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Oh What Fresh HE-double-hockey-sticks is this?!
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quiescence at last Offline

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Post: #1
Oh What Fresh HE-double-hockey-sticks is this?!
just minding my own business and all of the sudden I'm breathing like this!

Oh, and no - I didn't suck the cat up into the intake.

[Image: Bq7HGWU.png]

whole nite (so far):

[Image: jRsLdTw.png]

If anyone asks - I was having nightmarish dreaming.

By the way - this is the second night in a row where this happened sometime during the night.

Anyone got ideas as to what caused this?

Previous night:
[Image: ntfdh0S.png]
[Image: ITBHv9u.png]


QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
(This post was last modified: 02-25-2015 12:09 PM by quiescence at last.)
02-25-2015 06:06 AM
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Sleeprider Online
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Post: #2
RE: Oh What Fresh HE-double-hockey-sticks is this?!
QAL, nothing serious, but a disruptive series of hypopneas. I'm a little puzzled that your setting are 13.5/6,0 and the machine is topping out at 9.0, and staying at minimum pressure through the event cluster. I could post similar wave forms from my own data, but I haven't had periodic breathing for while (it is NOT CSB).

Double check your settings, raise minimum pressure by 1.0 and see if that eliminates this. Hypopnea normally responds to a better support pressure, and based on the expiration wave form, I'd say you're not exhaling well. What is your A-flex set at?

On your images, Please include the Event chart, flow rate, pressure and leak. The rest we don't need so much. Some of the attachments don't enlarge to a readable size. This works better: https://sleep.tnet.com/reference/tips/imgur

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02-25-2015 10:20 AM
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retired_guy Offline

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Post: #3
RE: Oh What Fresh HE-double-hockey-sticks is this?!
Attempts to control/eliminate possible aerophagia are best and most successful when using alternative methods rather than tying one's air hose in a knot.
02-25-2015 11:22 AM
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quiescence at last Offline

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Machine: REMstar System One with Autoflex
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CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

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Post: #4
RE: Oh What Fresh HE-double-hockey-sticks is this?!
@RG - haha. good point.

Also - I was not really that clear on what surprised me -

My concern is this (first) chart shows my wave form being transposed as if my exhales were above the zero line, so if accurate I did a series of inhale only wobbles with no exhale at all.?!

This is not characteristic of my normal breathing which always shows an exhale for every inhale. Normally, though exhales are longer than inhales, the area under the curve of exhale equals spikier area under the inhales.

FYI. I changed my pressure support to 0 about 40 days ago. So, I have an auto-titrating CPAP. This would be equivalent to a RedMed device set on EPR = 0.

I was mildly interested that sometimes I have erratic breathing that gets no scoring at all, and other times, like this that have scoring that seems close enough to trigger a pressure change, but my PRS1 at the current settings did not change the pressure.

Thanks for any additional observations.

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
02-25-2015 12:29 PM
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PaulaO2 Offline
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Post: #5
RE: Oh What Fresh HE-double-hockey-sticks is this?!
I can't click on any of the images to see them larger so I am assuming the first image is a closeup of the time span on the far right of the second image? Hyperventilating would result in those shapes I'm guessing. Too much inhale and not enough exhale. Which would lead to hypopneas perhaps, especially if dreaming.

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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.
02-25-2015 12:49 PM
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retired_guy Offline

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Post: #6
RE: Oh What Fresh HE-double-hockey-sticks is this?!
(02-25-2015 12:29 PM)quiescence at last Wrote:  FYI. I changed my pressure support to 0 about 40 days ago. So, I have an auto-titrating CPAP. This would be equivalent to a RedMed device set on EPR = 0.

(02-25-2015 12:49 PM)PaulaO2 Wrote:  Hyperventilating would result in those shapes I'm guessing. Too much inhale and not enough exhale. Which would lead to hypopneas perhaps, especially if dreaming.

Ergo, perhaps last night you needed a bit of pressure support?

Next time take the cork off the bottle before you swig the wine.
02-25-2015 12:57 PM
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justMongo Offline

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Post: #7
RE: Oh What Fresh HE-double-hockey-sticks is this?!
(02-25-2015 12:29 PM)quiescence at last Wrote:  My concern is this (first) chart shows my wave form being transposed as if my exhales were above the zero line, so if accurate I did a series of inhale only wobbles with no exhale at all.?!

Which trace are you looking at when you make that conclusion?
I'm looking at flow; and it's above and below the line.
(Are you looking at Insp Time? If so, you are drawing an incorrect inference.)

As Paula said, you seem to take a big breathe, then those that follow are lower amplitude. A hypoapnea can be scored when the flow reduces in amplitude.

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.
(This post was last modified: 02-25-2015 01:06 PM by justMongo.)
02-25-2015 01:04 PM
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quiescence at last Offline

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Posts: 753
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Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
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CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

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Post: #8
RE: Oh What Fresh HE-double-hockey-sticks is this?!
(02-25-2015 01:04 PM)justMongo Wrote:  
(02-25-2015 12:29 PM)quiescence at last Wrote:  My concern is this (first) chart shows my wave form being transposed as if my exhales were above the zero line, so if accurate I did a series of inhale only wobbles with no exhale at all.?!

