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Flow Rate Graph, Mini Arousals - Experts Needed
#11
RE: Flow Rate Graph, Mini Arousals - Experts Needed
I don't see appreciable flow limitation, and the the close-up graphs show a longer expiration time than inspiration, so I disagree with 2 out of 3 of Mper6794's observations.  Tidal volume is very good, and median respiration rate is on the low side, so there is a fairly long expiration time with extended null flow time that is for some reason not being properly interpreted by the "fuzzy logic" of the Resmed Autoset.  I don't see that as consequential and it is a fairly common pattern.  I do agree that it is helpful to see events in context and your graphs are coming up a bit shorrt in that regard.  The last set of charts are from a different date than the ones posted earlier, and range from 30 seconds to just over a minute in duration.  It helps to see the full night, with closeups of about 2-minutes (for example from 11:00:00 to 11:02:00). The 2-minute zoom does not have to be precise, but that approximate duration shows us a lot of information. I'll put an example below.

I can see moving to EPR 3 and a minimum pressure of 7.0 to give inspiration more pressure support, but I'm not sure it will have a significant effect. A trial at EPR 3 at least gives us a qualitative reference point, whether therapy feels better or not.

Examples of 2-minute screenshot with flow rate, mask pressure in the first one, and the second showing a flow limited arousal.

[Image: attachment.php?aid=4258]

[Image: attachment.php?aid=4414]
Sleeprider
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#12
RE: Flow Rate Graph, Mini Arousals - Experts Needed
May I first thank everyone who contributes to helping me to improve my sleep, I am in such a dire situation, not only have I had years of severe sleep deprevation, I also have to cope debilitating effects of severe arthritis and addisions disease and I do so whilst living on my own with little to no outside help.

So if I don't understand or do things wrong or I don't appreciative, my appologies, I don't mean to do this, I'm just struggling with everything, I'm trying my best, I am getting easily overwhelmed at times, I think this is down to pure exhaustion, I've never been in this situation before.

My sleep doctors have been a total failure and I'm trying to take steps to rectify that, but with what I struggle with on a day to day basis, trying to sort everything out and doing it on my own is a horrendous task...

What I hope is that if I can somehow get on top of the sleep problem, then I can start getting on top of everything else...

Sorry I needed to get out Smile


I've read what SleepRider & MPER have posted, both of you mention about things "being in context" and to be honest, I haven't got a clue what that means  Huhsign


What I will do is post what SleepRider has asked for, which is a a full night and a closeup of 11:00:00 to 11:02:00 for last night's session with the graphs as shown in the examples.

- Note, I only reduced EPR from 3 -> 2 last night.

- Where do I find the Resmed recomended protocols of titration with your machine. " Sleep Lab Titration Guide".

- On the UK website for Resmed there is information about clinics they hold, I wonder if I should make contact, would they be well placed to help manage me better than my current sleep doctor, maybe others on this forum could recommend another uk sleep doctor?
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#13
RE: Flow Rate Graph, Mini Arousals - Experts Needed
Screenshots Sleeprider requested:

   
   
   
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#14
RE: Flow Rate Graph, Mini Arousals - Experts Needed
Just to be clear, you can choose any 2-minute segment you want to evaluate. There are three pauses of breathing n this segment, all of which are breath-holds rather than apnea. There is an inhale ahead of each pause and it ends in an exhale. these are not apnea and seem to be near the end of a nap. You may be changing position or just arousing here. There is nothing remarkable or abnormal about the segment.
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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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#15
RE: Flow Rate Graph, Mini Arousals - Experts Needed
I’m sorry but having me in the driving seat isn’t going to work, I’ve got no clue what I’m looking at.

I need help to understand why I’m not sleeping a deep and restorative 6-8hrs, solid, why do I wake when I do, why do I have these short sessions... Maybe I’m asking for too much too soon?

To be clear, last nights 5hrs was an extremely good night for me, others have been as little as 2-3hrs or less.

When we looked at the 22, 23, 26 April, in my other post about jaw alignment, Sheepless said something didn’t look right about the flow rate, I posted those same graphs here and you (Sleeprider) have said those graphs aren’t informative, so I then post new graphs based on the example given to which you have then said nothing remarkable and I needed to post something else of interest.... what though, I haven’t a clue, what something of interest is... sorry if that is dumb, but I don’t know what to post.... I really do need a dummies guide for this...
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#16
RE: Flow Rate Graph, Mini Arousals - Experts Needed
Ok, I’ve read the “Sleep Lab Titration Guide”, so now I’ve got a little bit better idea about what I’m looking at, so a level up from dummy level Smile

I might now have a little better idea of what i’m looking at...
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#17
RE: Flow Rate Graph, Mini Arousals - Experts Needed
like  It is hard to remember what it is like when you haven't bot the background of thousands of case reviews, chart analyses and why things work the way they do.  You're doing great, and that is a fantastic resource to become more self-proficient.  My comment was to let you know that we can look at any time where you are concerned that your therapy is being adversely affected.  Also, your therapy is actually looking pretty good at this point, and despite my experience in seeing many charts, I can 't see a problem related to the CPAP therapy and settings.
Sleeprider
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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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#18
RE: Flow Rate Graph, Mini Arousals - Experts Needed
I will call Resmed on Monday and get in contact with their London clinic, I can’t this flying blind.

I don’t trust either my sleep doctor who wants to ditch the CPAP in favour of a dental device, after 16yrs where he has never suggested this before... Can you believe 16yrs and he hasn’t got to bottom of my sleep issues...

