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Highest Periodic Breathing, Leaks and Apnea Ever!
#11
RE: Highest Periodic Breathing Percentages Ever!
The "Wow" was because of the number of flow limits visible in the zoomed view. Note the FL values in the statistics in the left sidebar, FL = 0, and no "FL" events in the event chart.. In the range of events, there is a continuum, Apnea, Hypopnea, and then Flow Limitations. Flow Limits are the lowest of all of these. Most doctors never look at them and many consider them unimportant.
They do represent restricted breathing, nothing more. Here we like to minimize this as much as possible. Flow Limits bother some people a lot, others not at all.

You do have a fair number of RERA events. By definition, a RERA, Respiratory Effort Related Arousal, is a series of Flow Limits followed by arousal. It's the arousal that is bad.

Talk to your doctor about your RERAs, The same treatment that will manage the RERAs will manage your Flow Limits.

Monitor your RDI vs AHI. RDI = AHI + RERAs
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#12
RE: Highest Periodic Breathing Percentages Ever!
Jennie, Bonjour is reassuring you that the zoom-ins you posted are not showing the kind of periodic breathing that might indicate a serious change in your health. You shouldn't be scared. You are just (!) having airway problems that can be solved with a different machine.

For what it's worth, on the recommendation of Bonjour and Sleeprider, I switched to a ResMed VAuto some months ago, and it has really made a difference to the quality of my sleep. I bought a lightly used machine from a private party.

Ideally your doctor would write you a prescription for one and you could get insurance coverage for it. My guess is that that is not going to happen without (at least) another sleep study -- and who knows when that would be possible.

If you can afford the $300, I do recommend that you see whether you can buy the machine Bonjour has pointed you toward. Check the run hours to make sure that it hasn't already been used for years.

Keep us posted, would you?
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#13
RE: Highest Periodic Breathing Percentages Ever!
I thank you for explaining things a little better to me, and though some of the terminology is still foreign at least I have a clearer explanantion as to why my sleep never improves even after over 10 years on CPAP therapy. When I do my telehealth visit tomorrow with my Sleep Doctor/Pulmonologist I will ask about getting a prescription for a new machine. In the past I did bring up to him whether I might benefit more from a bi-level machine and he never thought it was necessary. It's been many years of suffering with little to no quality of sleep and being tired day after day. I don't like donning that restrictive mask night after night as I'm sure most sleep apnea sufferers don't, but I would have hoped that all of my good efforts and compliance would have helped me by now.
Thanks so much for helping me understand my situation a little better and I hope my doctor sees that a change in my machine is necessary now.
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#14
RE: Highest Periodic Breathing Percentages Ever!
Failing bilevel (Resmed Aircurve 10 Vauto), get the auto CPAP, Resmed Aircurve 10 Autoset. Do not get another Philips machine! The Resmed CPAPs use "exhale pressure relief" (EPR) which is identical to bilevel pressure support, but limited to 3-cm pressure difference between inhale and exhale. I'd love for you to have the full benefit of a bilevel machine, but the difference of the Resmed Airsense 10 Autoset CPAP, which should be easy to get, will be transformative compared to your current machine.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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: Highest Periodic Breathing Percentages Ever!
Thanks for the suggestions as to which machine can better serve my needs and help me get better sleep for my sleep apnea. In your opinion the Bilevel would best serve my needs over an auto CPAP? I will definitely approach these topics during my telehealth visit today with my Pulmonologist/sleep doctor and hopefully get approval since it has been over 5 years since I've had a new machine. Even if my insurance will not cover it I would be happy to pay out of pocket but then would I have to have my doctor set the pressure on the new machine for me? With everything being done remotely and by virtual visits I'm not sure how that would work. All I know is that my tired body craves a halfway decent sleep and reassurance that I'm not causing my current health conditions to worsen because my sleep therapy is not helping me as it should. 
Should I be asking anything else when I speak with him (this will be a video telehealth appt.) that is of concern? One other question that I should have brought to your attention is that I do take a 0.5mg Alprazalom (Xanax) tablet at bedtime every night. My primary doctor had prescribed this some years ago because I have such difficulty falling asleep and staying asleep. I have in no way abused the medication and take it only at bedtime. If not for this medication I would just lay awake most of the night and get little to no sleep.  So my question is could using the Xanax have any impact on the uneven respiration and airway restriction that were showing up in my flow charts?  I'm sure it does slow my heart rate but would it also slow my respiration to the point where I'm struggling more and more to inhale and exhale during sleep?  This has concerned me in the past and I've tried on a few occasions to wean myself off the Xanax but then I find I get no sleep whatsoever.  
Whatever light you can shed on this subject would help me a lot so I can try to look for other solutions to help me fall asleep. It was suggested that CBD oil may help but I have not tried that yet even though I have a bottle at home. My daughter suggests 20mg. I am hesitant though with my regular maintenance meds, Spiriva inhaler and allergy meds to add another supplement or drug.
Any help would be appreciated. Thanks.
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#16
RE: Highest Periodic Breathing Percentages Ever!
For your telehealth appointment, you need to be honest in your appraisal of how you feel (unrested, fatigued, uncomfortable) and point to your fairly high levels of obstructive apnea, hypopnea and RERA that are being flagged on your CPAP. You can discuss your concern with the periodic breathing, and tell your doctor that on closer examination, it appeared like a series of flow-limited breathing, interspersed with arousals and recovery breathing. You should consider printing a copy of the close-up graph to illustrate your point.

