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My 12 year old daughter just started cpap now I can't work Sleepyhead
#11
RE: My 12 year old daughter just started cpap now I can't work Sleepyhead
Exactly what I suspected with regard to flow limitation. It may or may not be important, but save the image to discuss with your pediatrician or sleep specialist. This suggests an upper airway flow restriction is in play that limits the flow rate during inspiration. A greater difference between inhale and exhale pressure can help normalize this, or it may be a transient issue we don't need to worry about. I saw a couple episodes of this, and it is typical of upper airway restriction syndrome (UARS). There is a good article in our wiki http://www.apneaboard.com/wiki/index.php..._and_BiPAP

I am not suggesting any changes based on this, but if you see this rapidly increasing pressure often, that is what it is, and she will do better with EPR at 3 instead of 2. I really enjoyed ColoradoMom's reply earlier in the thread. Lucy is doing a great job of adapting to this new and strange experience.
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#12
RE: My 12 year old daughter just started cpap now I can't work Sleepyhead
I've been reading about flow rate today and trying to understand what flow limitation looks like. Looking close up at my daughters data from last night I see that every 5 to 15 minutes she has these flat lines in the flow rate graph. Is that part of flow limitation? The majority of them aren't being flagged as apneas.


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#13
RE: My 12 year old daughter just started cpap now I can't work Sleepyhead
In addition to the flat lines, I am also curious about these graphs. One of the pictures looks more even, then she has one of those flat lines, then the spikes get more tight and stay like that for a half hour. Which flow rate graph is preferable? 

Thank you so much for everyone helping me figure this out!


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#14
RE: My 12 year old daughter just started cpap now I can't work Sleepyhead
I would ask the doctor to arrange for the little girl to be titrated on the machine. I don't think the pressure are set up properly for her, because the max is being reached and there is still disordered breathing at the time.

If the cost is too much. I would raise the max to give the machine more room to move.
To improve the areas you are concerned about. I would increase the min pressure by 1cm at a time and review. Increasing the min pressure, makes a stronger air splint to hold the throat open.

Understanding Sleep Disordered Breathing
https://www.youtube.com/watch?v=-gie2dhqP2c
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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#15
RE: My 12 year old daughter just started cpap now I can't work Sleepyhead
(02-25-2019, 01:29 AM)LucysMom Wrote: In addition to the flat lines, I am also curious about these graphs. One of the pictures looks more even, then she has one of those flat lines, then the spikes get more tight and stay like that for a half hour. Which flow rate graph is preferable? 

Thank you so much for everyone helping me figure this out!
The first is flow limitation the second is a transition from flow limited breathing then holding her breath while she likely changed position followed by awake breathing.
The following is a good reference for  normal and other mostly forms of flow limited breathing.

http://www.apneaboard.com/wiki/index.php...148d1f.jpg
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#16
RE: My 12 year old daughter just started cpap now I can't work Sleepyhead
In your graphs for 2/23 there were two very different sessions posted. One looked like a nap of about 43 minutes at mid-day, and the other was a longer sleep session from 2 AM to 8:25 AM. The nap was extremely disrupted with very high respiration rates. The pattern suggests hyperventilation with a minute vent of 10 L/min on small shallow breaths with a tidal volume of 260 mL. I don't know what caused this shallow, rapid breathing, but keep an eye on it, and bring it to the doctor's attention if it repeats with any consistency. The longer 6:23 session was far more normal with more typical respiration rate, and respiratory volumes. Flow limit is a flattening of the inspiratory peaks, and there is minor flow limitation in the images you posted, that does not appear to be a cause for concern. There are many reasons for the flow rate to appear irregular and to flatten out near the zero line like apnea as in the image below.

I'm surprised this was not flagged as a hypopnea or apnea, but the 10-second criteria for flagging apnea is interrupted by a fairly large flow-limited breath before the next short break, then respiration continues at 20 BPM. In my experience, you will drive yourself nuts if you try to pick apart these flow rate charts. Breathing is not always a pretty regular pattern, and the irregularities are not often an induction of a serious problem. We want to look for patterns of abnormality that have consequences on the respiratory rate and volumes. That is a kind of cold way of saying, don't worry about it unless it is a common feature of the therapy. In this case, there is no evidence of stress (recovery breathing), and this is just a normal break in the otherwise rhythmical breathing of sleep.

[Image: attachment.php?aid=10446]
Sleeprider
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www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Attaching Files

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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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