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Plmnb - the journey continues now with ST-A.
RE: Plmnb - the journey continues now with ST-A.
That’s a great article on FL’s. It’s the same one that taught me how to read my flow rate with its charts and graphs. They quickly had me realizing I needed a soft cervical collar to keep my neck as straight as possible. 

I don’t think it would hurt bringing that article with you.
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RE: Plmnb - the journey continues now with ST-A.
Good. I’ll either bring it or prepare an outline or synopsis or something.

As to discussing things like Flow Limitations with the drs, I only TRIED to discuss FL with one doctor, the one I have had 3 visits to in 3 1/2 months. At first I thought I had found a REALLY good doctor but I now realize I have just found a slightly above average doctor. He doesn’t get down in the trenches with you so to speak. God I miss my old primary care doctor. She was a DO that my husband, daughter, and I saw for about 20+ years. The kind of doc you didn’t mind sitting in the waiting room for hours doctor because you knew you’d get the tops in attention and detail.

I feel somewhat intimidated I think. I do have to laugh though. When it comes to the health of other people in my family it’s the opposite. My husband was having an exam and the doctor, a straight shooter, turned to me after asking a question of my husband that I started to interject a statement or question into, and he said “your an intense lady”. I ABSOLUTELY love that characterization of me. I think it describes me to a T. I don’t think being intense is a bad thing at all. And I can’t quite figure out if he meant it in a bad way or good way, and I don’t care.

Anywho, speak to you later. Thanks for the input everyone!

Plmnb
Phoebe
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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Question 
RE: Plmnb - the journey continues now with ST-A.
Mornincoffee Morning guys and gals.

I'm trying to determine if I can pick out RERA areas on my own.  Would someone take a peak of this zoom and tell me if I picked out RERA areas correctly?

Thanks,
Plmnb

   
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
You've picked out areas of flow limitations.

However, to be a RERA, it needs to be immediately followed by an arousal.  In other words, followed by a few deep high-amplitude breaths.

Remember that the "A" in RERA means "arousal"

This image shows the kind of thing you are looking for:
http://www.apneaboard.com/forums/attachm...?aid=18041
My example had a single recovery breath but you may find cases with 3 or 4 deep breaths in the "recovery" period.

In the image you provided, we could argue that the right hand red box is the recovery portion of a RERA that began just to the left of it.

BTW: You may have better success if you change the y-axis scale back to +/-60 or so. It's crept back up to +/- 180 somehow.

EDIT: To be honest, that whole period of breathing looks flow-limited from start to finish.


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RE: Plmnb - the journey continues now with ST-A.
I am impressed with the very low AHI you have achieved in a short time along with very normal looking respiratory statistics. The sequence you show has some flow limitation, but very regular respiration rate. It appears the flow rate slowly declines and pressure support slowly steps in to recover volume. It's hard to know if the increased respiration flow is arousal or the impact of pressure support restoring normal.

Seeing results like this make me confident you are on the right path to have sleep be as normal as possible for you. With other machines we often saw a clear struggle to breath, fighting to get more, and that's simply not showing up on iVAPS. When we get down to looking at nice regular respiration and seeing some minor variations, that is pretty amazing, compared to where we were a short time ago. Moving up to 4-hours is an improvement, as well, but not arrived. I still think the biggest challenge you have is hours, not flow.
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RE: Plmnb - the journey continues now with ST-A.
like Sleeprider!  



Thanks.

Now if I can just lick this Meralgia.  Last night was awful agonizing pain, thank god it only lasts a few minutes at a time.  I feel twinges of attacks during the day, many times while driving and that is pretty scary.  If the action that is causing the Meralgia is the "yoga" sleep then I am hoping to obliterate the "yoga" sleep action with decent breathing thereby not causing further damage to the femoral thingy.

I hope to find out from the neurologist if this femoral situation is permanent or not.  

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
Huh

Bit confused.  In one post I am filled with flow limited breathing and in another post things look really much better.  Possibly get a little clarification?

Most Respectfully,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Plmnb - the journey continues now with ST-A.
Your glass is half-empty and it is also half-full

I think sleeprider is giving the good news from the glass-half-full perspective.
The glass-half-empty perspective says you've still got a bunch of flow-limited breathing.

Do you recall when you talked to the doctor about Flow Limitations and ASV and they responded with "...but your tidal volumes look good.." (or maybe they said the minute-ventilation looks good.. I'm not sure which)? That was probably a glass-half-full response suggesting to you that the key thing to look at is your level of ventilation and if you are getting enough air or not instead of being unduly worried about the details of the flow limitations.

I can swing either way on the "half-empty" versus "half-full" perspectives.

As you have been titrating the ST-A you are (hopefully) getting better and more stable ventilation volumes (glass-half-full) but you may still have residual flow limitations (glass-half-empty).

I'm not certain why you are looking to hunt down unrecorded RERAs.. I was just answering your RERA questions "as asked".
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RE: Plmnb - the journey continues now with ST-A.
Only you can tell us if this is working. Are you able to sleep through a full night now? Or still only getting an hour or two before pulling mask off etc?

The example you posted shows worsening flow limitations followed by recovery breaths (which are still flow limited). The machine might be doing just enough that those aren't RERAs (I believe last one was though) or all 3 might have been RERAs. It is impossible to know for certain without EEG data telling us if an arousal occurred.

One thing to note is that you drew the boxes backwards (the RERA ends with the recovery breaths instead of starting with it), as ApneaQuestions showed in his image.
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RE: Plmnb - the journey continues now with ST-A.
Angry My current sleep doctor's sleep lab discarded the raw data.  So all I have to base anything are the base line sleep study report and the Bipap titration sleep study report.  I do have the OSCAR charts, but I don't know how they will be received by the new doctor I will be seeing.

Sleeprider, yes the AHIs are lower, but I feel so tired still.  I actually fell asleep at work a few days ago.  I can't even drive any appreciable distance without feeling drowsy.  I know MORE sleep is a big part of the puzzle, but I can't recall consistently having had this little sleep prior to starting therapy again.  Last night I laid down for sleep around 11:00PM, which is good for me, but I awoke numerous times without my mask on.  I also had air leakage part of the time.  In addition I awoke with Meralagia attacks.  


I have been doing a-lot of research through Google for information on FLOW LIMITS.  Two things that have been mentioned in parts of the articles I have found are REM sleep and RDI.  But the only information I have regarding these two areas are from my December Bipap Titration report. I don't know if the readouts are applicable now that I am on the ST-A.  If they could be helpful I can post them again and maybe someone could tell me what the numbers may show?

Thank you,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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