Let your doctor know you are still using an older System One fixed CPAP, and that you think you would benefit from the use of a new auto CPAP. Tell him your preference for a Resmed Airsense 10 Autoset For Her with humidifier and heated tube, because you have heard it is a better machine for women with flow limitations. The Autoset will let you try a range of pressure, so it could be set for a minimum pressure of 10 and maximum pressure of 15 with EPR at 3. This will allow you to work with your doctor to find a more effective and comfortable therapy. Using the Auto CPAP will allow your therapy to be monitored remotely, and your doctor can better advise of any changes you should make without requiring a clinical sleep study. You do not want a sleep study when a newer machine will let you see your results at home. Note the Resmed Airsense 10 Autoset For Her is a CPAP class machine and will be approved by insurance as a replacement. All you need is the prescription. Ask for this script to replace your old machine with this modern auto CPAP during your appointment.

A really significant part of your therapy problem is the use of ramp starting at 4.0. Look at all the events that are happening before your machine reaches therapy pressure. You need to discuss increasing the minimum ramp pressure or turning off ramp. You need to make your pulmonologist aware of your Xanex prescription. It can increase the effects of COPD and airway restriction, and may be a cause of the periodic breathing you observed, so it is relevant to your therapy. Your continued use of this medication may need to be a discussion between the pulmonologist and your doctor.

[Image: attachment.php?aid=22229]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#17
RE: Highest Periodic Breathing Percentages Ever!
A quick addition. Your supplier can set the Resmed Airsense 10 Autoset for her remotely or prior to delivery. You can easily make changes yourself. Here is how https://www.apneaboard.com/resmed-airsen...setup-info

Here is a brochure on the Airsense 10 Autoset For Her. Read it so you are aware of what this machine offers. That will let you talk to your doctor without saying "I heard on a forum". https://www.resmed.com/us/en/healthcare-...r-her.html
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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: Highest Periodic Breathing Percentages Ever!
   

   

   

I thought I'd add a couple of zoomed charts from last night for comparison with April 22nd's charts. These are also 2 and 5 minute zoomed areas from the Flow Rate. Is there any difference or much of the same problems?
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#19
RE: Highest Periodic Breathing Percentages Ever!
Jen, there is some clustering of the obstructive apnea and some of the very flow-limited breathing appears like positional apnea that we have seen effectively treated by using a soft cervical collar.  The problem is caused by chin-tucking which causes a restriction in the airway by compressing the tissues in the throat.  Read the wiki and take a look at some of the example charts
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar 

In this example from above we see that the inspratory flow is very limited and expiratory flow is very rapid and high volume. That could be seen better by limiting the time of the screenshot to 2 minutes which wold really define that wave-form. What we see is arousal/recovery-breathing at 06:29, 06:23 and following each apnea.  In fact we can see you don't fully stop breathing during the apnea, but that airflow becomes so restricted that barely anything is moving.  This is pretty typical for positional apnea.  As you tuck your chn, the soft tissues under the jaw are pressed upward causing a restriction or collapse during inspiration. It takes very little pressure to make this happen and the negative pressure of the airway during inspiration increases the restriction. You can simulate the chin tuck by pressing lightly upward on the tissues at the back of the lower jaw. Relatively light pressure on this tissue creates an increasing flow limitation ultimately resulting in a series of apneas. Another way is to sit in a comfortable chair and relax letting your head tllt forward. You will likely feel more airway restriction. The series of apneas causes an arousal that either corrects the airway and/or causes mouth breathing.


[Image: attachment.php?aid=22281]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#20
RE: Highest Periodic Breathing Percentages Ever!
Thanks for taking a look at this data from last night. I was told on several occasions on this forum that I did have a problem with chin tucking and I did purchase a soft cervical collar. I found it uncomfortable to wear with my mask so I did not wear it much at all. 
I did have my video telehealth visit with my Pulmonologist a short while ago and had all of the information that this site suggested to me at my fingertips to go over with him.  He didn't seem interested in anything other than asking me over and over how my breathing was.   He had access to my CPAP data through the modem but the only thing he kept focusing on was the leaks and so he will be getting me set up with a new mask. He never went over any of the other data from my machine that I feel should have been addressed. I felt rushed and a little put off that he did not even ask about my vitals, like BP, temperature, pulse or O2 levels. So all in all I feel like I came away with more questions than answers. His only real advice to me was to stay home during this Covid 19 crisis. 
I appreciate all of the help and advice you all have given me and I know this site is where I will continue to go to get help when I have concerns.
Thanks again and be safe.
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