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Mal777, this is not your first rodeo with irregular breathing patterns and even periodic breathing. I think these charts need to be looked at in context with your previous thread. http://www.apneaboard.com/forums/Thread-...espiration
This kind of irregular breathing, has characteristics of hyperventilation, and yet has a periodic inspiratory and expiratory peaks that is closer to your normal 15 BPM respiratory rate. I have seen this in a few other members, and the solution was ASV to even out the wildly irregular breath rate. In some of these examples, the breath rate is over 40 BPM, and it seems you are either suffering from a periodic limb movement or respiratory spasm that barely clears the dead space. As i told Hojo at the time, you might need to see your doctor. He ultimately resolved this with ASV. This is the post I first noted his high respiration rate similar to yours http://www.apneaboard.com/forums/Thread-...#pid223896 and an example of his respiratory flow...look familiar? Hojo was normal weight and in good physical condition with regular exercise. His problems turned out to be primarily central, contrary to what this image looks like.
Getting back to your results, you are using pressure at 10 to 15 with EPR 3. Have we ever tried less EPR or removing it all together? This is the problem when you start new therapy threads, we lose some of the context of what has been tried previously.
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.
As for what machine you probably need I honestly don't know. The high frequency of that strange respiration makes me think it could be a significant issue and I am not sure what remedies that kind of breathing.
A basic bilevel (S or vauto) might be able to straighten out that breathing using ticontrol but that is the main feature those units have that I think might help and they wont help the central apneas if the centrals are happening during sleep (an ST might though due to backup rate ). ASV would be best to deal with the centrals and may be able to remedy the strange breathing but I don't know if it actually would as it only uses pressure and backup rate and I don't believe they have ticontrol so if machine doesnt consider that breathing to be off then it wouldn't do much to try to correct it.
I guess my opinion on the matter would be that I wouldn't buy any unit especially if they can't give you an explanation about what this breathing is and what is going to fix it. When they make a recommendation get them to do a trial period with the recommended machine and see how your sleep seems to be and if this breathing is still present.
The solution might be something else like medication too.
(02-09-2020, 10:20 PM)Sleeprider Wrote: Mal777, this is not your first rodeo with irregular breathing patterns and even periodic breathing. I think these charts need to be looked at in context with your previous thread. http://www.apneaboard.com/forums/Thread-...espiration
This kind of irregular breathing, has characteristics of hyperventilation, and yet has a periodic inspiratory and expiratory peaks that is closer to your normal 15 BPM respiratory rate. I have seen this in a few other members, and the solution was ASV to even out the wildly irregular breath rate. In some of these examples, the breath rate is over 40 BPM, and it seems you are either suffering from a periodic limb movement or respiratory spasm that barely clears the dead space. As i told Hojo at the time, you might need to see your doctor. He ultimately resolved this with ASV. This is the post I first noted his high respiration rate similar to yours http://www.apneaboard.com/forums/Thread-...#pid223896 and an example of his respiratory flow...look familiar? Hojo was normal weight and in good physical condition with regular exercise. His problems turned out to be primarily central, contrary to what this image looks like.
Getting back to your results, you are using pressure at 10 to 15 with EPR 3. Have we ever tried less EPR or removing it all together? This is the problem when you start new therapy threads, we lose some of the context of what has been tried previously.
Thankyou Sleeprider, Bonjour, Geer1 and Deep Breathing
I had another restless night. Tried to reduce EPR to 2 but felt suffocated and put it back on 3. Reduced Max pressure to 14, but was hitting peaks so will return it to 15 tonight.
Interesting comparison to Hojo. It seems ASV may be the solution and my last Echocardiogram in December 2019 EF is still 62%. I have a pacemaker (have LBBB) and valve heart surgey in 1996, so I do have other cardiac issues, but luckily no HF. Also had a BNP blood test to confirmno HF. And with the new Advent HF study having no issues to date, I would take the risk, as this apnea/ breathing issues has to be resolved.
I have an appointment with Pulmonologist on 28th Feb, and should have results of my bilevel sleep study before then. Of course I will post it on here for comment and recommendations. He told me he tried an S machine, then an ST. Didn't mention ASV
Bonjour I did the "straw test" Bubbles went everywhere including over my shirt! My exhale pressure seems good . I also did a lung function test and had a chest xray a coupe of weeks ago....all normal, as are my blood tests
The other thing I should mention is that I suffer from severe insomnia and have been taking stilnox (Zolpidem) for past couple of years. Without it I basically cant sleep. Have tried all the natural medications/ melatonin, meditation, behavioral therapy with psychologist etc etc without success. Could stilnox be a contributing factor to my problems?
Last night my 95% RR was 44.80. Does this mean I breathe 44 times a minute at times? (Median 19.2) Seems unbelievable.
I have attached my screenshots from last night , including close up of RR and centrals.
The hardest part about deciding a therapy course is to determine if your issues are central or obstructive in nature. The two solutions, ASV or ST-A (iVAPS) are respectively applicable. My inclination after seeing the spectrum of respiratory disturbances you have shown in this thread, is you tend towards the central spectrum that includes periodic breathing, CA, H and unregulated respiratory rate. That's about all I can conclude at this point. Getting to ASV seems logical, but may not be an easy thing to accomplish. At least your cardiopulmonary results seem to support that it is a safe choice. A few things to keep in mind are that you rely on pressure support to feel comfortable. ASV would step in to maintain your respiratory rate and volume where you apparently are unable to do so spontaneously, and ASV will resolve CA and H events in a way your CPAP simply cannot match.
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.
(02-10-2020, 06:06 PM)Sleeprider Wrote: The hardest part about deciding a therapy course is to determine if your issues are central or obstructive in nature. The two solutions, ASV or ST-A (iVAPS) are respectively applicable. My inclination after seeing the spectrum of respiratory disturbances you have shown in this thread, is you tend towards the central spectrum that includes periodic breathing, CA, H and unregulated respiratory rate. That's about all I can conclude at this point. Getting to ASV seems logical, but may not be an easy thing to accomplish. At least your cardiopulmonary results seem to support that it is a safe choice. A few things to keep in mind are that you rely on pressure support to feel comfortable. ASV would step in to maintain your respiratory rate and volume where you apparently are unable to do so spontaneously, and ASV will resolve CA and H events in a way your CPAP simply cannot match.
Most of my centrals in the past have been at the onset of sleep (when I start by lying on my back then lie on my side when ready to sleep) I have had only 5 recorded episodes of Periodic breathing (shown as Cheyne stokes on Oscar) in past couple of months
I presume ST-A (iVAPS) would help my breathing irregularity mainly? As it doesn't have "Easy breathe" I might have trouble using it too...
I don't think ST-A is the way I would steer you. My comments were to show the options for irregular respiratory rate. ST-A would be more appropriate for hypoventilation.
On a different tact, what happens when you remove the cap on pressure at 14? Also, we can see your respiration is very irregular throughout the February 10 screenshot. How about a zoom around midnight to see what is happening?
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.
Ive removed cap on pressure (now 10-20), and have attached a closeup of respiration at midnight
I also suffer from severe insomnia and have been taking stilnox (Zolpidem) for past couple of years. Without it I basically cant sleep. Have tried all the natural medications/ melatonin, meditation, behavioral therapy with psychologist etc etc without success. Could stilnox be a contributing factor to my problems?
Last night my 95% RR was 44.80. Does this mean I breathe 44.8 times a minute at times? (Median 19.2) Seems unbelievable.
![[Image: 0w7KiIl.png]](https://i.imgur.com/0w7KiIl.png)
