In anticipation of my BIPAP Re: New Thread

[Plmnb]

I have read all your replies just now. I am out at for a couple of hours and will try to digest all comments when I get home. Especially interested in matching times mentioned by ApneaQuestions with video.

Slowriter, I need to research the Easybreathe and what it’s all about, then maybe I’ll have an answer on that.

I wonder how often a person with out sleep apnea tosses and turns? I feel like I do it a lot by looking at the video. You are correct though, nothing stands out in the video as to why my breathing is as it is.

One thing I want to ask you all about, and we might have covered this, but the AirLift guy mentioned I might have UARS? I have read some of the literature and had discounted it as being one of my issues.

Back later.

Regards,
Plmnb

[slowriter]

One thing I want to ask you all about, and we might have covered this, but the AirLift guy mentioned I might have UARS?  I have read some of the literature and had discounted it as being one of my issues.

Why did he say that?

In my sleep study, the thing that identified UARS was a lot of RERAs. I don't see that in your study, though not sure if that means anything (possible I'm misreading it or something).

On Easybreathe, you can see its impact on your mask pressure graphs. With it off, the pressure is a square wave. With it on, it tries to mimic natural breathing.

[ApneaQuestions]

Unless I was trying to convince an insurance company to pay up, I wouldn't worry too much about the specific definitions of UARS and the criteria for inclusion or exclusion of a diagnosis.

There are several arbitrary thresholds used in sleep medicine to categorize people and phenomena.  Thresholds also exist in many other parts of medicine.   

I see many phenomena as existing on a continuous spectrum of severity.  However, to provide common vocabulary and to simplify understanding, thresholds are often introduced.

The problems arise when these arbitrary thresholds are used to determine if the patient will or will not receive care and treatment and if an insurance company will or will not pay up.
In such cases, shades of grey are turned (artificially) into black or white thinking.

As I've said before (in your other thread I think)... If you stop breathing for 9.99 seconds... you did not have an apnea... but if you stop breathing for 10.01 seconds.. you did!
I believe that both situations are simply subtle shades of grey on the "I stopped breathing spectrum" and it is not particularly helpful to treat them as different black or white cases.

There are lots of other arbitrary thresholds used to carve up the population. 
1) small, medium, large. XL. XXL
2) under weight, normal weight, overweight, obese
3) normal, pre-diabetic, diabetic
4) hypotensive, normal, hypertensive
5) mallampati class I, II, III, IV
6) Hurricane class 1,2,3,4,5
7) Earthquake Richter scale.
8) there are many more.

Some of these delineations are more useful than others because they give an indication of relative severity...
but I try to avoid turning values on a continuous spectrum into black-or-white, yes/no, healthy/unhealthy thinking.

[Plmnb]

What was going on between 00:20 and 01:20 ?  It looks like you had the machine turned off.  
Were you wide awake for an hour or did you take the mask off for some reason and sleep for an hour?

Hey ApneaQuestions, going to work my way through all the replies, eventually.  I will start with your reply.  This time line is longer than what you mentioned, but I got caught up in the detective work.
I have reviewed the video clips and I found that 12:20-12:22 I had the mask on and appear to be asleep.  However, in the clip that starts at 12:52, the next clip's time stamp, I am awake, no mask on.  I am with out my mask from 12:52 clip to the 1:27 clip, at which point I have the mask back on and am laying down.
I still have the mask on and appear to be asleep in the clip that starts at 2:50, except near the end of the clip I remove my mask.  I don't see my mask being on again until approximately 3:01 and 3:02 because something is blocking the distance view of the camera.  It appears that I put the collar on to see if it would help.  By 3:05 I was sitting up again fiddling with the machine and then back to sleep.
I did notice in the clip of 3:25 that I was breathing so deep(?) that it was noticeable in the clip.  
I awake around 4:18 and have removed my collar by the time the 4:23 clip starts. 
Don't know what any of this has to do with last night's charts, but maybe it helps you help me?
Gonna take a break, not sure I'll get back to apnea biz again tonight.  Unless I have questions on the settings.  I'm going back to Vauto and trying to get all the settings correct.  The RT messed them up a bit.
Sincerely,
Plmnb

[Plmnb]

 Good morning!

Before I post last nights charts, I want to wrap my head around CA (Clear Airway Events).  Why?  Because last night I had a heck of a-lot of them.  Usually, as best as I can determine from looking at all my previous charts, I have maybe one, if even that.  Last night I had 23 CA Events!  

At first I thought maybe this had to do with trying to sleep more upright as suggested by a fellow member.  But, in reviewing my video clips I removed the pillow that was allowing me to do this, and I still had them.

