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Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
#1
Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
Lacking means to employ an EEG sensing device, can concerned seekers learn to spot sleep disturbing arousals from close readings of bursts of several increasingly deeper breaths? What exemplars showing typical recovery breathing has anyone at AB posted or seen in sleep medicine literature? Desirably such patterns have been presented somewhere and I would hope those would have been substantiated by EEG. Of course, without EEG results, there would be false positives and negatives: misreading of the FR bursts.  But would there be so many errors that trying would be useless for sleep seekers who complain "AHI is now 1.0, but sleep continues unrestful".

My guess is that most work done on this topic would have been in the context of the usual scoring metrics for scoreable apneic events as supported by EEG, pes, thermistors, and other usual sleep lab sensors. What affects sleep below the scoreables is for researchers and probably too deep in the weeds. Yet it seems likely that analysis of enough sleep studies that had EEG outputs might yield answers, especially if there is a reliable motion sensor and related synchronized ("channel" is it?). If motion in sleep reports is by tech observation only, then synchronization would seem little better than using an inexactly synchronized video camera at home.

However, expert lay advisers here, I believe, and elsewhere do express their judgments of arousal events and breathing and do understand what patterns in the zoomed FR curves mark them. It seems that correlations of motions with the arousal kind of breathing patterns would enhance accuracy of assessments. It would be necessary to establish means of distinguishing motion caused by RERAs from mere comfort seeking motions (if there are such in restful sleep). My present ability to synchronize real time clock data of my accelerometer with VAuto time is too crude, but can be improved as would seem necessary to decide, for example, whether the motion came first and caused the FR disruption. 

There may also be distinguishable patterns of breath holding for comfort seeking that differ from RERA recovery breathing patterns. 

I attach some examples from my 8/19-20 sleep and ask which, if any of the graphics numbered 2 through 7 look like RERA and ask why or why not?

   

If the images of the breathing bursts are too small, I'll post larger ones. But there may be enough there to decide RERA or not.  I apologize for experimenting with Powerpoint, as advised by my daughter, as a means of keeping post numbers and file size down. That program is much easier than any other I know of for assembling snippets together.

There is one Central at 0830 and after the break before the CA there is about 20 minutes of either palatal prolapse or lip leakage.

I believe it is PP on the basis that before the PP began, leak was mostly 2.4 L/min with some 3.6, after the transition leak was 2.4 and 3.6, but was alternating with about half 3.6. (I see changes in I and E proportions in the PP period, but hoped to find in OSCAR or ResScan the ratio and curve of same. I definitely shortens but differences vary) I'll include the transition into "PP" in another post.

Notes:
  • Motion bursts are shown in second downward from FR graph in nos. 2 - 7
  • Only nos. 4 and 7 have FL among nos. 2 - 7
  • No. 5 includes the moments before getting up to calm mybladder--I slept to end AFAIK?
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#2
RE: Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
Are you able to use the Attachment Feature to post your graphs, as the graphs you posted are too small and unreadable.

You will probably receive some responses if they can be read.

http://www.apneaboard.com/wiki/index.php...ganization
OpalRose
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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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#3
RE: Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
Thankyou Opal Rose, I should have redone those small images, not posted them. Here they are enlarged attachments, along with the earlier noted differences among the snippets. 

My apologies to all--long gone and probably not to return--who took a look but could not read the small images. 

Again, the questions are do any of the snippets show RERA and if so (or not so), why?
 
The green color FR marking of image 1, showing the overall sleep session, shows the period I believe I was experiencing Palatal Prolapse.  In another post of this thread I will show a 2 minute view at the transition point into PP before leak eventually increases. The grey vertical bar makes clear the increased leak did not occur at the transition, but after a time in it.

The yellow marks highlight approximate times of each of the snippets, all in the time sequence.

Notes:
  • Motion bursts are shown in the second graph downward (below the FR graph) in images nos. 2 - 7

  • Only nos. 4 and 7 have FL among nos. 2 - 7

  • No. 5 includes the moments before getting up to calm my bladder--but I slept to the end AFAIK?

                  
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#4
RE: Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
You asked in a PM why no one has replied to this thread. As someone that is usually willing to dig pretty deep into therapy, I look at an AHI of 0.13 and a deep dive into things like accelerometers, inclinometers and and other tech and feel I'm completely out of my lane. I am not comfortable trying to interpret minutia of good therapy where the flow rate changes or an irregularity occurs. You are using terminology like "motion bursts" that have no meaning to me. As the village idiot, I don't even know what a "FR" is. Arousal is usually indicated by a change in respiratory volume or rate, and certainly a respiratory effort related arousal has flow limitation. None of the events in your graphics above is relevant or controllable through settings on the CPAP, and simply have no ideal how to guide you to avoid them, if that is even your question. Please don't think we are ignoring your posts. Speaking for myself, I don't see what I can offer or even what you are asking.

