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Flow Chart pattern- Snoring?
#11
RE: Flow Chart pattern- Snoring?
in this screenshot of my respiratory response to periodic limb movement you can see what my moans/groans in response to the movements look like.  they look like expiratory snores but aren't in this case.


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#12
RE: Flow Chart pattern- Snoring?
(09-14-2020, 08:04 PM)sheepless Wrote: in this screenshot of my respiratory response to periodic limb movement you can see what my moans/groans in response to the movements look like.  they look like expiratory snores but aren't in this case.

Sheepless, if you have a chance, can you post a 2 minute graph view typifying the worst of it? You know I recall being a little cold and having a LOT of classic PLM as I tried to go to sleep last night. Many nights it's not noticeable, but last night was not good. Probably continued to have PLM throughout the remainder of the night as I slept. How does PLM impact the flow rate graph? Arousals and restlessness? Could you explain in detail what you see in your posted flow rate graphs. Thanks
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#13
RE: Flow Chart pattern- Snoring?
In asking you to search Catathrenia, I by no means was drawing any conclusion. We don't see a lot of exploratory snoring, so I thought I'd just put it out there, similarly my suggestion to look for correlations to pressure and other conditions. We just don't have a consistent idea why this pattern occurs, or if it is even significant. That might be why your Resmed Autoset has no response to it. I'll follow along and see where this goes. Thanks for posting.
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#14
RE: Flow Chart pattern- Snoring?
Last night was a good one with no PLMs noticed. I decreased Min/Max a little and dropped EPR to 1 to keep EPAP up, just looking for lowest pressures needed to manage event numbers. I took a couple of screenshots, one with an interesting 1 minute window view of the atypical snores. Looks like these snores are actually occurring in very early inspiration, as expiration has already been completed, and the inspiratory curve is heading up towards the red dotted zero line. Do you agree? Not that it matters. Just curious to note if the snoring is more typical inspiratory vs atypical expiratory. Just academic at this point. Not concerned at all, just curious. I'm happy with my apnea therapy so far. Feel a lot better. Only issue is mild aerophagia, which may get better with time as I'm working on the "tongue to upper palate" seal. Thanks

       
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#15
RE: Flow Chart pattern- Snoring?
The snoring occurred near the minimum set pressure. To interpret the flow rate chart with the zero-flow dotted line, everything below the line is the expiration air flow rate in mL/second. Your snores occur at and immediately after the expiratory flow rate reaches a maximum flow/velocity. Expiration is ending as the flow rate rises near the zero line and levels off near zero ahead of the next inspiration. So the snore is actually at the peak expiratory flow. There are two expiratory flow reductions that look like a flow interference, like a flapping gate, right at the peak expiratory flow. This may not be a snore, but could be nasal congestion or other fluid in the airway that interferes with expiratory flow for a split-second causing turbulence.
Sleeprider
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____________________________________________
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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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#16
RE: Flow Chart pattern- Snoring?
Bobaloo, I'm responding to post #12 above.  first, I didn't know you have plm; I was posting to show you what my moaning/groaning vocalization looks like. plm, catathrenia, flug in your throat, expiratory snoring -  imo any one could be the reason for the pattern you question.  again, an audio / video recorder would help sort it out.

I've attached 3 shots from last night.  in the all night pic, notice the first hour or so is more 'hairbrushy' than the rest.  that's not determinative but it's a hint, especially since I know I often have plm at the beginning of the night.  I find my predominant plm pattern (i.e., my respiratory response to plm) is most visible in a view scale of 7-10 minutes in order for the repetitive pattern to stand out.  the pattern should be clear in this 10 minute shot: a sharp inhale followed by several breaths of lesser volume, often flow limited, often accompanied by a moan/groan that looks like an expiratory snore, repeat, repeat, repeat.  most of mine are like shown, with roughly 3-9 breaths between sharper inhales that I associate with the movements.  the timing & number of breaths between movements is nearly uniform per episode and can vary from episode from episode.  less often I might see up to 30+ seconds between movements.  episodes come and go throughout the night (but are fewer and farther between for me with ropinirole).  episodes last for less than a minute to 30 minutes or longer although I can't recall seeing one lasting more than an hour, maybe it wakes me before that (imo arousals and awakenings, fragmented sleep, are inevitable with plm). I also see a waxing waning pattern that I suspect is a softer version of my response to plm but that's not confirmed and there are other possible reasons for that more sinusoidal pattern. one reason I suspect that is because one pattern often morphs into the other. however, the bookended pattern is confirmed to my satisfaction.  I've also seen it in the flow rate graphs of other members that report plm. the 3rd screenshot is a 2 minute view as you requested.

