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Cheyne Stokes isn't always heart related
#11
RE: Cheyne Stokes isn't always heart related
that looks brutal. curious that it wasn't marked csr as it looks very similar to your other shots that were. in this latest shot, pressure rose against oa, which may aggravate the ca. hard to tell though because flow rate and ca in other shots with no oa look pretty similar without the increase in pressure. that, combined with your sense that you were having central events without the machine lends some support your thought that the ca isn't treatment emergent or pressure induced. did you have a sleep study? did you have ca during the initial (not titration) study? did it show anything else, like plm? I hope some more-experienced members will jump in here!
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#12
RE: Cheyne Stokes isn't always heart related
I would say that with poor doctor support from that office fire this incompetent quack ASAP. Take your therapy needs and insurance boat payments elsewhere. This duck has proven to be unable to help. Get your Nikes on and run somewhere else.
Dave

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#13
RE: Cheyne Stokes isn't always heart related
Interesting....  I do think PLM is represented in some of my charts. I have little balls of material that have appeared in the mattress cover where my feet at at....  my wife's side doesn't have this wear pattern.  Dancing
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#14
RE: Cheyne Stokes isn't always heart related
(03-11-2021, 05:13 PM)sheepless Wrote: that looks brutal. curious that it wasn't marked csr as it looks very similar to your other shots that were. in this latest shot, pressure rose against oa, which may aggravate the ca. hard to tell though because flow rate and ca in other shots with no oa look pretty similar without the increase in pressure. that, combined with your sense that you were having central events without the machine lends some support your thought that the ca isn't treatment emergent or pressure induced. did you have a sleep study? did you have ca during the initial (not titration) study? did it show anything else, like plm? I hope some more-experienced members will jump in here!

My sleep study was at home. I hadn't had the vaccine and I am 66, male, bald and a BMI of 25.2...  so... I was chicken to get tubes pumping air into my lungs during all of this Covid.

The home study gave AHI of 46.88 OA and 3.47 CA, sO2 under 90% for 46 minutes and under 80% for 1.6 minutes. He said I could come in for a lab study, but I was still too sheepish. That was my mistake because I thought the A10 could get me dialed in. While my AHI is under 4 on average, I am learning that number doesn't always correlate to your sleepiness during the day. There is a LOT more to all of this, isn't there.....

I am wondering if there are criteria I should use in selecting a clinic to go to where they are really geared toward success with CPAP.
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#15
RE: Cheyne Stokes isn't always heart related
I would suggest reducing or disabling EPR and see if that reduces the cycling while maintaining comfort. I think sheepless's graphs show hyperventilation breaths that are outside the CSR style sinusoidal pattern, while coldfeet7's do not. Looking further back in time to identify where the pattern starts might be informative... it could just be a natural arousal/movement which results in a pause in breathing (which is normal) followed by a cycle of hyperventilation (enhanced by EPR) and hypocapnia.

Here's my PLM driven trace... including measurement of leg movement and changes in orientation (rolling from back to side @4:02, then to other side @4:11). You can see hyperventilation reflected in flow rate spikes and high tidal volume associated with movement, followed by a reduction in breathing (sometimes to the extent of a CA or H) and then a climb back up.
   

Did your sleep study measure leg movement?
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#16
RE: Cheyne Stokes isn't always heart related
I agree coldfeet's pattern isn't clearly plm but neither is it clearly csr - to my layman's eye anyway. but then yours, kappa, isn't as clearly plm as I've seen in my flow rate and elsewhere either, but I think you've confirmed yours by other means. I suspect it can present somewhat differently from individual to individual.

hopefully it's not plm but it could explain a lot if actually present.

similar to your balls of material on your side of the bed, coldfeet, I wore a hole through a bottom sheet on my side of the bed at about where my ankles would be. had bad plm last night but I only know that from my flow rate pattern. aside from waking too often and feeling tired today, I'm completely unaware of it when it occurs. I can't even tell that's what woke me at the time of awakening.

coldfeet, if your experience is anything like mine, it'll be difficult but see if you can get your wife to observe you sleeping periodically through a few nights, looking for leg/body movements and anything else unusual. alternatively, use an audio or better yet a video recorder to see what turns up.
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#17
RE: Cheyne Stokes isn't always heart related
(03-11-2021, 06:50 PM)kappa Wrote: I would suggest reducing or disabling EPR and see if that reduces the cycling while maintaining comfort. I think sheepless's graphs show hyperventilation breaths that are outside the CSR style sinusoidal pattern, while coldfeet7's do not. Looking further back in time to identify where the pattern starts might be informative... it could just be a natural arousal/movement which results in a pause in breathing (which is normal) followed by a cycle of hyperventilation (enhanced by EPR) and hypocapnia.

