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richb Online

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Post: #11
RE: Comments on Data Please
(06-06-2016 06:25 PM)rkl122 Wrote:  Ok here are a couple zooms around the suggested windows. Any new info here?

9 min zoom from penultimate cluster

zoom from around 2AM

Thx, -Ron

The rising and falling pattern is characteristic of Periodic Breathing and Central Apnea. Zoom in on about a minute of breaths during one of the Hypopneas. That way we could look at individual breath wave forms to see if they are cut off or look normal. Cut off = obstructive.

Rich

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-06-2016 07:27 PM
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rkl122 Offline

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Post: #12
RE: Comments on Data Please
(06-06-2016 07:27 PM)richb Wrote:  ................

The rising and falling pattern is characteristic of Periodic Breathing and Central Apnea. Zoom in on about a minute of breaths during one of the Hypopneas. That way we could look at individual breath wave forms to see if they are cut off or look normal. Cut off = obstructive.

Rich
Ok, here's a 29 second HA from a region with no other event immediately nearby. The shape of the individual breaths is typical for the night (except when other events are coincident.)

minute window with 29 sec HA

What's the verdict? What should a normal breath look like? Is that leading shoulder abnormal?

EDIT - I see I had my y-axis skewed. (I've fixed it for future.) That leading shoulder is actually the zero flow line.

Thx, Ron

BTW, to my eye, many of my HA patterns are indistinguishable from nearby patterns that are not flagged. It's not immediately evident to me why the algorithm flags them.

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
(This post was last modified: 06-07-2016 08:39 AM by rkl122.)
06-07-2016 08:28 AM
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richb Online

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Post: #13
RE: Comments on Data Please
Those breaths are not typical of Obstructive Apnea. The fact that they resemble previous non flagged breaths is significant. Obstructive Hypopnea breaths have the top flattened like a mountain with the top cut off. The Hypopnea breaths are scored because of significant reduction in flow and that they last for 10 or more seconds. Periodic Breathing is also a sign of Central Apnea but because there is still significant flow it is not scored as a Hypopnea. You have several suggestions as to how to try and reduce the Hypopnea and Central events. It is worth trying these suggestions first. Most insurance plans including Medicare require that you fail at using CPAP or BiPAP before being allowed an ASV machine. An ASV machine eliminates most Central Hypopneas and Central Apneas. It also levels out the Periodic Breathing. This in turn just about eliminates the desaturations that interrupt your sleep.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-07-2016 10:17 AM
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green wings Offline

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Post: #14
RE: Comments on Data Please
If you put your cursor over the values on the flow rate graph Y-axis and right-click, there's an option to have the graph draw a dotted line at zero.

The hypopneas look like typical obstructive events to me. I'm still a relative newbie to analyzing these graphs, though.
06-07-2016 10:19 AM
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green wings Offline

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Post: #15
RE: Comments on Data Please
I can't tell the difference! It looks like at least two of them have flattened tops. I'm going to put a screenshot here of one of my hypopnea events for comparison.

[Image: WenOzU6.png]

(06-07-2016 10:17 AM)richb Wrote:  Those breaths are not typical of Obstructive Apnea. The fact that they resemble previous non flagged breaths is significant. Obstructive Hypopnea breaths have the top flattened like a mountain with the top cut off. The Hypopnea breaths are scored because of significant reduction in flow and that they last for 10 or more seconds. Periodic Breathing is also a sign of Central Apnea but because there is still significant flow it is not scored as a Hypopnea. You have several suggestions as to how to try and reduce the Hypopnea and Central events. It is worth trying these suggestions first. Most insurance plans including Medicare require that you fail at using CPAP or BiPAP before being allowed an ASV machine. An ASV machine eliminates most Central Hypopneas and Central Apneas. It also levels out the Periodic Breathing. This in turn just about eliminates the desaturations that interrupt your sleep.
06-07-2016 10:26 AM
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rkl122 Offline

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Post: #16
RE: Comments on Data Please
(06-07-2016 10:17 AM)richb Wrote:  Those breaths are not typical of Obstructive Apnea. The fact that they resemble previous non flagged breaths is significant. Obstructive Hypopnea breaths have the top flattened like a mountain with the top cut off. The Hypopnea breaths are scored because of significant reduction in flow and that they last for 10 or more seconds. Periodic Breathing is also a sign of Central Apnea but because there is still significant flow it is not scored as a Hypopnea. You have several suggestions as to how to try and reduce the Hypopnea and Central events. It is worth trying these suggestions first. .......
Thx Rich. The only suggestion I see is Sleeprider's. Guess I'll start there - a cautious incremental pressure increase. Understood about ASV.