The other things I did were to go back to CPAP mode from BIPAP mode.  I also had increased my Max IPAP, which I think I did wrong, should have increased my MIN EPAP instead?  Anyway, for what it is worth, I had the Max IPAP set at 25 and the Min EPAP at 14.  Lastly, I had the PS set at 7.  Do you think the reason for the huge increase in CA due to the Max IPAP setting?

What say you all?  I'll post charts shortly, just thought I'd get a start on my questions first.

Regards,
Plmnb

[Plmnb]

Here is just the overview.  The zooms to follow.  The AHI is pretty much as high as I have had, there may be one or two around that or higher.  I'd have to look through my old charts more carefully to find them.


[attachment=18877]

Plmnb

[slowriter]

 Good morning!

Before I post last nights charts, I want to wrap my head around CA (Clear Airway Events).  Why?  Because last night I had a heck of a-lot of them.  Usually, as best as I can determine from looking at all my previous charts, I have maybe one, if even that.  Last night I had 23 CA Events!  

At first I thought maybe this had to do with trying to sleep more upright as suggested by a fellow member.  But, in reviewing my video clips I removed the pillow that was allowing me to do this, and I still had them.

The other things I did were to go back to CPAP mode from BIPAP mode.  I also had increased my Max IPAP, which I think I did wrong, should have increased my MIN EPAP instead?  Anyway, for what it is worth, I had the Max IPAP set at 25 and the Min EPAP at 14.  Lastly, I had the PS set at 7.  Do you think the reason for the huge increase in CA due to the Max IPAP setting?

No, was because of the PS setting.

Remember when we said CAs can be a side effect of increased PS? At a certain point that was likely to happen, which basically tells us to you want to back off on the PS (maybe to 6.4?); that 7 is too high.

What's going on? Basically, the more efficient ventilation is confusing your body and brain.

There is no reason to change modes.

[Plmnb]

And here are my zooms.  It appears that in this "BAD" wave zoom, that some of my breath shapes are rounded at the tops? And in the second chart, these are good wave breath shapes, or at least better?

[attachment=18879]  
[attachment=18880]


But why are my wave shapes "bad" again in this view when it does not appear that I am having events or anything?

[attachment=18881]

Wrapping my head around all the data.

Plmnb

[Plmnb]

 Good morning!

Before I post last nights charts, I want to wrap my head around CA (Clear Airway Events).  Why?  Because last night I had a heck of a-lot of them.  Usually, as best as I can determine from looking at all my previous charts, I have maybe one, if even that.  Last night I had 23 CA Events!  

At first I thought maybe this had to do with trying to sleep more upright as suggested by a fellow member.  But, in reviewing my video clips I removed the pillow that was allowing me to do this, and I still had them.

The other things I did were to go back to CPAP mode from BIPAP mode.  I also had increased my Max IPAP, which I think I did wrong, should have increased my MIN EPAP instead?  Anyway, for what it is worth, I had the Max IPAP set at 25 and the Min EPAP at 14.  Lastly, I had the PS set at 7.  Do you think the reason for the huge increase in CA due to the Max IPAP setting?

No, was because of the PS setting.

Remember when we said CAs can be a side effect of increased PS? At a certain point that was likely to happen, which basically tells us to you want to back off on the PS (maybe to 6.4?); that 7 is too high.

What's going on? Basically, the more efficient ventilation is confusing your body and brain.

There is no reason to change modes.

Morning Slowriter!

Ahhh, the PS setting.  Ok, I'll reduce it tonight.  When you say "There is no reason to change modes", do you mean go ahead and stay on CPAP again?  Or do you mean I should go back to BIPAP?

I was going to try the newer BIPAP settings tonight that Sleeprider suggested?

Plmnb

[ApneaQuestions]

These are some of the best waveforms we've seen for you... but it came with a cost.

However, as slowriter said, the PS of 7 is a little too high for you. Going back to the ping pong analogy... the bat is too big.
Ping-pong: https://photos.app.goo.gl/gZibMihu9xr9GAB67

To see the PS visually, look at the gap between the red line and the green line on the pressure chart.
To see it explicitly, look at the number 7.0 on the left side of the chart under "machine settings"

The reason that a high pressure support can cause treatment emergent CAs is as follows...
Your breathing becomes more efficient. In other words, you are taking big breaths in and big breaths out.
That means that you get lots of O2 (oxygen) into your body and you get rid of lots of CO2 (carbon dioxide).
However, if you get rid of too much carbon dioxide... the brain doesn't think there is any reason to breathe and you stop breathing.
That's basically what a treatment-emergent CA is. You stop breathing because your brain doesn't see much CO2 and it's CO2 that triggers the breathing response.

If we can keep your waveforms looking like these but get rid of the CAs... we will have finally turned the corner for you.

Tonight, it will be important to get the settings right and then run for three or four nights to see how consistent we can get the improvements.