[Diagnosis] Periodic breathing

[quiescence at last]

I did some math, and the period between 3:15 and 6:15 is not counted as therapy hours, which totaled 04:11 (and I can see about 4 hours of data that is crumbly.) My guess is big tony is doing up time, or sleep without machine. looks like he is wide open, in APAP mode, and has flex set to highest (x3). thanks to dave p. for the detailed posts.

QAL

[bigtonio]

very quick reply - I am sorry that the explanation of Last night and the screenshots were separated.  what happened was that - after a period in bed (with CPAP) I got up I sat in my chair and instantly fell asleep (not with CPAP).  When I awoke (3 hours later but feeling more refreshed than I have any morning for months) i went back to bed (and CPAP).   so yes QAL you are right!  sorry if what i did confused you sleeprider but there was nothing to show!  the same situation applied to the original screenshot which a period from 6:30-9:30pm showed no events in the eventflags chart - i had gone to bed in the afternoon to try to get some sleep then got up...   if a chart shows no flags for 10 minutes at the moment it is a triumph.    

Tonight i have brought the CPAP with me so that i could see what happened if i used cpap IN THE CHAIR - - the result is that my AHI for the night so far is 47.30  my time in the chair showing as virtually constant "CSR".  I will see what a couple of hours back in bed can do....

Thanks for your help folks - and particularly to Dave for posting the screenshots.

[Sleeprider]

Bigtonio, going back to your first post it's clear that the sleep lab is relying on incomplete or poor data to make its conclusions. When you read "numbers off the unit and they were happy" that was only compliance data. It shows you have been using the machine, so of course they think that's great. The results of your "Respiratory Polygraphy at home" are still pending, but we have no idea what that entailed. Were you using your APAP or using their recorder without CPAP? Did you feel like you slept better while recording the data or the same as with CPAP.

Here is a theory regarding your CPAP therapy. The use of AFlex at +3 is causing you to have many more events. Flex is only used when the pressure rises above 4 cm, and as soon as it does, you start having events. It might be possible to turn off Flex and use a fixed pressure of 6 or perhaps as high as 8 and have a more comfortable sleep. You definitely have central apnea, and it is accompanied by what appears to be CSR, both of which can be made worse when Flex is enabled. I really would like you to trial a night without Flex and at a fixed pressure of your choice to compare against the data we have seen so far.

[bigtonio]

I am learning so much about my sleep problems!  (and my machine!). 

First let me try to answer questions that i have been asked -i phoned my sleep clinic as i was concerned that my therapy was not effective. the CPAPpractitioner i spoke to asked me to give details of the 7 day and 30 day averages from the machine 'info' display there are 6 headings with 2 values for each - therapy hours - days >4 - Large Leak (%) - AHI - periodic Breathing% and 90% pressure.  I do not have the figs I gave her (unfortunately)  it was  about a week later i decided to record these figures everyday (as I could talk to them about changes and whether things were getting better or worse based on them at least.   she mentioned possible central sleep apnoea and would talk to my consultant- and be in touch.  within a week i was to do a sleep diary and the home Respiratory Polygraphy tests (on 6-7 july)   The test took place with me using my CPAP as normal. ( I slept slightly worse than normal that night) "we will contact you in the near future to discuss the results"  (I have since found out that the results will be about 6 weeks so 25th August would seem the earliest I can hope for).

They seem to assume that the figures NOW will be close to those i gave them  - but all i can do is compare the figures from a week after i gave them with now...  LL%(7) 9 - now 3 (30) 21 - now 7.  AHI (7) 26.5 now 29.1 (30) 26 now 23.8.  PB% (7) 15 now 21 (30) 14 now 17 and P90% (7) 14.2 now 17.2 (30) 11.9 now 14.7.  as I was supplied with a new mask (same make and model) I expected leak improvement.  the other changes are a general trend i think - worsening?  

