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Is my breathing shallow ?
#31
RE: Is my breathing shallow ?
The respiratory pattern is very unusual. The only thing I can think of is possible PLM which might account for some of it. I'm glad you are going to be discussing this with the doctor because I'm really flummoxed. In the closeup image provided back on page 2, I count 36 breaths in a 1-minute period, and the pattern is something out of my experience, and probably anyone else on the forum. This really deserves professional attention:

[Image: sVmsOH6.png]
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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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#32
RE: Is my breathing shallow ?
Average BPM of 36 a minute puts a big load on your cardio system. It would get a lot higher when the events happen. High 20's is classed as respiratory failure and they look at ventilating. (said for effect, I don't think you need ventilating because it's ok when you are awake)
Just a referral isn't enough. Time to ring the sleep doc, drop off your SD card for review and ask for an urgent appointment. Or at the least be put on the cancellation list. Whatever it is, it needs to be looked at ASAP.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#33
RE: Is my breathing shallow ?
My problem is my sleep Dr is 250k away in Canberra.
I feel good in the day went for my half hour walk this morning -2 C had me going a bit faster then normal at 5.2km/h.
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#34
RE: Is my breathing shallow ?
First of all: I'm from germany ... so this might sound awkward or funny phrased at least - my active vocabulary in english is a lot smaller than my passive vocabulary. So, some things might get lost in translation .. maybe if someone understands what I'm trying to say can jump in and put it in proper words.

(07-06-2017, 02:37 PM)dwd1249 Wrote: When I woke my right nostril was completely blocked and left one stuffy . This is not unusual for me.

That would explain to me what we see in your "breathing pattern".
I would really advise you to see a doctor - a pulmonary specialist or an ENT might be in order too.

Next thing: to my believe it is the time to try a full-face-mask and start mouth-breathing. (This might be a huge bumper for you, if you trained hard in the past to not mouth-breath.)
I really do believe that what we are seeing are in fact obstructions. Obstructions caused by your stuffy nose - or the secretion "flowing" aroung in your nose. (in contrast to your airways collapsing)

Shortly after I went to bed last night I felt the need to use a handkerchief / clear my nose. .. thought of you and decided to wait a few more minutes. I'm using a FFM and I have "hay fever" or allergic rhinitis, so what your are describing is nothing new to me. (that's why I'm using a FFM) And please keep in mind that I was still awake during the following.

Here I was breathing just through my nose (at least mostly) - while stuffed / nose "filling up":
   

during the very short and rapid inhales I was "sniffing back snot" - what looks like "normal" breathing was in some parts pure mouth-breathing:
   

I have a different machine than yours and the resolution of the flow-curve is much lower than yours - but I would say: the pattern looks astonishingly equal. (considering the fact that I was still awake)


The fact that we don't see much mouth-breathing on your charts makes me wonder a little bit. I would assume you (still) get enough air.
the only problem is: your machine can't make anything out of it.
I would go even one step further and say: without the positive pressure your nose would block completely and you would start mouth-breathing.

The only problem I see here is: I'm not convinced that the machine delivers the right pressure for your obstructive sleep-apnea.
With a nasal mask you now have the problem that the machine is "seeing" 2 kinds of obstructions: the one from your stuffe nose / secretion and the "real" obstructions (collapsed airways) from your OSA - both overlapping.
If you do this "double inhale" thingy your breaths are really short and the machine cannot tell if there are flowlimitations or not - If the machine would know, that it is not looking on 2 inhales but one single really distorted one it would flag it as a bad flowlimitation / partial obstruction and raise the pressure. Hypopnea detection is mostly impossible, because the tidal-volume seen by the machine is not your "real" tidal volume - thus hypopneas can no longer be correctly flagged.

These machines have one task: keep your airways open with the air-pressure - thus fighting obstructions. But it should be mentioned that "normal operation behavior" includes one, in your case really important, assumption: obstructions here are meant to occur AFTER your nose - not IN your nose or in other words: collapsed airways NOT stuffed up airways. These machines are not meant to treat rhinitis / coryza / running nose. (although quite obvious they are to some degree capable of that^^)

If you have the chance to use a FFM - really give it a try and start mouth-breathing with it.

In the meantime I would give CPAP some considerations. Your overall pressure is pretty high - you somehow feel "refreshed" in the morning - so I would say: therapy is still working. If the pattern from the last nights is always the same, I would prognosticate that as follows: you go to bed with the lower pressure of 8 ... your nose starts to get blocked ... the machine raises the pressure (which somehow keeps the "secretion" out of the way) .. you still get enough air and not start to mouth-breath.
Maybe - just maybe - this blocking of the nose can be avoided or postponed if you start with a higher pressure?
As your machine cannot make out if you inhale or exhale or what is going on, it makes not much sense to put it on auto. - but I might be totally mistaken there. Maybe raising the pressure some more in the night really is helping and avoids mouth-breathing. - but than: why not just raise the pressure right from the start?

But that should only be really short-term until you get your nose under control^^ - Do something against that - if you want to stay on nasal masks.