Which trace are you looking at when you make that conclusion?
I'm looking at flow; and it's above and below the line.
(Are you looking at Insp Time? If so, you are drawing an incorrect inference.)

As Paula said, you seem to take a big breathe, then those that follow are lower amplitude. A hypoapnea can be scored when the flow reduces in amplitude.

Thanks. I am looking at the top "flow rate" line, and there are fluctuations that occur that exist entirely above the zero flow rate line.

I took 6 or 7 real inhale and exhale, then the 8th thru 10th breaths all look like breaths but the lowest they go is only almost to the zero line. After a short break of either zero or constant low inhale, I repeated the pattern.

That was really weird, not like my many hundreds of hours of breathing.

@PaulaO2 - try this link -> http://i.imgur.com/Bq7HGWU.png

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
02-25-2015 01:38 PM
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archangle Offline
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Post: #9
RE: Oh What Fresh HE-double-hockey-sticks is this?!
(02-25-2015 06:06 AM)quiescence at last Wrote:  just minding my own business and all of the sudden I'm breathing like this!

Note that you're "inhaling without exhaling." Those bump ups of the bottom of the flow rate waveform are probably leaks. Probably periodic mask farts.

Go back to chart # 1 and slide back in time to show both sides of where the weirdness starts. I suspect you'll find that the leak rate jumps up when this stuff starts.

Also, change the scale for tidal volume and minute vent such that the top of the waveform is not clipped.

Gee, I just realized that it looks like PRS1 machines only update the leak rate info about once every two minutes. Makes it hard to see short term variations in mask leak like this.

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02-25-2015 03:11 PM
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dottore Offline

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Post: #10
RE: Oh What Fresh HE-double-hockey-sticks is this?!
what a timely thread. I am getting very similar conditions. I'm gonna call it period breathingic since it seems to meet that definition. Note that I also record audio so I can often infer if I'm waking up, moving or vocalizing (mumbling in my sleep or grunting). I sync the audio with the cpap recording and I can usually match the events with some movement or noise, which gives me a clue as to whether or not I'm in quiescent sleep, or just falling to sleep. Not as good as EKG, of course, but its what I have.

Here's what I've found so far:
1) The episodes of PB are strongly correlated with falling to sleep. I will usually get one of these episodes when I am falling back to sleep. The duration and amplitude will vary.

2) there have been some episodes that I can't correlate with any audio event. They just seem to start on their own, usually with a sharp intake of breath that comes out of no where though the breathing pattern up to that point has been steady and normal. I do notice that some of the sharp intakes are preceded by movement and/or vocalization, as evidenced by the audio recording, which might indicate that I'm waking up before the periodic breathing starts, or at least moving to a lighter stage of sleep.

3) When I look at the periods of uneventful sleep (i.e. when there are no obvious variations in breathing, pulse, O2, no events detected, and the audio has nothing of interest), I often have some oscillation in my breath. That is, the amplitude of the flow plot will vary by 10% or so with a period similar to the plot below.

4) pressure does not seem to affect it. I have had periods of perfect sleep of up to 4 hours with none of these events at pressures from 8-10, and I have had nights where the machine was set to CPAP mode at a pressure of 8.5 or 9, and I get them. I set the ramp start to 4cm, and I got them all during the ramp.

5) I have been using CFLEX (AFLEX drives me crazy as it feels like it's pushing air down my throat) and have tried settings of 1, 2 and 3 with no difference.

6) It varies from night to night. I don't have enough data yet to correlate it with anything, such as how tired I am, but some nights I see events only at the beginning of the evening and after I've gotten up to pee. Other nights I see events thru the night. I am aware that on the nights with fewer events I sleep more continuously than on nights with more events, but I'm not sure which is the cause and which is the effect.

I think this breathing pattern has nothing to do with my obstructive apnea or my CPAP. I have long experienced the following, since way before I was an adult:

I feel my self falling asleep, then suddenly I startle awake. Sometimes I just feel like an electric jolt has woken me. Sometimes I feel like I'm falling backwards. Sometimes I feel like I'm drowning and desperately need air. In the last few years it's mainly been the jolt.

Since my teen years I have had trouble falling to sleep. I have felt exhausted and start to sleep, but wake up as described above. I think I finally have an explanation. I don't know what causes it, but when I'm falling asleep I do the PB thing.

I've read some explanations of PB. one is that hyperventilation causes it. Another is that the brain "forgets" to breath. Another is that it is more likely to occur in REM sleep. And, no, I have had no stroke or heart trouble and I am a very healthy 67 year old.

As a sound tech, I see beat frequencies. If my wake breath circuit and my sleep breath circuit had slightly different frequencies, then this is exactly what I would see if they were both running while I fell asleep, i.e. a beat frequency equal to the difference between the two frequencies. (I have no idea if there even are two circuits).

Anyway, I gather that this is fairly common and was happy to see this thread. I hope my experience helps someone.

If anyone has suggestions of how to reduce it, I'm open to them. I am planning on trying more pressure settings and taking more data over time.

Also, I would love to have a home device that can record sleep states. I hate the idea of going to a sleep lab. Anybody know of one?

[Image: uXu0pmEl.png]

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(This post was last modified: 02-26-2015 03:17 PM by dottore.)
02-26-2015 02:58 PM
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