I don’t trust a neurologist who I recently saw for a separate sinus issue who also happens to head up a sleep unit at a top London hospital, he is suppose to be one of the Top UK neurologists, very famous apparently... however he ignored the sleep lab conclusion of OSA, stating instead I have significant sleep initiation insomnia, without any knowledge of me and who also wrote to a psychiatrist incorrectly stating that I have a significant psychiatric history, when I do not have one... he also wanted to throw anti-depressants at me, all because he was too lazy to do his job properly...

All I wanted to talk to a psychologist for was to help me manage my health better, to get to one, in UK, via private health insurance you need to go via a psychiatrist... the neurologist didn’t mention that in the referral letter, totally screwing me over, Total negligence, if I wasn’t so damn unwell I’d sue his arse...

This is how I’ve ended up on this forum lost, because at this time I have no medical backing, I’m on my own...
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#19
RE: Flow Rate Graph, Mini Arousals - Experts Needed
(05-01-2020, 02:51 PM)hallra Wrote: Ok, I’ve read the “Sleep Lab Titration Guide”, so now I’ve got a little bit better idea about what I’m looking at, so a level up from dummy level Smile

I might now have a little better idea of what i’m looking at...

Hi,

_  this is great!: persistent own observations, driving seating, noting, trying some knnowledge and insight is all what this CPAP issues would be about in my experience;

_ SleepRider experience is huge, I am aware and have profound respect about it; learned a lot with his posts. However, If were me, I would not be satisfied with outcomes on CPAP like yours. You look to be an UARS person, and, as such, even one or two minor flow limited breath would be able to awakening you (it is my case, progressively improving; still learning...). And arousal/awakenings can be very, very detrimental;

_ then, I would still try to tame your flagged FLimited respiration. It may not be possible with current machine, rather than with the BiPAP;

_ As I mentioned earlier, you could eventually trying increasing EPR to 3.0 and Pressure minimum. Low hopes;

_ you might have other issues, besides CPAP's. But you would have to clear up this part first;

_proper interpretations from my side, still would depend on seeing your combined set of curves: TV, MV, FR, leak, FL, and Inspiration time, throuhg full night and 10min-duration windows. I might change my view after this.

Trying to broad my perspective: are you in any medication? do you have a very good sleep hygiene? you consider yourself an anxious person?


all the best
Mper
I am not a doctor. Nothing that I say here is medical advice
All my posts include only outcomes/learnings from my own/other therapies and medical literature



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#20
RE: Flow Rate Graph, Mini Arousals - Experts Needed
Hi Mper,

That is very interesting what you write, how did you come up with the UARS diagnosis from the limited data I have posted, I've not mentioned anywhere about this in my posts...??

Though I've read the Titration guide I still feel fairly lost, just a little less Smile

How to 'tame your flagged FLimited respiration' I'm not sure how this is to be done, but I think that is what we are working on...

Last night I up'd the EPR to 3.0, I will post some charts on this...

The posting of charts... I clearly still not understanding what i'm doing... I thought what I last posted for SleepRider was correct, it appears not? I will make another attempt on last night sleep... Please advise what I get wrong...


Below is the background info you ask for...


Background
--------------

I've been having sleep difficulties that have progressively worsened since my mid 20s, some 25 yrs now, the difficulties have worsened over time and have coincided with the overall decline in my general health.

I was first sent to a sleep doctor, this Psychiatrist in Sleep Medicine that I spoke of yesterday in my post, in 2004.

Over the years, I've had several overnight sleep lab tests with this guy and with via the NHS, that mainly came back inconclusive due to lack of data recorded, due to lack of sleep...

Eventually in 2010, I was given a diagnosis of UARS, when a home based study recorded enough data to allow a diagnosis... 

However, the condition never got treated due to other areas of my health taking far greater priority and this area getting forgotten about...

- One possibility very important recent event that occurred in Aug 2017, I had Artificial Cervical Disc Replacement Surgery, one of the Cervical discs in my neck was replaced, has this impacted the breathing as I sleep, because remarkably my sleeping has considerably worsened since this time... But it can also be said that the steroid medication and my weight also shot up as a result... 

Roll forward to 2019, I'm back again in front of the sleep doctor, this time when he sent me for the overnight sleep lab test, he knocks me out with sleeping tablets... 
- One over bearing question in the back of my mind is... why did it take someone 15 years to knock me out with sleeping tablets, why did this never happen before... 


Medical Conditions
-----------------------

I have medical conditions whose symptoms and treatments interfere with my sleep:

1) Ankylosing Spondylitis - an arthritis that affects the spinal and joints throughout the body.

2) Adrenal Insufficiency (Addison's disease) - non functioning adrenal glands.

Major Symptoms
---------------------

Pain, Stiffness, Fatigue


Medications
--------------

Topiramate, Prednisolone, Hydrocortisone, Paracetamol, Codeine, Secukinumab, Testosterone, Vit D, Vit C, NSAID.


For completeness, here are the reports from the 2019 sleep lab study and the 2010 home based study.



.pdf   Ebrahim 20190614 Analysis report.pdf (Size: 471.41 KB / Downloads: 4)


.pdf   Ebrahim 20190614 NPSG report.pdf (Size: 315.61 KB / Downloads: 5)


.pdf   stardust report, R Hall, Apr10.pdf (Size: 313.82 KB / Downloads: 5)
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