some/many nights I feel rls in the late afternoon/evening hours and while trying to fall asleep; sometimes I feel it coming on even earlier in the day.  plm tends to follow on those nights, but it's hard to be confident in suspecting a clear relationship because I have plm virtually every night.  the difference, besides rls occurring while awake and plm while asleep (I believe), is that I'm aware of rls and oblivious to plm; and my response to rls, unlike plm, is voluntary and sporadic (not periodic).  I will say that on at least one occasion I thought I was awake and working my legs in response to rls and saw my plm pattern when looking at my flow rate the next day.  I think we're really bad at knowing and reporting in retrospect whether we were asleep, especially in 'transition' & light sleep. 

I don't know if everyone presents and interprets as I have.  it seems little is known about this malady.

I hope this is useful to you and others.  feel free to ask if I've left anything out.


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#17
RE: Flow Chart pattern- Snoring?
Sheepless, thanks for the detailed graph info and discussion. At first glance, I don't see the same patterns in my own data. Your plm sounds far worse than mine. I'm hoping mine to some degree is associated with low iron. My recent ferritin was only 19. I'm taking iron pills now and hoping to rebuild my iron stores. I gave blood twice in an 8 month period and almost crashed my ferritin. Lesson learned.

Sleeprider, thanks for your valuable input as always!
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#18
RE: Flow Chart pattern- Snoring?
Sleeprider, thanks for the recent comments about the 95% flow limit numbers on another thread. Posting response in my own thread. I have been wearing a soft cervical collar for about a month and I think it has helped a lot, as I had many clusters of obstructive apneas when I first started Apnea treatment. Occasionally, I still "overcome" the collar (wake to find my chin slightly tucked), so I need to modify it for another 1/2" to 3/4" in height under the chin for an ideal fit. I realize that there is a sweet spot for how loose the collar needs to be for comfort and function. I'm making sure that there is no impingement on throat/airway. I think that tweaking the SCC to stop chin tucking is what I need right now, to limit arousals at night. I also note that every time I have the slightest mask leak above the baseline, I get an arousal based Sleep,Wake,Junk flow disturbance. I must be sensitive to the hissing sound of even small mask leaks.

I've increased my Min/Max pressures to 10-13 and same EPR 2. Last night's 95% flow limit was .03. The max pressure comes down to minimum reasonably quickly with resolution of the periodic flow limits. All things considered, I'm actually feeling pretty rested now. I'm eating healthier and taking a daily iron supplement pill (SlowFE) to boost my low starting Ferritin levels (19), and I am not noticing any more PLMS (restless legs during sleep) at after about 30 day on the iron pills. Ferritin below 75 is the cutoff to try iron supplementation with PLMS. My iron levels were low because I donated blood twice in 8 months. 

Thanks for your guidance!

                 
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#19
RE: Flow Chart pattern- Snoring?
the spikes around 4:13:50 & 4:14:40 are probably recovery breaths following flow limitations. however, if you scroll to the right and see more of these in succession roughly the same distance apart, they may be from plm. easier to see at a 7-10 minute view scale. if no more than shown, probably not plm. no matter if it's not bothering you, just mentioning for possible future reference.
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#20
RE: Flow Chart pattern- Snoring?
(09-27-2020, 03:32 PM)sheepless Wrote: the spikes around 4:13:50 & 4:14:40 are probably recovery breaths following flow limitations.  however, if you scroll to the right and see more of these in succession roughly the same distance apart, they may be from plm.  easier to see at a 7-10 minute view scale. if no more than shown, probably not plm.  no matter if it's not bothering you, just mentioning for possible future reference.

Sheepless, I attached a 10 min flow graph interval at the timeframe you referenced. Looks like three perfectly spaced spikes, with the last one more subtle. Otherwise, the other sighs/moans during the night are pretty scattered and not clustered at even intervals. I'll keep an eye on it. Now I know what to look for. Thanks!

   
MacBookPro Catalina, Windows 10 (Parallels 16), FlashAir 16GB W-04, FlashPAP,
Contec CMS50F Pulse Oximeter (08/2020), Hardware v2.0.0, Software v2.0.5, 
Smart Device Assistant 3.1.0.1
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