got a much better (but not great) AHI. However, when I was using APAP, my median pressure was around 13.

If a pressure of 13 is what you need at least half the time, maybe you can slowly work up to using 13 or 14?

Not sure why you are using 10, except maybe just to proceed cautiously?

Do your centrals increase excessively at pressures above 10? Changing from C-Flex+ to standard C-Flex may make treatment less comfortable (C-Flex+ provides 2 cmH2O greater exhalation pressure relief, compared to standard C-Flex) but some patients have fewer centrals when using C-Flex compared to when using C-Flex+.

In general, I think central apneas (in themselves) are not worse than obstructive apneas. Central apneas can lower our blood O2 and can cause arousals, just like obstructive apneas do, but I think centrals (especially if fairly short) can sometimes be far less troublesome than obstructive apneas.

With central apneas, as soon as we try to breathe again, we are breathing again. With obstructive apneas, I think often more stress is caused, because we are trying to breathe but can't, and a strong arousal is needed before we manage to start breathing again. All the adrenalin and stress hormones caused by strong arousals from obstructive apneas have got to be more stressful on the heart and whole body, I think, than an equivalent number of short central apneas.

But some patients do get a completely excessive and serious amount of long centrals at higher pressures, so it does not hurt to proceed cautiously.

Take care,
--- Vaughn
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#14
(05-19-2015, 10:27 PM)gbesq1 Wrote: Maybe I should do a week of, say, 11L/min constant pressure and then try a week of APAP with a 10-20 range. Any advice?

If you have no indication that you get more than 5 fairly short (30 seconds or less) centrals per hour at higher pressures, then yes, I suggest changing to APAP with A-Flex of 2 and with Min Pressure 10 and a Max pressure of 13 or higher.

Don't over-do it with the Max Pressure at first. You can always gradually increase the Max Pressure later, after you see high pressures are not causing problems.

Take care,
--- Vaughn
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#15
(05-24-2015, 04:47 AM)quiescence at last Wrote: Sure.

Here is a plot of a recent dreamy REM period.
[Image: BTjeo2e.png]

A closer look shows the transition from normal NREM sleep to REM sleep at 23:15:55.
[Image: yHOoZ0C.png]

Then transition back, this night seems I had wakening 23:43:40 and possibly re-position 23:44:00.
[Image: QgSSalq.png]
QAL




Was I misinformed about sleep stages? Have read they can't reliably be determined without use of a EEG, etc.?





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#16
I'm just wondering what was chasing him, or maybe it was a beautiful..... Smile
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#17
(07-14-2015, 06:09 PM)Sleeprider Wrote: I'm just wondering what was chasing him, or maybe it was a beautiful..... Smile

you made me laugh out loud, no truly.....Thanks

Storywizard

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