Don't take this the wrong way. You are an experienced and advanced member of this forum. You know there are limits to our insights and we might sometimes miss the point of a thread like this. My hope is you will turn your efforts toward helping others rather than dwelling on small details of your own therapy, that may not have an answer we can provide. The truth is, there are limits to our understanding of sleep, and weird stuff that happen on graphs. I sometimes don't download my own data in a month's time, and I certainly never look at it through a microscope. All I see in your post is "technical" observations. What is the problem? Do you have a concern with what you are seeing? What is your goal in understanding this better? Will this help anyone, especially you?
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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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#5
RE: Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
(08-24-2020, 06:23 PM)Sleeprider Wrote: You asked in a PM why no one has replied to this thread. As someone that is usually willing to dig pretty deep into therapy, I look at an AHI of 0.13 and a deep dive into things like accelerometers, inclinometers and and other tech and feel I'm completely out of my lane.  

But my bet is that when a post is not cluttered with what you justifiably cite in mine, you can spot fairly accurately the arousals you may see in, say, a 2-minute view of a suspect Flow Rate (FR).

My posts above, the first ones being too small for complete reading, asked for help identifying arousals. As I understand the word "arousal" it means real disturbances of rest, even if one does not recall waking. Those arousals not flagged as arising from time-coincident apneas, Flow LImits (FL), Snore or RERA by PAP machines (for Oscar display) are factors in UARS (I think) that many at AB suspect or do suffer from. Lacking as we do electroencephalograph (EEG) flagging, the gold standard detector of arousals, many of us could use training, by you or other seasoned lay experts, to make "educated guesses".

When I see the many posts by people who have low AHI's, yet report bad sleep, there are lay experts I have learned to trust who talk about or mention seeing arousals in other persons' Flow Rate (FR) curves. Somehow they have a good idea of what EEG (rest disrupting) arousals look like in FR curves. I can and do guess at which kinds of clustered, spiking wave forms they are focusing on as arousal markers. But I want to get a clearer idea for myself and (wrongly?) assume that many others with low AHI but still fighting unrestful sleep would too. If a "papper" can count them, even roughly, then, if driven onward to improve sleep, he or she can adapt life style changes and assess over time which changes, if any, are effective, tolerable and compelling. As you note, those are beyond reach of our current machines' settings, but those are still a worthy sleep topic and are often commented on by the knowledgeable.

I am not comfortable trying to interpret minutia of good therapy where the flow rate changes or an irregularity occurs. Good points and well taken. Others do dive in from time to time. Your comment, below, describing arousals is a good statement of anything I think I know about them, little that that is. 

You are using terminology like "motion bursts" that have no meaning to me. 

My bad, again, in "motion bursts". I failed to point out in my posts that what one graph in my Oscar imagery identifies as "Inclination" (as it is marked by Oscar at the left of one graph) presents motion information as I and a couple of others have begun to use it. It shows motion timing and relative values or significance (the latter indicated by varying lengths of the small vertical cross hatches on the horizontal baseline trace). Each crosshatch, in 1 or 2 minute views is actually a burst of waves above and below the baseline and I call those "motion bursts".

Though tardy in trying to rehab my posts above and to get such answers as might address my thread title and opening question, I have added, below, a bit of necessary explanation and clarification of the relationships among my second post's graphs above.


 Arousal is usually indicated by a change in respiratory volume or rate, and certainly a respiratory effort related arousal has flow limitation.  

None of the events in your graphics above is relevant or controllable through settings on the CPAP, and simply have no ideal how to guide you to avoid them, if that is even your question. Understood, especially if increased pressure, and more, would not help or would make matters worse.  

First, I want to be reasonably accurate in identifying arousals and have asked for more help learning how. If true (and you didn't say it was), it would be simplifying and great to learn here the answer to my key OP question: arousals, those sleep disturbing things, account for all those "bursts" ( all those short series, of, say, 5-20 breaths) of sharply increased FR amplitudes. Arousals, if applicable, would account for those bursts/series/clusters of large amplitudes that underlie most of the needle-like spikes that rise way above and below neighboring FR in the 8-hour Oscar views of FR.  Those  clusters' amplitudes rising far above and far below the preceding and following "normal" breathing FR. 

Please don't think we are ignoring your posts. I suspected your explanation. The posts were off-putting and unclear.  Speaking for myself, I don't see what I can offer or even what you are asking of this forum.  You know there are limits to our insights and we might sometimes miss the point of a thread like this.  My hope is you will turn your efforts toward helping others rather than dwelling on small details of your own therapy, that may not have an answer we can provide. 