In case you forget until here: GO, SEE A DOCTOR! (pulmonary specialist / ENT ... and your sleep-doc on top of that)

Just my 2 cents on what we saw.
Please keep in mind: I'm not a doctor nor a trained specialist ... just another patient who just looks a bit different on the data from the machines^^
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#35
RE: Is my breathing shallow ?
Thanks for your replies. I had no problem following your post. I never attempt a post as long as yours as my spelling is so bad that when spell check gives me options, sometimes the right one isn't there. Other times I have to Google it to make sure it's right.    
My sleep Dr said that I had narrow nasal passages and my old Resmart wasn't providing high enough pressure in apap for a person my size, so he put me on a fixed cpap of 14. When I got my Resmed  A10 December 3 2015 I started using apap. The Resmart machine had a fault and wouldn't boot up.
I'll try to post the report tomorrow.
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#36
RE: Is my breathing shallow ?
you didn't say much about your nose - or why it is, it is "stuffy".

In case you have something like allergic rhinitis or "hay fever" (I'm not sure if this translates correctly) what helps me a lot is "dymista" ... breathly checked and it seems it is available in australia as well .. in germany it should also be a "over the counter medicine" ... never checked as I get that prescribed.
It has some anithistamine and some cortisone (50 micrograms - so, not much) - keeps my nose "clean" thorugh the night and during the day it helps my eyes. (yes, my eyes^^ - "hay fever" thing)
I would not advise to use that on a daily basis without seeing a doctor and not more than twice a day.

(Once again: NOT a doctor - I don't know anything about medicine at all .. just a patient^^ AND: all this goes under the assumption that you have an allergic rhinitis .. or rhinitis / stuffy nose at all^^)

CPAP 14 looks like a good starting point to me (I'm not the guy you come running to and asking for therapy-optimization ... I'm the kind of guy you come running to with some weird looking data and asking for some clues to what it could be, that the machine has recorded there!)

EPR is not and probably never was helping you, as the machine couldn't figure out if you inhaled or exhaled ... so the pressure itself shouldn't be a problem. I would skip any ramp and start directly with that pressure - or choose a very short ramp of 5 minutes or so.
If you wake up feeling "air starved" or (really!) breathing rapidly increase the pressure a little bit (with the nasal mask you hovered around the top of 16 ... so maybe 14 might not be enough for you + that mask + your nose.)

If your nose gets stuffed up with secretion you should indeed breath more shallow. Which is nothing more than flow-speed (and to some degree tidal volume). If you breath in deep (or fast) the flowspeed increases - not so easy with a stuffed up nose - except you do that really fast: sniffing back snot - nose is "clear" once again (for the next few seconds / minutes).
If the pressure is too low that might build up - ending in mouth-breathing. ... so you need to find your sweet-spot. (or take a higher pressure from the start, if you tolerate that and have no problem itself with the pressure.)

OT: as english is not my first language and this is in fact some complicated topic, I try to put it in as many words as possible. If I make a translation mistake (or typo ... which happen a lot to me) or can't find the proper words, it should be easier to figure that out or understand it at all from the overall context.

BTW: I would appreciate it, if you could keep us updated on what actual medical proffesionals / doctors made out of this and advised in the end.
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#37
RE: Is my breathing shallow ?
I have tried a few sprays for my nose without much success. Those ones that you can only use for 3 days seem to clear it but I only use them when I am really stuffed up.
The stuffiness seems worst in winter.
I went back to the nasal pillows last night and cpap at 14. Results seem about the same .
The sleep study was done 15 Jan 13.
[Image: cugbtEAl.png]
[Image: saUrKAnl.png]

last night
[Image: YNOJIRhl.png]
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#38
RE: Is my breathing shallow ?
David,
After looking at your previous SH charts and the one from above, I think I'd recommend you turn the EPR back on to address your Flow Limits.  When you had it on, it looked like it eliminated, or greatly reduced, your Flow Limit and you Flow Rate pattern looked better as well.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
Apnea Helpful Tips

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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#39
RE: Is my breathing shallow ?
(07-07-2017, 04:08 PM)Crimson Nape Wrote: David,
After looking at your previous SH charts and the one from above, I think I'd recommend you turn the EPR back on to address your Flow Limits.  When you had it on, it looked like it eliminated, or greatly reduced, your Flow Limit and you Flow Rate pattern looked better as well.

What you're actually saying is perhaps he should be evaluated for bilevel therapy.  If indeed his respiration can be smoothed out by pressure support, a bilevel might be a solution.  The suggestion to turn off EPR was based on the erratic respiration such that the machine could not switch from IPAP to EPAP with any predictability, but if ENOUGH pressure support could indeed stabilize inspiration/expiration then there might be a significant benefit.  While the Autoset is limited to 3 cm EPR, I agree that experimenting with higher pressure support could be interesting.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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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#40
RE: Is my breathing shallow ?
Sleeprider, you are correct. I'm currently on a laptop and having difficulty seeing some of the charts. The best that I can tell is a maximum EPR of 2 was attempted. What happens if he was to try setting it to 3? If he has, then I just couldn't see it.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
Apnea Helpful Tips

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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