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Respiratory Rate Increase - Thoughts on This Please
#1
Respiratory Rate Increase - Thoughts on This Please
After 9 months of APAP therapy, I just noticed an increase in my respiratory rate with a clear pattern that is showing in Oscar. For each of the last 4 nights, my respiratory rates increased significantly on each of the 95%, 99%, and median rate measurements shown on the Oscar graph -- to respiratory rates of 48, 29, and 15, respectively. This differs from my 6 month average of 25, 18, and 13, respectively for the same 3 measurements (95%, 99% and median).  Why would this be happening consistently for the last 4 nights? What would trigger that?  Is there any recommendation?   Please see graph attached which clearly shows the issue. 
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#2
RE: Respiratory Rate Increase - Thoughts on This Please
Post a 3 minute view of the problem Respiratory rate. I don't believe your base rate changed much at all, but your flow rate likely dipped below 0 mid flow falsely indicating a high RR.

You should post a full night screenshot of the entire night including the RR and the closeup. Standard charts please.
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#3
RE: Respiratory Rate Increase - Thoughts on This Please
Gideon - Hope these are the right views.  Here are the various charts you suggested that I post.  Lots of sleep interruptions this night also.
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#4
RE: Respiratory Rate Increase - Thoughts on This Please
Tell me about your bed and pillows.

The clusters of flow limitations say you are having positional issues and support my thoughts on your having significant flow limitations during your false reporting of high flow limitations.

I need to clearly see the individual breaths in the flow rate chart to irrefutably state that is the cause of your high reported respiration rates but the flow limit chart tells me what I need to know.

I would like you to set your EPR=2, fulltime to address the flow limits. This may not work.

The type of positional apnea, ok flow limitations since your actual apnea is low is most likely caused by folding your chin into your chest, this the questions about your pillows and bed. This can be caused by too high of a pillow so try 1 vs 2 pillows, flatter or less firm pillows as we seek to flatten your neck. This may require a soft cervical collar, see the link in my signature.
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#5
RE: Respiratory Rate Increase - Thoughts on This Please
Thanks, Gideon. I use a very low profile, memory foam pillow.  I have a cervical collar, which I ditched when my AHI started coming under control, and the AHI seemed just as good without the collar (the collar made me hot at night and somewhat uncomfortable).  However, you could be entirely correct about my burying my chin in my chest, as I might have a tendency to do that.  I may just bring back the cervical collar and attempt F/T EPR of 2 per your suggestion.  Thanks so much for your input. Greatly appreciated.
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#6
RE: Respiratory Rate Increase - Thoughts on This Please
Sleeper396, turn on EPR full-time at setting 3. That will knock down the flow limitations and RERA and be much more comfortable.
For respiratory rate, I don't think there will be a problem once you add in EPR, but it helps to see a chart with the Resp Rate chart so we can see when the rate is high, then consider looking at the flow-rate close-up in those periods. The respiration rate detected by the machines is prone to significant error as it often interprets changes in flow during a single breath cycle as multiple breaths. This is particularly common during the expiration phase.
Sleeprider
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#7
RE: Respiratory Rate Increase - Thoughts on This Please
Thanks, Sleeprider.  Will give it a go once again.
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#8
RE: Respiratory Rate Increase - Thoughts on This Please
If you haven't changed your air filter recently give that a go as well.
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#9
RE: Respiratory Rate Increase - Thoughts on This Please
Thanks, Geer. I'll keep that in mind.
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#10
RE: Respiratory Rate Increase - Thoughts on This Please
Hello Apnea Board Team.  I am providing an update on your recommendations and would greatly appreciate your thoughts again.

At the suggestion of Gideon and Slleeprider, I have been experimenting with EPR on F/T 2 (multiple nights) and one night of F/T 3.  I am attaching the screenshots of multiple nights indicated with the corresponding EPR settings of 2 and 3.   

Try to ignore my most significant problem - fragmented sleep sessions averaging 1.25 hours each. I get out of bed and pee 3 times per night (perhaps waking up for that reason).  I am being aggressively treated by a urologist for this (with medication), but seeing little improvement after 30 days on meds to stop the nightime peeing (nocturia).  I am also disappointed that the the APAP did not contribute to the cure my bathroom wakeups, as I understand that it does in perhaps 75% of the people that are plagued by this condition. 

Getting back to the apnea, without EPR, my respiratory rate is approx. 30% higher at the median and 95%, and significantly higher at the 99.9% level. It is strange, because this appears to have randomly jumped up in the last week before I experimented with any EPR -- just all of sudden consistently higher respiratory rates for no apparent reason. EPR has appeared to smooth out flow rates, and reduced some of the respiratory rate artifacts that had popped up consistently for multiple nights without EPR, but also may have triggered some increased apneas. I have also taken the suggestion of wearing the cervical collar again at night.   

Please give me your thoughts, and if you would like to see any other graphs.  I believe that for the time being, I  should stick with EPR of 2 and settings of 8.6/14.6, which seemed to be manageable and slightly improving flow and respiratory rates. However, I am very confused and not sure of next steps. Thank you as always.
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