An aside here: My hope would be that a sticky or some wiki might be developed to pool illustrations of typical breathing patterns: good breathing curves of sleeper-normals (which won't be perfect of course), of arousals, of palatal prolapse, of CSR, of variable breathing, of breath holding during body shifts, of low level unflagged FL-like disturbances as in UARS, of even sneezes and coughs, etc., to help identify these patterns and have appropriate labelling words for them.
[quote pid='363626' dateline='1598311437']
[I'm not sure how I triggered this sudden appearance of s second text box (?) and hope it does not garble this reply of mine more.]

Many, if not the majority, of my posts have been prompted by seeing posts of matters that have parallels to what I have been looking at over the course of my 5 years here. A relative few have been motivated by need for help with personal therapy matters. I have only details of my own PAP experience or readings to relate to any another topics at hand in any attempt to be helpful, or at least to elicit others' help or promote discussion, to gain better understanding of a the sleep apnea (SA) subject. I do find it very complex, interesting and challenging. As in my PM, I think, it's not clear now whether my sleep is good or bad. It is by far the best I've had in many years, my youthful baseline long ago forgotten. But I see the irregularities and relate them to the spikes in my and others' FR curves, others who are concerned about definitely unrestful, low AHI sleep.

 The truth is, there are limits to our understanding of sleep, and weird stuff that happen on graphs. 

It's a "papper" luxury to get to a low AHI and then continue trying to understand that weird stuff, especially when there are regular unexplained irregularities. But I should not inflict that quest on you as in the PM. Having read here for a long time I know that there are members or lurkers at AB (MD's no doubt as in the past here or elsewhere) who are dealing with these and legitimate Rx matters. Some of them have far far deeper knowledge than we can aspire to. I must sharpen my posts to gain their and other concerned pappers reading of and comments on my posts. 

I sometimes don't download my own data in a month's time, and I certainly never look at it through a microscope.  All I see in your post is "technical" observations. What is the problem?  Do you have a concern with what you are seeing?  What is your goal in understanding this better?  Will this help anyone, especially you?
[/quote]
_________________________________________________________________________________________________________________________________________________
Thank you SR for your excellent and constructive reply above, as was expected if you did reply to my PM asking what to do to gain readers and comment on the subject posts and question.  I totally appreciate your reply  (in black) above and your reply to my PM. I interspersed my reply comments between yours above using blue colored font.

With reference to my second post below the OP, if any care to look:

Oscar graph 1 shows the whole sleep session with yellow colored dots showing times of each of the six small snippets, 2-7.

All but two snippets have no FL associated with the bursts of large FR amplitudes. Those bursts are needle like spikes in graph 1.

The order of the graphs in the snippets correspond to the order of the graphs in overall graph 1.

Inclination with the scarlet or dark red horizontal trace and cross hatches show movements that correspond to each snippet's Flow Rate burst and related movement burst--those little red squiggles on the red horizontal trace farther down the snippet.

2SB
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#6
RE: Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
Your observations on the flow rate spikes are consistent with what I observe in many users. I think they may be arousal, but if not related to respiratory effort, then it is hard to mitigate with therapy modifications. As far as a wiki, I support your idea and there are several threads where you, and I think Slowriter, Sheepless and others have discussed in depth issues like PLM and other movement related arousals. I don't consider myself very well versed in those issues and usually do not get involved. Back to a wiki. You should become a wiki editor http://www.apneaboard.com/wiki/index.php...iki_Editor . We have a very helpful group that can get you up to speed, and your contributions to the knowledge base of the forum would be greatly appreciated. I hope you will take the bait and run with the idea.
Sleeprider
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____________________________________________
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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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#7
RE: Quest to detect RERAs via FR irregularities & ("INCLINATION") motion
(08-25-2020, 07:57 AM)Sleeprider Wrote: Your observations on the flow rate spikes are consistent with what I observe in many users. I think they may be arousal, but if not related to respiratory effort, then it is hard to mitigate with therapy modifications.

This has always been the rub for me. I can see funky breathing in the FR graph, but I can't easily distinguish RERAs.

So I don't even bother to try anymore. 

I more aim for general metrics: duration of sleep, number and duration of awakenings, etc. If I'm generally sleeping more than 7 hours without waking up much, I'm happy.

I agree with SR, though, that it'd be helpful to have some wiki content, including example graphs, that demonstrate some of this, including a more "normal" graph (without excessive spikes) for comparison.

I have established in my own case, spikes on the graph tend to mostly correspond to movement (say turning), or REM sleep.
Caveats: I'm just a patient, with no medical training. And my first experience with xPAP was fairly recent. So I'm somewhere along the path of a steep learning curve.
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