My last night experiment is something I do not intend to repeat.  from being refreshed after sleeping in the chair (without CPAP) i felt dreadful this morning when i woke having used the CPAP.  a couple of hours back in bed did make me feel a little less exhausted
 
I attach a snapshot of the whole night (note the two gaps when the machine was not in use as i was awake).  The pressure when I was in the chair was much lower - why?  I cant understand that at the moment.

After I have done our evening meal I will see if I can look at carefully changing the settings - I will just have to prepare for the possibility of cross "professionals" (if they look at what the machine actually shows).  



[attachment=3685]

[quiescence at last]

if you make adjustments that would be sensible, you can explain why you did it, with graphical evidence you now have.

Looking at your latest chart, it is clear you are having severe snoring, so there is resistance to breathing (in or out), yet there is a low or zero FL meant to track how badly restricted you are.  My take on this is that the resistance is actually during the exhale, since your machine type does not seem to really assess or track the flow constrictions during exhale.  FL is a measure of flow limitations on the inhale portion of the breath.

Do you find there is actual nasal resistance or blockage during exhale that make you shift to mouth breathing?  I believe some/many of the clear airway results are brain fighting against that hip-hopping between nasal and mouth flow.

-  Can you give us a 3 to 4 minute close up plot from 1:50 on Tuesday night (weds morn)? This should show whether the snoring is on inhale or on exhale.

Hope all goes well with adjustments.

QAL

[your saved image on imgur:]

[DavePaulson]

Didn't show up for me QAL. so reposting.

[bigtonio]

I have had 4 machines over the 21 years.  for over 11 years i was on CPAP at 8 cmH2O (ramping from 4 cmH2O) since then I have been on auto  with a setting of 4-20 cmH2O.    So going back to 8cm seems a good option.  If I am to evaluate (what i really mean is if the forum experts!) what the effects have been I cannot use my old 'dumb' CPAP so i have set my machine to CPAP 8  for when I settle down  (in about 2 hours time)..   I assume that If I have problems I can tweak things between sessions although that will screw up the statistics.

On the breathing side I started on CPAP with a nasal mask - and all the time I was on CPAP i had nasal mask only.  When I went to auto i was switched to the full face mask type I still use - BUT - as far as my wife and I are aware I have never mouth breathed.  when I had an operation on my forehead to remove a cancerous lesion I could not use the full face mask so went back to my CPAP nasal mask with no problem.  Is there any clue anywhere in the charts which can confirm or deny this?

this may be a dumb thought but if pressure is too high wouldn't that make exhalation difficult? I have an awful lot to learn!

I attach the close-up you asked for if there is anything else you think would help just ask! or if you need to see any other graphs for the timeslot of course.  maybe I will have a chance to have another go at imgur tomorrow (I have taken the quick and easy option of attaching today) - if CPAP gives me a better night's sleep (it could hardly be worse) I could be full of beans instead of like a limp dishrag.

Once again thanks for all your help.



[attachment=3687]

[ajack]

As you know, the cpap isn't the answer for you, but you will learn a lot by getting the cpap working for you the best it can. There is a lot to be said about sleeprider saying a fixed pressure around 8 and trying to balance the ca and oa. It is harder to breath out as the pressure increases, but the muscles get use to it after a week.

I thought you would have done better in the recliner, did your head come forward and put your chin towards your chest? I would like to see what a $10 soft foam, cervical collar would do for any positional apnea.

If it were me, my highest priority would be to go to a cardiologist and get the heart tests out of the way. So that will speed up approval for an ASV come august. Or it may turn out a ST or avaps/ivaps mode may be more suitable.

[Sleeprider]

Once again, I really want to see the fixed pressure at 8 with no AFlex. We need to see if a fixed pressure helps.

[bigtonio]

8cm CPAP with no flex is just about to start.... one thing is certain (I hope!) it has to be better than last night!

lets hope we all sleep well when the world is in the right place for each of us