My Therapy Thread: [reports+updates]

[sheepless]

this is probably over simplified & maybe not the only factor, but think about it: having apnea are pauses in breathing so obviously respiration rate drops. in addition, if you're prone to ca, breathing may slow & become shallower for a bit preceding a flagged event. maybe it all adds to a noticable difference in respiration rate.

[Sleeprider]

We saw that there are unexplained long inspirations that look obstructive at the transition, but end in a full flow rate. I don't know the cause or appropriate response. The cyclical nature of it is interesting. In some ways it has the same clustered appearance we associate with positional apnea.

[MADAwake]

The "events" (whether official or user defined), consistently, everyday, gather at periods of reduced respiratory rate. This is cyclic! Last night's chart is a good example that shows the cycles and correlation.

Every night while asleep, when I'm breathing near & above my median rate I get little or no events or flags. Rate slowly goes down to a point when stuff starts happening. Then slowly goes up and no events or flags. Then slowly goes down and the cycles continue.

I continued looking into this...

I reviewed my sleep study report again (here) and it seems this interesting cyclic pattern happened during the study too (CPAP titration part). Also looked at all nights since I started CPAP and the cyclic resp rate pattern is consistently there. My conclusion thus far: the lower resp rates (& the clustered events) happen during REM sleep it seems. It would be interesting to hear other explanations from forum members.

Google returned this about REM sleep which I think basically says this pattern is normal; but again I'm new to all this and would love to hear from better educated members!

[sheepless]

what I read and what I think is my own experience, is that our respiration rate usually increases in rem.

I'm a little confused about whether it's the event pattern or fluctuations in respiration rate or the flow rate that's cyclic. rem could be described as cyclic, occurring in about 90 minute intervals. on the other hand, Sleeprider mentioned unexplained long inspirations (in the flow rate); it doesn't sound like that's what you're referring to but if those are cyclic at roughly 10 to 30+ second intervals, it could be periodic limb movement. however, it's my limited understanding that plm is less likely in rem because of the degree of paralysis we experience in deeper sleep. it's worth a closer look to rule it out.

scroll through your flow rate at a 10 minute view scale looking for a cyclic pattern. post a screenshot if you see anything that looks like that.

[MADAwake]

       

The only other semi-cyclical thing I noticed is the attached sudden single spike in flow. Is that me gasping for air?!

The general advice on the forum seems to be to try a VAuto or AutoSet and see what happens. That might end up being the thing I have to do. However, the cost is significant and I have no indication that it will help with whatever is happening to my breathing during what I'm assuming is REM sleep.

I can't be the only only having these events at (what I believe is) REM sleep, there must be others having more events at REM. Need to find their posts and the solutions they found.

[Sleeprider]

Those spikes are flow rate in mL/second. The result in higher tidal volume if the time of inspiration is equal or longer than the other breaths. I don't know if I'd define it as a gasp, it can also be a sigh or just a deeper longer breath. Flow is limited or variable throughout that segment with many very small breaths that don't stand out like the spike, but they are clearly present. It's possible those have a cumulative effect that the larger breath could be a recovery, but hard to know. I never knew someone using a CBAB before (profile).

[sheepless]

idk, it's not definitive by any measure but there may be indications of something like plm in that screenshot. interestingly enough, it's actually more visible in the exhales, 'spiking' in roughly 7 breath intervals or so. in my graphs, the darker spots below the 0 line (like you have) are moans/groans in complaint of the movement. your larger spikes with the arrows are likely just sighs, maybe recovery breaths following a series of flow limited or reduced breaths or movements. I can't say it's plm but it's suggestive enough to keep an eye out for more defined patterns like this and to keep it in the back of your mind if you have fragmented sleep, feel tired after getting your ahi down, see many events in these areas, have problems with flow limitations regardless of settings that should resolve them... to list the things that quickly come to mind.

[MADAwake]

Thank you for your input, guys. Well, it seems there's no alternative at this point to getting a machine that better identifies/deals with the FL. After that we'll see what happens with the other stuff. I know an AutoSet has a max of 3 for PS, and there's a probability 3 won't be enough. However, considering the cost, I'm hoping it will at least be a tool to identify the FL and hopefully show me that improvement is possible using PS, thus justifying the extra cost for a VAuto. What do you guys think? Is the AutoSet a suitable tool for identifying and debugging (but not necessarily completely solving) my sub-AHI problems?

I never knew someone using a CBAB before (profile).

Haha, nice catch. Fixed & thanks.

[Sleeprider]

Of course we have seen individuals that were unable to control flow limitation with the Autoset, that moved successfully to the Vauto. The Autoset measures relative flow limitation as well as any machine out there, but as you can see, there are limits to that capability, and you actually have to move into the flow rate to really identify what is going on. The Autoset can give 1 to 3 cm of pressure support, while the Vauto is not limited, and has additional tools for inspiratory time and sensitivity for trigger and cycle, that the Autoset can't offer.

[MADAwake]

Seeing that many buy a soft collar, I thought why not try it since the cost is so low; even if I wasn't advised by the forum to try it. So yesterday I bought the FUTURO Soft Cervical Collar from a local pharmacy and wore all night last night. The collar was comfortable for me, it held my neck straight & my chin up like when I'm standing up, I had it on not very tight but not loose that it won't do its intended job for apnea. The question is did it help with my sleep breathing? Let's see...

Here is the summary(+events) for last night...
   

1. I think I see a higher number (not %) of OA, H, VB events in this chart BUT they are more spread out than non-collar days, thoughts?
   
2. VB% @ 15% is the lowest since starting CBAB. I estimate my 3-week average to be around 21% or a bit more.
   
3. I notice A LOT more Vibratory Snores (VS2) than usual, I never had such a high number of them since starting CPAP 3 weeks ago.
   
4. Interestingly, I think I see that my custom flags are "slightly less dense" in the usual problem periods. Do you see what I mean?
   
5. My Tidal Volume was about 10% below my average, this is not unique to last night but is not common.
   

So does the forum see something in the collar chart vs the previous charts? Thoughts?