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Cheyne Stokes?
#11
RE: Cheyne Stokes?
The definition of RERA is a series of Flow Limits ending in arousal. I have seen many times RERAs without flagged Flow Limits in the Flow Rate chart that are not flagged. I see many instances of flat-topped waveforms indicating a Flow Limits that are not tagged at all. That and Flow Limits and Hypopneas are considered similar but hypopneas are precisely defined in terms of duration and 'resistance' or 'blockage'. In the flow rate I see things not being tagged when I feel they should be.

It is in the past year or so that we actually found references to ResMed Flow Limits chart being a 'flatness index' with values between 0 and 1.
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#12
RE: Cheyne Stokes?
I’m glad the simple solutions worked here. Altitude is a complication in therapy and results vary quite a bit. I’m impressed with the interpretation that pressure support acts as an amplifier in this case. I hope you will hang around and help others with similar problems. Thanks for the follow-up and feedback on what worked. Based on that I won’t be surprised if you ultimately find fixed single pressure is your best solution. Interesting how individual the response to this therapy can be.
Sleeprider
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#13
RE: Cheyne Stokes?
thanks, bonjour, I didn't realize our understanding has shifted. I understand that peaks of the flow limitation 'traces' are flatish/slanted/jagged and many flow limitations and especially rera's are not flagged, but thought it was because flow limitations were identified and flagged only in relation to the previous few minutes of flow. that explained why we see so many unflagged flow limitations; in contrast, not knowing much about anything, I'd think assessing the flattening would be easier and more accurate than comparing to the previous few minutes of flow. the more I learn the less I know!
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#14
RE: Cheyne Stokes?
Hi Fred,

Thanks for the explanation. I had to look up flattening index. I actually found a quote from you in another thread that much better explains what I was attempting to convey about some of my flow limitations not always being flagged.

"Sometimes Flow limitations are so consistent that they are not recognized because they look very nearly like normal breaths."

And here's an example of what I meant about oscillations making the flow limits worse. Granted I was having flow limits in this chart but it appears to me that the oscillations cause the Resmed algorithms to score the flow limitations higher than I typically see when my flow is not oscillating. Please correct me if I'm way off base because this is pure speculation on my part and I'm just trying to make sense of something I know very little about.

   


Thanks,

Dave
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#15
RE: Cheyne Stokes?
that looks a lot like my periodic limb movement pattern. did you have any documented in your full sleep test results (it may not be included in the summary). take a look at the periodic limb movement thread currently near this one at the top of the list of threads (and search for others on the topic). the latest example I posted is a bit more striking than yours but I get patterns that look like yours too. I see a repetitive series of larger inhales followed by relatively uniform number of relatively flow limited breaths. if it's plm, to my knowledge no machine setting or modality will resolve it. I'd have to search for examples because I quickly move past settings that don't work well for me, but with some machine settings I get repetitive events like your hypopnea during plm episodes.
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#16
RE: Cheyne Stokes?
How often do you see clusters like that? I'm looking to see if this can be ignored.
I see the OA cluster morphing to a lesser event, hypopnea cluster.
These clusters are often caused by tucking your chin, the fix is a soft cervical collar, see my signature. The odd thing is that no amount of pressure will eliminate that.

What you see in the Flow Rate chart is extremely shallow and flow limited breathing, then arousal (series of large recovery breaths), then repeat. THIS is chin tucking.
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#17
RE: Cheyne Stokes?
Hi Fred.

I did a search on google scholar and there are several Resmed patents that mention calculating a flattening index. Unfortunately it's way above my pay grade. Here's the link if you are interested.

https://scholar.google.com/scholar?start...6&as_vis=1

Hi Sleeprider,

I'm sure you guys already know all about this stuff but since I'm a total neophyte,  I did a lot of reading over the weekend about chemoreceptors and how they detect carbon dioxide levels in our blood and trigger our breathing. And how a lot of us have overly sensitive chemoreceptors from years of living with oxygen de-saturation. How with sleep apnea our chemoreceptors have been working overtime and tend to overshoot (high loop gain) when correcting for low oxygen/high CO2. That explanation seemed to fit me to a tee. Contributing factors are age, male sex, past oxygen de saturation, altitude, heart issues, opioid use, ect. I don't use opioids and I don't have heart issues that I know of except for mildly high blood pressure but I fit most of the other criteria for high loop gain.

The good news is that "in theory", after one to three months of proper CPAP therapy, my chemoreceptors will "magically" become less sensitive and I might "just maybe" be able to tolerate pressure support. But for now I'm sticking with straight pressure. Maybe in 6 months I'll give pressure support another try and see if I can turn my flat topped inspiration waveforms into nice crisp round tops. But for now, I'm ok with occasional flat tops as long as I can get some decent sleep.

Hi Sleepless,

I might very well have some plm. I haven't had a full sleep study since 1995 and I don't remember anything about Plm back then. This time around, I got a home sleep study. The home study report did mention that I moved around a lot. I'll check out the plm thread.

Thanks again for all the help,

Dave
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#18
RE: Cheyne Stokes?
Hi Fred,

Good eye. I definitely have a chin tucking problem. Based on reading one of your posts, I got a cervical collar a month ago and it brought my AHI way down. It not only fixed the chin tucking, it stopped my occasionally mouth breathing as well. It's hard to believe that the sleep doctors haven't embraced cervical collars yet.

It's possible that I may have left the cervical collar too loose that night or have been using a "too soft" collar. I'm now using a firmer collar and make sure I keep it snug enough to avoid chin tucking.

Dave
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#19
RE: Cheyne Stokes?
sosotired, I'm really impressed with your grasp on the relationship of CO2, chemoreceptor role in respiratory drive and the problems with a high loop gain. That makes it all more understandable for most people. This is an area where we really need a wiki article, but it needs to be written so any lay person can understand it and apply it to their situation. It's great how you synthesized what is usually presented to doctors specializing in ventilation, and made it meaningful. Thanks for that, and if you ever want to take a shot at a wiki article, your help would be appreciated. This site and its knowledge base was built by its members and mostly non-professional individuals.

Your conclusion that in time, you may become less sensitive to pressure support is completely accurate, and was the case with me. We have seen members that could not tolerate EPR or pressure support without triggering CA and variable respiration that eventually were tolerant of increased ventilation. Your therapy will evolve, and you seem well-informed to make appropriate changes.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: Cheyne Stokes?
Hi sosotired!

Greetings from a couple dozen miles south of you! It appears that I'm currently going through a lot of the same periodic breathing symptoms that you recently experienced ("Altitude, dehydration, and centrals"), with reducing your PS solving a lot of those. Hopefully a reduction in EPR on my end will have a similar effect.

Question for you: from your post, it appears that you've been in CO for quite a few years, possibly a native. Have you ever fought altitude issues when heading west into the hills? I'm wondering if there's another common pattern here as well.
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