High Resp Rate

[HoseHead58]

Try Thor's hammer! :-)

[zimlich]

As both of these resp. rates are within normal limits I would not be concerned. You got some good replies about what may cause the increase.
Good luck,
Mary

[Ugly]

Try Thor's hammer! :-)

Ah yes. Thor's hammer. Don't mind if I do!

[HeadWrench]

Hi kbeckman and hello to the rest of the forum.

I also have noticed jumps in my respiration rate graph and have assumed that indicated different stages of sleep. However, my tidal volume and ventilation remained fairly constant during those periods, just as we see in the graphs that you posted.
Here’s an example of one of my charts:

   


When I zoom in on the flow rate graph I see that my inspirations during the higher resp rate are not uniform, and I suspect that the jagged form of each breath is being counted as two breaths:

   


This is what my breathing typically looks like during the remainder of the night:

   


I first noticed this phenomenon after I switched from the a nasal pillow to a nasal mask. I have only been on CPAP for 30 days and have my first follow-up appointment with the sleep specialist later this week. I will ask if those breathing patterns indicate any problems. It would be interesting if any of you veterans have any experience with this.

Getting accustomed to sleeping with a mask has been very difficult so far, but being able to read about others’ experiences in this forum has been very helpful and informative. Thanks for sharing all the info about how to read the data card. I can see improvement in my numbers every week, and getting an objective view of my progress has been most valuable in overcoming the initial frustration. I haven’t yet had a good night’s sleep since starting CPAP which has been very discouraging, but I’m going to stick with it. At least my wife is sleeping better since the snoring has stopped!

[vsheline]

I also have noticed jumps in my respiration rate graph and have assumed that indicated different stages of sleep. However, my tidal volume and ventilation remained fairly constant during those periods, just as we see in the graphs that you posted.
...
When I zoom in on the flow rate graph I see that my inspirations during the higher resp rate are not uniform, and I suspect that the jagged form of each breath is being counted as two breaths:
...
I first noticed this phenomenon after I switched from the a nasal pillow to a nasal mask. I have only been on CPAP for 30 days and have my first follow-up appointment with the sleep specialist later this week. I will ask if those breathing patterns indicate any problems. It would be interesting if any of you veterans have any experience with this.

I haven’t yet had a good night’s sleep since starting CPAP which has been very discouraging, but I’m going to stick with it. At least my wife is sleeping better since the snoring has stopped!

Hi HeadWrench, welcome to the forum!!

A few basic questions:

What is your AHI (Apnea + Hypopnea Index) and the breakdown/categorization of your various events, like Obstructive Apnea Index (OAI) and Central Apnea Index (CAI)?

Personally, I would suspect your Flow waveform is showing partial obstruction or light snoring.

Does the S9 Elite report a time plot of Snore and/or FL (Flow Limitation) like it does for Flow? I think Snore and FL should be close to zero if the pressure is adequate.

If you print out and show your data to the sleep specialist, I suspect he would want to increase your pressure by 1 or 2 cmH2O and send you on your way with another followwup appointment in a month or two.

However, I think it would be best if you can get your doctor to change your prescription to specify an AutoSet machine for you. You already have the S9 humidifier which can be used with the S9 Autoset. (By the way, Supplier #2 on the Suppliers List has "gently used" S9 Autosets for about $500.)

If the doctor won't do that, I suggest you ask for a home titration, in which you would be supplied a data-capable auto-titrating (APAP) machine such as the S9 AutoSet for a week or as long as possible, to get a better idea of what pressure you need fairly quickly.

I think overnight sleep studies are good to properly diagnose any unusual issues, but after having done that recently, I think a home titration with an APAP mschine, covering many days, would give your sleep specialist (and you) much more information for determining your needed pressure than another expensive overnight titration study.

I hope you can get your treatment optimized and will soon be be feeling better.

Take care,
--- Vaughn

[DocWils]

There isn't much about the respiration rates posted that seem unusual - I would take them in to your sleep therapist to be sure, but most of this fits well within the norms for sleep, especially if you are relatively new to the mask. Respiration rates vary over the night according your state of arousal, and there isn't a major rate change here - if they don't tie into a OA incident, usually they don't have much significance beyond the normal workings of the sleep cycle. Sometimes a flow rate adjustment might be necessary, given this data, but again, never expect to have a constant respiration rate all night.

(I remember in med school when we studied this, the teacher said "this isn't rocket science, not this part". That was before sleep studies became a science area bonna fide, of course, but even then, early parts were focussed on the neurological side of sleep, and very little was on the physiological side of it, beyond gathering some basic data. Nowadays, the whole system is examined, but still, basic diagnosis of apnoea is pretty easy, and respiration rates are well understood. The big change over the last 40 years is that we didn't understand the significance of apnoea on long term health before, and had nothing we could really do about it - now we do, a lot better, and have the tools to combat it. Don't we live a blessed age, in some ways?)

[vsheline]

.
Many thanks for your comments, wilorg.

A question for HeadWrench:

In the unusual airflow diagram you posted the true breathing rate was around 4 breaths in 20 seconds, or around 12 breaths per minute. Was this during a time when the reported Breath Rate was around twice that much?

If yes, that would show that (in your case) the strongly non-monotonic aspect of the airflow during inhalation was indeed causing the BR to be misreported by the machine. This would not be a problem in itself. (I think the BR is reported for information only in the case of your machine and is not used in the treatment algorithm by your machine.)

The question in your case is whether your present pressure prescription is providing adequate treatment. Looks to me like it is not.

Good luck when you meet with the sleep specialist this week. You may need to be politely assertive in asking for a better machine or a home titration.

Take care,
--- Vaughn

[HeadWrench]

Thanks for your input Vaughn and Wilorg,

The unevenness of the inspiration seemed odd to me, so I’m glad it didn’t raise any serious flags amongst you. I’ll let you know what the doctor has to say.

The S9 Elite does record Flow Limitation and Snore. My snore index stays well below 0.05 for the night and my wife hasn’t reported any snoring. The FL occasionally shows some very brief spikes to 0.30 but generally events stay below 0.15. I didn’t see any apparent correlation between those periods of unusual airflow and FL, and interestingly those period are generally free of apnea events.
Leaks are well under control and AHI over the last 2 weeks has been below 5 with about 75% being Central and the rest a varying mix of Obstructive and Hypopnea.

From what I’ve been reading, the AutoSet machine seems to be the way to go for patients that want to be actively involved in their treatment. I’m sure an upgrade is in my future and hopefully the doctor will just swap it out for me. Otherwise I may have to do something on my own in the aftermarket. I’m glad to hear that home titration is an option, because my titration study last week didn’t go very well. It was such a sleepless night that I suspect the data will be insufficient to be valid. Anyway, I’m very much looking forward to meeting with the doctor on Friday – will let you know.

[Shastzi]

The only way I know of to check on your sleep levels without spending a ton of cash on a sleep study is to use a Zeo.

Its a little headband that reads your brainwave frequencies and logs it all to a chart for you.
Once you do that you can compare the Zeo chart for REM activity vs your Sleepyhead chart and see if the uneven breathing matches up with the time of night.

Cheers!

[HeadWrench]

Met with my sleep doctor this morning and she could not shed any new light on my unusual air flow patterns, nor did she think they were anything to be worried about.
However, she was concerned about the number of Central Apneas that were showing up, something that wasn’t there at my initial sleep study. So tonight I go for another sleep study to get titrated for VPAP ASV, and next week they’ll get me a new machine. I’ve got plenty of reading to do in the forum to get educated about this new technology. Let me know if any of you have any experiences with the ASV.
Thanks for the tip on Zeo - didn't know that existed.