(06-07-2016 10:26 AM)green wings Wrote:  I can't tell the difference! It looks like at least two of them have flattened tops. I'm going to put a screenshot here of one of my hypopnea events for comparison.
Green Wings, thanks for pointing out the dotted line menu! I've been staring right at it without using it. Got it enabled now. It actually makes a highly zoomed graph more meaningful.

Your graph catches my eye. Notice how the H event marker falls right in the middle of a breathing pause, but the H event itself is considered to end at the marker. I've noticed this in my traces as well. The event always ends at the flag, even if there is apparently anomalous behavior following the flag. What I think is happening in your case: that pulse following the H is unrelated to the H. It's the machine testing for obstruction because there was 10 seconds of zero flow. It probably used the response to call the CA and/or FL which are just beyond the right margin.

Don't we dataphiles have fun.

-Ron

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
06-07-2016 11:29 AM
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green wings Offline

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Post: #17
RE: Comments on Data Please
(06-07-2016 11:29 AM)rkl122 Wrote:  What I think is happening in your case: that pulse following the H is unrelated to the H. It's the machine testing for obstruction because there was 10 seconds of zero flow. It probably used the response to call the CA and/or FL which are just beyond the right margin.

Agreed. I went back to the graph to see what happened next. As best I can tell, the "no flow" lasted for 9 seconds, so nothing got scored for that particular pressure pulse.

"What happened next" below: (27s H, 22s CA, 12s FL)

There's some of that expiratory mouth breathing going on above that I probably am eventually going to need to get a chin strap to stop. Sad

At least, I think that's what it is.

[Image: 5yYJ7wX.png]

Quote:Don't we dataphiles have fun.

Fun, obsession - something like that!

If you'll notice, I have a fixed pressure machine. I was feeling so bad when I got it early last winter that I didn't even realize the implications of it not being an APAP until I'd had it for about 6 weeks.
06-07-2016 02:28 PM
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rkl122 Offline

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Post: #18
RE: Comments on Data Please
Your analysis of that graph makes perfect sense.

(06-07-2016 02:28 PM)green wings Wrote:  .................
If you'll notice, I have a fixed pressure machine. I was feeling so bad when I got it early last winter that I didn't even realize the implications of it not being an APAP until I'd had it for about 6 weeks.
SH is reporting your PAP mode as APAP. It also shows different pressures under the statistics. Are these bugs in SH?

Whatever the regimen, if that night is typical, you're doing better on it than I am with auto and Aflex. In fact, you've given me an idea Green Wings. Before bumping my min pressure, I'm going to turn off the Aflex. Maybe that alone will improve my profile. Thanks, and good luck with the mouth breathing problem. I get that too some nights, usually after rolling to supine. A tooth guard seems helpful, presumably because it forces the jaw a bit forward, widening the airway.

-Ron

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
06-07-2016 04:59 PM
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richb Online

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Post: #19
RE: Comments on Data Please
(06-07-2016 02:28 PM)green wings Wrote:  
(06-07-2016 11:29 AM)rkl122 Wrote:  What I think is happening in your case: that pulse following the H is unrelated to the H. It's the machine testing for obstruction because there was 10 seconds of zero flow. It probably used the response to call the CA and/or FL which are just beyond the right margin.

Agreed. I went back to the graph to see what happened next. As best I can tell, the "no flow" lasted for 9 seconds, so nothing got scored for that particular pressure pulse.

"What happened next" below: (27s H, 22s CA, 12s FL)

There's some of that expiratory mouth breathing going on above that I probably am eventually going to need to get a chin strap to stop. Sad

At least, I think that's what it is.

[Image: 5yYJ7wX.png]

Quote:Don't we dataphiles have fun.

Fun, obsession - something like that!

If you'll notice, I have a fixed pressure machine. I was feeling so bad when I got it early last winter that I didn't even realize the implications of it not being an APAP until I'd had it for about 6 weeks.

Hi Green Wings,

It looks to me like your there is a small problem with the location of the event flags in your SH report. The first H is about 10 seconds long and maybe should have been scored an OA. It seems that your machine doesn't use the FOT technology to score CAs, so I think that either the machine or SH has to guess. Looking at the 2nd pair of event flags, that also looks like an extended OA event. It appears that you tried to take 2 unsuccessful breaths during the extended event. Both of those breaths seem to have the flattened top of an Obstructive Hypopnea breath. What was happening (in my opinion) is that you began to take a breath and your airway closed causing the flattened top. Yes that is a Flow Limitation as well. You might benefit from a more sophisticated machine. One that can better respond to your OA events and provide more diagnostic technology.

Rich

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-07-2016 07:55 PM
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justMongo Offline

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Post: #20
RE: Comments on Data Please
I wonder why SH says: "Please note: This day has missing pressure, mode and settings data."

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06-07-2016 08:12 PM
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