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[Pressure] Data Interpretation
#11
RE: Data Interpretation
(02-02-2022, 06:52 AM)SarcasticDave94 Wrote: As Stacey made mention to gain full benefit of EPR 3 your Min pressure must be at least 7. You're currently at 5. It would also be helpful to present us a standard OSCAR screenshot. If you're using a Windows based PC while viewing that daily detail data press F12. This should show Events, Flow Rate, Pressure, Leaks, Flow Limits, etc. Those 5 charts are the most helpful. As is your AHI isn't bad though.

I thought I did - I attach 4 examples one from last night with EPR2 - one end of Jan with no EPR - and previous two in October with EPR2

How can I count breath per minute on a 1-2 min zoomed chart?


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#12
RE: Data Interpretation
I think the machine reported respiration rate is based on zero crossings. I think a better way is to find the time (in seconds) between peaks or between lows, and divide 60 by that time. Pretty easy if you have the graph in front of you.

How to do that programatically is not so easy. I have some ideas, involving differentials and average peak values, but I haven't worked on them enough to include them in OSCAR.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#13
RE: Data Interpretation
(02-02-2022, 08:42 AM)pholynyk Wrote: I think the machine reported respiration rate is based on zero crossings. I think a better way is to find the time (in seconds) between peaks or between lows, and divide 60 by that time. Pretty easy if you have the graph in front of you.

How to do that programatically is not so easy. I have some ideas, involving differentials and average peak values, but I haven't worked on them enough to include them in OSCAR.

so if one peak days 45 and next one 50? time difference is 5? Not sure what you mean
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#14
RE: Data Interpretation
I was looking at your 4 minute zoomed screenshot... In the flow rate chart, just to the right of the green cursor line, there is a sharp dip. If you place the cursor on the dip and note the time, then move the cursor to the next big dip, note the times. Calculate the difference in seconds and divide 60 by that time, you'll get the RR in breaths per minute.

In this chart, the dip is at (approximately) 05:20:25, and the next one is at 05:20:30. So 5 seconds into 60 is 12 bpm (roughly)

The exact cursor time can be found at the bottom of the graphs; It doesn't usually show on screenshots.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#15
RE: Data Interpretation
The times when your respiration rate is shown as elevated corresponds to very high flow limitation that is under-reported by the machine. You can see you have very flattened or downward sloping inspiration peaks followed by a relatively rapid inhale that rebounds to a near zero flow where the flow rate appears to fluctuate above and below the zero flow line multiple times before the next inspiration begins. This flow limitation is a restriction in the upper airway, and while we are not certain, the flow fluctuations may be cardiogenic oscillations http://www.apneaboard.com/wiki/index.php...cillations We see this pattern in several members, and it usually resolves with higher bilelvel pressure support (EPR) and higher minimum pressure. This pattern was very pronounced on your January 29 results when you were not using EPR. The pattern resolved best when the minimum pressure rose above 7.0 cm.

You clearly need EPR and I think your minimum pressure should be set to about 9.0 to prevent this flow limitation and mis-reported high respiration rate, which is actually a cardiogenic or other influence that causes the unstable flows during expiration.

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#16
RE: Data Interpretation
I tried to explain this last time but I will try again.

EPR is exhale pressure relief. What that means EPR is set to 1, 2 or 3. Whatever number you choose is subtracted from the min pressure.

BUT the absolute min the machine can go is 4. If you have the min set to 5, it does not matter if you set the EPR to 3! It can only go down to exhale 4. (5-3can not happen it can only go don to 4)

Sleeprider suggested a higher min for 2 reasons. One being to use the EPR 3 to reduce flow limits that in turn will stop higher pressures. Not the he needs my agreement but that is what needs to be done.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#17
RE: Data Interpretation
In that zoom you can see little blips in flow rate that go positive then negative before main inhale starts. These machines/software are not smart enough to realize those are not inhalation and it counts them as qla breath.

Some people have these and it isn't clear why. As you have noticed higher EPR often helps minimize this but doesn't necessarily make it go away. In short data showing less of these periods is probably better but the main thing to note is that isn't your actual respiration rate.
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#18
RE: Data Interpretation
Right - Changed my settings with min pressure 7 and EPR3.
Something strange happened arounf 6:27 and 6:30 that made me wake up feeling I was being suffocated by the air -
I attach the zoomed charts of that time -

It looks there was on onset of Flow limitation that caused a sharp rise in the pressure and then a leak happened? I am not sure what;s going on so your views might help. Pulse and movements from my Oxymeter seems to indicate I was quite still?

This is not the first time it happens...


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#19
RE: Data Interpretation
That is an image of the machine almost doing its job. You can see how your breathing was semi constant and then at 6:27:45 flow rate dropped significantly and flow limitations started. That is because a partial obstruction was occurring. The machine responded to the flow limitations increasing the pressure and as you can see the increasing pressure actually improved the obstruction and increased flow rate. Unfortunately it did not do so in time to avoid the arousal just after 6:28:30 (first large breath). The arousal triggered your sympathetic nervous system (fight or flight) and after waking up you had a little mini panic attack and removed the mask.

This is actually helpful because it shows that the low pressure being used is not adequate to prevent the obstruction from occurring and that higher pressure helps get out of/avoid obstruction.

I would try increasing your pressure to min 10, max 16.

Edit: The higher pressure may feel uncomfortable at first and take a bit of getting used to but your data so far indicates it may be necessary so it is worth doing so.
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#20
RE: Data Interpretation
(02-03-2022, 01:09 PM)I’m Geer1 Wrote: That is an image of the machine almost doing its job. You can see how your breathing was semi constant and then at 6:27:45 flow rate dropped significantly and flow limitations started. That is because a partial obstruction was occurring. The machine responded to the flow limitations increasing the pressure and as you can see the increasing pressure actually improved the obstruction and increased flow rate. Unfortunately it did not do so in time to avoid the arousal just after 6:28:30 (first large breath). The arousal triggered your sympathetic nervous system (fight or flight) and after waking up you had a little mini panic attack and removed the mask.

This is actually helpful because it shows that the low pressure being used is not adequate to prevent the obstruction from occurring and that higher pressure helps get out of/avoid obstruction.

I would try increasing your pressure to min 10, max 16.

Edit: The higher pressure may feel uncomfortable at first and take a bit of getting used to but your data so far indicates it may be necessary so it is worth doing so.


Thanks for useful insights - how does it work with having a higher min pressure ? I guess the machine will ramp up to that pressure with EPR 3 - I will increase from 7 to 8.5 /9 and keep monitoring till I find the right balance . 

Im just concerned a too high min pressure will make me too uncomfortable- I guess it’s a bit of trial and error now .
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