Here's my PLM driven trace... including measurement of leg movement and changes in orientation (rolling from back to side @4:02, then to other side @4:11). You can see hyperventilation reflected in flow rate spikes and high tidal volume associated with movement, followed by a reduction in breathing (sometimes to the extent of a CA or H) and then a climb back up.


Did your sleep study measure leg movement?

I'll put the EPR back to 2. 

How are you capturing your movements and orientation?

No. The study was a home study. It just had a chest and abdomen belt, canula and O2 sensor. That is ANOTHER reason I should have gone into a lab. My Dad had a sleep study years ago and they said his legs moved more in the night than anyone they had ever seen. I don't know if that can be genetic.

I suppose I can get an app that has motion activated recording on my phone, but I am into tech so I'll check out whatever Kappa is using.
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#18
RE: Cheyne Stokes isn't always heart related
(03-11-2021, 08:29 PM)coldfeet7 Wrote: How are you capturing your movements and orientation?

No. The study was a home study. It just had a chest and abdomen belt, canula and O2 sensor. That is ANOTHER reason I should have gone into a lab. My Dad had a sleep study years ago and they said his legs moved more in the night than anyone they had ever seen. I don't know if that can be genetic.

I suppose I can get an app that has motion activated recording on my phone, but I am into tech so I'll check out whatever Kappa is using.

RLS is often associated with PLM, and RLS can be genetic.

The device and logic I'm using is described in this post. I should probably post my code for the bluetooth data collection, which runs continuously on a laptop nearby overnight since the device I'm using doesn't have any memory...

sheepless, agree that the traces are different, but there is a similarity in the sudden peaks in flow. Perhaps having a Vauto machine compared to a regular CPAP results in different behavior?
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#19
RE: Cheyne Stokes isn't always heart related
"Perhaps having a Vauto machine compared to a regular CPAP results in different behavior?"

I have little to go on but my own situation but I suspect it varies more by individual than machine because my plm pattern(s) look(s) pretty much the same with apap, vauto and asv.

coldfeet, I'm not at all sure your pattern is plm but if only for the relatively uniform timing it is suggestive. combined with your comments, I think there's enough there to warrant further investigation.

your sleep test indicated many more oa than ca. that's not definitive since we know ca are inconsistent but it should be accorded some substantial weight in your considerations. it looks like treatment has effectively addressed your oa so if you're just 6 weeks with the machine, the ca may still diminish with time. generally, that period is thought to be 30-90 days.

your pressure settings are quite low so unless you're really really sensitive, it seems unlikely your ca are pressure induced. reducing pressure variation may help so incrementally lowering epr could be instructive. you could experiment with a tighter range, even fixed pressure (min=max) as well. your oa might rise but with cpap, all you can do is try to find the optimum how-you-feel balance between oa and ca.

finally, rereading above it sounds like you haven't seen that much of the csr-like flow rate so again, maybe it'll all settle down in time.

if you do suffer from plm, pap won't help and you'll likely continue to feel fatigue until the plm is treated somehow.
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#20
RE: Cheyne Stokes isn't always heart related
Thanks Sheepless for the thoughtful reply.

I do need that investigation, but my current folks aren't up to the task. They seem to be shuffling forms (at least it feels that way). This is a PERFECT use for an AI. Study a bunch of charts and look for a pattern. If they can make an AI that reads biopsies for cancer that can rival a pathologist they can make one that studies these charts. I would rest easier if I knew they are studied daily by the AI and that it flags things for one-on-one care. That would save human eyeballs and increase quality of care. Win win.

I not sure how to find them, but I am going to hunt for a better sleep clinic.

I agree. I don't think my CAs are pressure induced. Last night was again a disaster (see charts). I tend to do very well for the first 3-4 hours of the night and then it falls to pieces. My sinuses seem to swell and I can't breath well. I have humidity at 3 and tube temp at 75. If I have warm air I feel like I am suffocating. Cold, brisk air feels MUCH better but it may not be better. Anyone know if sinuses tend to clog up because of too much or too little humidity?  I can't add much humidity at lower temps because of the condensation potential.

As you will see, my SaO2 dipped below 90 which was really troubling because I felt the PAP would avoid that, but the number of events was overwhelming. This is a classic example of a 10 something AHI masking a barrage of events. There needs to be a way to express a burst rather than average them over the night. That is like having a car wreck and having the G force averaged over the trip and having someone say "What's the problem"?   Thinking-about

I switched from the N30i to the F30i coming back to bed and it was even more bonkers. AHI over that hour was 55! So far I have found an F20 or F30i both create this storm of AHIs. So I am stuck with clogged sinuses pushing me off the nasal mask and the full face for some reason causing this horrific mess.  Ideas?

Sorry, I forgot to move EPR from 3 to 2. I moved it to 2 for tonight and I set the pressure for 8 (min and max). My long term avg pressure has been 7.5-ish.


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