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Sudden Change - Me or Machine?
#1
Sudden Change - Me or Machine?
Hi folks, long time since I was last here.

I have been using my Devilbiss DV64 CPAP machine for just over 5.5 years with the same pressure settings & with an average nightly AHI over that period of around 2.5.  Lowest 0.5, highest (on just one occasion ) of 4.75. 

This suddenly changed a couple of days ago - quite dramatically! I am wondering whether it's me or the machine. Not really sure how I would tell. The machine still appears to be working as usual. No strange noises, filter not blocked. Mask leakage still being reported as 0.0% as always. I use a nasal mask & sometimes mouth breathe a bit, but I don't think any more than I've ever done since commencing CPAP use. 

My initial pressure prescription was 8cmh2o & I have had the machine set to a range of 8cmh2o to 9.5cmh2o pretty much since I got it. 

I have included 3 charts below. From 6th, 8th & 9th of November. 

The 6th November was an 'average night' with an AHI score of 2.14. 

The 7th November is the first time in over 5 years I missed using the machine for a night. I was pretty sick, struggling with a Crohns disease related bowel blockage that evening (so not a respiratory condition). This had resolved by the following morning.

The 8th November,  I had the highest AHI score I've ever had on the machine of 5.89. This surprised me, I didn't feel like I'd had a bad night's sleep. 

Last night, 9th November my AHI score rose to 10.1.  I still don't feel like I had a bad night's sleep. 

As you might imagine I am puzzled & concerned about why the sudden rise. I would very much welcome informed thoughts from those of you with experience in interpreting the OSCAR graphs. 

   

   

   
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#2
RE: Sudden Change - Me or Machine?
Cuppa,

For 6 Nov, I am wondering if the 7.37 Flow limitations, became Hypopena?

I do not know of RDI includes flow limitations. RDI is one of the choices in OSCAR.
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#3
RE: Sudden Change - Me or Machine?
Charts show a lot of flow limitation and leak. A close-up of the respiratory wave would confirm. Have you tried turning on expiratory pressure relief or whatever it's called on a DV4?
Sleeprider
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#4
RE: Sudden Change - Me or Machine?
(11-09-2022, 05:47 PM)KeepSmiling Wrote: Cuppa,

For 6 Nov, I am wondering if the 7.37 Flow limitations, became Hypopena?

I do not know of RDI includes flow limitations.  RDI is one of the choices in OSCAR.

Hi KS, thanks for posting. 
As a result of your post I checked out & learned what RDI is.  According to the WIKI here RDI is AHI +RERA's (which include 'Flow Limitations'.)
I cannot find any reference to RDI in OSCAR & I don't think my machine records RERA's.
However I have looked back over the past month at my flow limitations & they don't appear to correlate with my AHI scores, ranging from 2.23 up to 8.71. On the night the flow limitations was 8.71 my AHI was 1.98. 

The big difference appears to be Periodic Breathing which has consistently been 0.0% for as far as I looked back, but on the 8th Nov showed 0.12% & on the 9th jumped to a whopping 8.68%.  Looking at the pressure during the period when Periodic Breathing was recorded the pressure remained flat at 8cmh20 (apart from one period of 'Periodic Breathing' around 4.30am when the pressure rose to it's upper set limit of 9.5cmh20).    

Two things are therefore where my thinking is at 1. Why the sudden introduction of Periodic Breathing, when it hasn't previously been an issue at all, & 2. Why no response from the pressure when it occurred on most occasions, even though there were a few hypopneas recorded during that period too? 

Of course I could be barking up the wrong tree!

   

   
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#5
RE: Sudden Change - Me or Machine?
(11-09-2022, 07:04 PM)Sleeprider Wrote: Charts show a lot of flow limitation and leak. A close-up of the respiratory wave would confirm.  Have you tried turning on expiratory pressure relief or whatever it's called on a DV4?

Hi Sleeprider,
The machine screen report said 0.0% poor mask fit.

Do either of these screenshots give what you referred to? (If not I can try again if you are more specific). 

First is from a point where Flow limitations were at a high point 

   

And second from the point where highest leakage was shown. 

   
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#6
RE: Sudden Change - Me or Machine?
I do not know why the increase in periodic breathing.

Get a copy of your clinician guide/manual and see if the machine responds during periodic breathing.
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#7
RE: Sudden Change - Me or Machine?
(11-09-2022, 10:33 PM)KeepSmiling Wrote: I do not know why the increase in periodic breathing.

Get a copy of your clinician guide/manual and see if the machine responds during periodic breathing.

Good thinking! Not sure why I didn't think of it. Oh-jeez I already have the clinicians guide. It appears that the machine is supposed to respond to both periodic breathing & flow limitation. (See attachment below). My reading of the info from OSCAR suggests to me that this did not occur (much) last night. Which I guess (if my reading of the OSCAR info is correct) it could mean one of two things.

1. The machine has ceased working as intended or
2. That it is still in the process of adapting it's algorithm to something it has not been familiar with - the periodic breathing which has only occurredf or the first time, as far as I know, in the last two nights.

Of course this leaves the unanswered question of either a) why would the periodic breathing have suddenly started now or b) has the machine previously encountered me Periodic Breathing, but done something to assist & make it a 'non reportable' issue?

To try to answer that I've looked back over the past 18 months finding only 3 reports of periodic breathing, all very minor compared to the past two nights - 0.07% 12 months ago, 0.11% in July this year, & 0,07% again in late September. Every other night has been 0.0%. Not sure what to conclude from that though, other than that periodic breathing is reported when at very low levels, & has rarely occurred before. 

Here is what the Devilbiss clinicians manual say about how the machine manages these issues. When values are given as a range it just means that they are adjustable on the machine. 

   

If were at home I guess I would be making an appointment with my sleep physician, but I am more than 4000kms from home in a very remote wilderness area - nearest city with a hospital is almost 1000kms away via dirt roads & river crossings. We are in a rainforest with the closest 'civilisation' being a tiny aboriginal settlement  with little in the way of infrastructure. We will be here until the end of the Wet (Monsoon) Season, when river levels drop & it again becomes possible to drive out & don't expect to be home again until around June'23. I do have a brand new replacement CPAP machine back home, same as what I have here, & if necessary can get a friend to post (via mail plane) it up to me, but that really is only going to happen if really necessary. We don't have room for two machines in our off road travelling outfit.
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#8
RE: Sudden Change - Me or Machine?
(11-09-2022, 07:04 PM)Sleeprider Wrote:   Have you tried turning on expiratory pressure relief or whatever it's called on a DV4?

Sorry Sleeprider, I didn't answer that part of your question. Yes it is turned on.
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#9
RE: Sudden Change - Me or Machine?
Approx 1 month ago I stopped wearing a soft cervical collar to sleep. I had been wearing one for a neck condition for around 10 years. 

Last night, I wore it again, just as an experiment, to see if it would make any change to my overnight AHI score. 

AHI Score was 3.6. Periodic breathing 0.0% Leak rate was down a bit. 

   

Another thing which has occurred to me - it relates to 7th Nov when I missed a night on the machine. Because of the severe Crohns symptoms, I was experiencing that day, I didn’t have my usual after dinner coffee, a strong stovetop moka pot brew. I haven’t yet started drinking it again (1 cup after breakfast , 1 cup after dinner every day for the past 30 years). 

My wife has suggested that perhaps the periodic breathing may have been some sort of caffeine withdrawal effect? 2nd night without coffee periodic breathing occurred, 3rd night it went right up, 4th night (last night) it was absent. 

Any thoughts on that?
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