Is this real Cheyne Stokes Respiration or not ?

[jsljsljsl]

What effects might I be feeling from it ? Would it affect breathing during the day ?

[jsljsljsl]

It is consistent since beginning therapy in April. Could it be related to movement in bed by a child or SO interrupting my sleep ? Also, so likely since this is consistent, I could assume my respiration rates are false high more in the range of 20 or so if you look at the drops to -60 ?

[Sleeprider]

Let me be clear about what these graphs show:

This is classic flow limitation and would be best treated with pressure support from bilevel or at least using your EPR at 3. Based on this chart alone, I would recommend a pressure of 10/7, or 10 with EPR at 3.  We would watch for more emergence of CA as a result of the pressure suport.





This next 3 images show irregular breathing that is counted by the PAP unit as over 50 breaths per minute. It appears flow limited and may be affected by PLM or other significant, rhythmical movement.  The pulses have a very regular interval and looks spastic.  If this was a regular feature of your respiration through the night, I would want to identify the cause by using video or a recording oximeter to measure pulse and oxygenation.  This problem has been encountered by individuals with central apnea problems and has been resolved with ASV (see my previous reference to Hojo).  Note, these are REAL respiration pulses as shown by the mask pressure. This is not just a heartbeat but is a rapid, incomplete inhale and exhale.  There is an interval of 19 breaths per minute, but why it is punctuated by these puffs is really unusual.  It might respond to pressure support/EPR, but this specifically would be better treated with a true bilevel where the minimum time of inspiration (IPAP) can be set to ensure pressure support continues long enough to cause a proper breath.   This is something to discuss with your doctor. The flow rate is not lying, this is how you are breathing.

[jsljsljsl]

Adjusted the settings and seems to have resolved the respiration issue for now. My only concern is it flagging Cheyne Stokes again at the end which I am hoping is sleep-wake junk. Could you take a look at the screenshots and let me know your thoughts.

Thanks again !

[Gideon]

Certainly at least some of that is SWJ. It is definitely not CSR.

[Sleeprider]

We may be seeing expiratory snores. If so, this is airway instability as you approach the low EPAP pressure of 4.0. Even though it is not causing apnea, I would move minimum pressure to 7.0.

[jsljsljsl]

Now moving forward, I guess my immediate goal would be to see if I can eliminate more of the CAs throughout the night. If I took the last hour or so of SWJ out my numbers for the night would be about 1.7. There aren't that many CAs throughout the night but maybe look at my settings to see if I can do anything else ?

[jaswilliams]

Now moving forward, I guess my immediate goal would be to see if I can eliminate more of the CAs throughout the night. If I took the last hour or so of SWJ out my numbers for the night would be about 1.7. There aren't that many CAs throughout the night but maybe look at my settings to see if I can do anything else ?

Reducing your EPR To 2 may reduce your CA’s but you won’t know until you try

[jsljsljsl]

Followed your suggestion and even though it is just one night the CA number came down to a 0.9 and the total AHI at 1.5 with minimum pressure raised to 7.0. Respiratory rates came down as well.

Will try for a few nights and report back.

Any other suggestions ?

Thanks again.

[jaswilliams]

Followed your suggestion and even though it is just one night the CA number came down to a 0.9 and the total AHI at 1.5 with minimum pressure raised to 7.0. Respiratory rates came down as well.

Will try for a few nights and report back.

Any other suggestions ?

Thanks again.

Let your numbers settle for a few nights as CA’s can be inconsistent