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Sanity check on next steps (still tired)
#51
RE: Sanity check on next steps (still tired)
Flow Limits and centrals can definitly be a balance act.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#52
RE: Sanity check on next steps (still tired)
Thanks Dormeo. That's interesting. 

The attached looks like a RERA, right? There's sort of a recovery breath afterwards, and even after that my breathing is irregular, which I presume means I was awake (arousal breathing?)...

I have no problem having high CAs if I feel more rested... even when I've gotten my AHI down to 1.5 or so for a night, I don't feel well rested, so I'm more than willing to make adjustments that may address other issues and ignore AHI.

Sorry for flooding with posts. I'll wait for another response...


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#53
RE: Sanity check on next steps (still tired)
I set EPR to 2 and have been slowly increasing the min and max pressure by 0.2 over the last couple of nights to try to get the flow limits down.

The CAs are relatively stable and still seem lower when I sleep in a sitting position.

I figure that I'll keep increasing the pressure slowly until I stop seeing results in flow limits. Please let me know if this isn't a good approach.

Attached are OSCAR results from the other night, a zoomed in view during a period of flow limits, and an anomaly in breathing that wasn't flagged. Anyone know what that would be?
  • I wear a mouth guard, mouth tape, and a chin strap, so I don't think it's snoring...
Thanks!


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#54
RE: Sanity check on next steps (still tired)
You're pretty young. If you're sleep apnea isn't primarily central maybe you want to consider MMA (jaw surgery). Most people that have used CPAP and then had MMA report they sleep better after MMA compared to CPAP. The surgery really isn't that bad if you go to a good surgeon. I'm going that route myself later this year.
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#55
RE: Sanity check on next steps (still tired)
In addition to tracking the FLs, keep close track of how you feel. That's hard to quantify but no less important.

The odd incident looks to me as though you held your breath after breathing in, then expelled it abruptly and paused before taking some recovery breaths. Maybe you held your breath while changing the position of your body and then paused as you settled into the new position??
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#56
RE: Sanity check on next steps (still tired)
(09-16-2020, 08:09 AM)TSomm Wrote: I set EPR to 2 and have been slowly increasing the min and max pressure by 0.2 over the last couple of nights to try to get the flow limits down.

The CAs are relatively stable and still seem lower when I sleep in a sitting position.

I figure that I'll keep increasing the pressure slowly until I stop seeing results in flow limits. Please let me know if this isn't a good approach.

Attached are OSCAR results from the other night, a zoomed in view during a period of flow limits, and an anomaly in breathing that wasn't flagged. Anyone know what that would be?
  • I wear a mouth guard, mouth tape, and a chin strap, so I don't think it's snoring...
Thanks!

It's good to see your post here.
I'm Canadian too...and starting to see good results with my apap machine.
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#57
RE: Sanity check on next steps (still tired)
Hey Dave, I'm glad to hear you're getting good results! That's awesome!

A couple questions for everyone - I'm still making some adjustments and trying to reduce flow limits and centrals. I'm wondering about two things related to the result section I posted here. Please let me know what you think.

1) On the right side of the graph (~56:15) there's a section where it's relatively flat. Is this a central that isn't flagged? I understand that centrals have to be at least 10 seconds and it seems like the machine started to check for one around 56:20 (looking at mask pressure, that's when the little pulses appear to begin).

2) I keep reading that flow rates should look sort of like little mountains. My flow rate has a fairly consistent flat line at the beginning of each breath. Is this because there's a pause between when I finish exhaling and when I start to inhale? This is shown on the left side of the graph, from 55:45 through 55:55. I'm not sure whether I'm understanding the graph properly and whether this is an abnormality I should be looking into.

FYI - I wear a soft cervical collar, mouth tape, mouth guard (for bruxism), and chin strap.

Thanks again for your advice and thoughts!

PS. I'm still making adjustments as I continue to be tired through the day and require medicine to offset this tiredness. I'm trying to focus in on a couple things at a time to see if I'm able to make some progress. Right now, my flow rates show some oddities, so I'm trying to tackle that.


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#58
RE: Sanity check on next steps (still tired)
Hi TSomm. I'm sorry you're still feeling tired. I hope your good efforts will yield better results before long.

That long flat line just barely missed being flagged as a central. The algorithm may have counted a second or two at the beginning as the completion of your exhalation. And yes, you can see the FOT kick in -- that's the little oscillations around the zero line.

It is normal to pause between breaths. Your overall median respiration rate looks fine, so I would guess the overall pace of your breathing is fine too.

For an idealized depiction of a normal flow rate, take a look at the line inside the O on the Oscar welcome page. We see a smooth inhalation curve above the zero line, a pause, then a sharper exhalation curve below the zero line.

Could you change the scale on your flow rate graph? Maybe 50 to -50? I think that will make it a little easier to judge what is going on.

But as far as I can tell, most or all of the breaths in what you've posted are flow limited to some degree. The ResMed algorithm is pretty good at picking up on flattened tops and "miniature" breaths. It is not so good at picking up on pointy tops (like the two before your long pause) or dented tops (like the two just before the pointy tops).

You are in that tough spot where a little more EPR might help with the FLs but give you more CAs. Both can be disruptive -- or not. Since you are tired pretty consistently, it's hard to tell whether you should choose the rock or the hard place.

Do you feel like trying an experiment? You could try boosting the EPR back up to 3 and set min = max = 9.8. This will eliminate pressure changes as a potential source of arousals. The 9.8 might do a reasonable job of managing OAs, and the EPR of 3 might help with FLs. The biggest question mark will be what happens with CAs, though as before I think their significance is mainly in the mini-arousals that often precede them.
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#59
RE: Sanity check on next steps (still tired)
Thanks for the info, this is good to know!

I'm definitely willing to experiment and I'm more than happy to focus on eliminating one possibility, then shifting to the other (i.e. temporarily making one worse is completely fine with me).

I've adjusted the flow limits as you mentioned. I'm also posting an older graph sample where the settings were quite different and EPR was set to 3 - looks like the flow rate is better there, so I'm thinking the EPR of 3 might make a difference for the flow rate issues. Fingers crossed.

Thanks again!


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#60
RE: Sanity check on next steps (still tired)
Yes, the flow rate traces look better with EPR of 3.  Keep us posted, would you?

By the way, I see you have some little oscillations around the zero line.  (They are easier to see with this rescaling.)  I have them too; they are not that uncommon, and if you're interested, they are caused by your heartbeat.  They are of no medical significance whatsoever; I just thought you might like to know.  The name for this is cardioballistic effect or artifact.

And if you want to get really nerdy about it, on the rare occasions when I have an honest-to-goodness OA, the cardioballistic oscillation is absent, though it is present during CAs.  See attachment.


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