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[Treatment] May be Too Late for Me Too
RE: May be Too Late for Me Too
Hmmmm...
Respiratory rate over 25 means I should be in a nursing home.  I guess somebody should come and take me off my lawn tractor (when I'm mowing the lawn) or maybe remove me from behind my snow thrower and shovel when I'm clearing my walks, driveway and in front of our mailboxes in the winter.  Or maybe while I'm out grocery shopping at  the various grocery supermarkets around where I live.  If I interpret that statistic correctly somebody should then put me in a nursing home....???  You must be kidding.

Something is very wrong with that 25+ respiratory rate statistic, I think!  I am still doing the above activities, pushing my wife in her wheelchair when she has medical center appointments, doing home & appliance repairs, washing dishes, etc.  I've slowed down a little bit but I don't think I'm quite ready for assisted care, much less a nursing home just because some statistic says I breathe at a little faster rate than I should breathe while I'm sleeping.

Please excuse my sarcasm but I don't think that statistic is very accurate in my case -- for obvious reasons.  I've had respiratory rates in the 26+ range ever since I started CPAP in June 2016 and probably long before then and I didn't even know I had a respiratory problem.  I haven't felt like going to a nursing home, etc., anytime yet.

As I've tried to explain in one (at least) of my previous postings -- and as my nickname implies ("Tubaman"), I played very very hard on my tuba for many years.  My horn was built in 1936 (one year before I was).   It is a large-bore thick gauge heavy brass horn (they don't make them anything like that any more) and as such, requires much lung pressure & air volume to make it sound right for outdoor and indoor German Band performances.  I managed to do that, probably at the expense of my lungs over the many years I did it.  I'm still breathing and functioning with acceptable %SpO2 levels so I don't think my rapid respiratory rate and low tidal volume is anything other than normal for me at this stage of my life -- and is maybe much to do because of my tuba playing history.

I saw a pulmonologist in 2016 or 2017 (can't remember) and he gave me a multitude of breathing tests as well as CT scans of my lungs (I deeply fear the heavy radiation from those scans).  I was already experiencing respiratory rates of 25+ and 26+ at that time and he said nothing about them and I didn't know my rates were problematic.  I was given (at least that's what I was told) a clean bill of health at that time (except the CT scans showed what looked like an unexplainable snowstorm throughout my lungs).  Maybe I was lied to in an effort to patronize me (happens a lot, I think, because it's difficult for them to tell you the bad news -- easier for you to find out yourself in the long run).

I think you're getting the wrong idea about the funny feeling in my chest when I hit the CPAP button and the pressure instantly drops from 20 cm H2O to 5 cm H2O.  Naturally I can feel the sudden loss of pressure in my lungs and that feels kind of strange.  It doesn't hurt but the instant loss of 15 cm H2O, while not like the pressure loss in an auto tire blow-out, is still noticeable in my chest -- as I think it should be because it is a significant pressure reduction as far as my lungs are concerned.  It doesn't start going up again because the autoramp feature will hold it at 5 cm H2O until I go back to sleep -- it's supposed to hold steady @ 5, anyway.  Unless I don't understand how autoramp works and I think I do.

Questions about statistics SH and you folks are quoting -- please correct me if I'm wrong...?
1) "Med" stands for "median" or middle point between individual maximum and minimum population values...?

2) "95%" Is this the +2 sigma (+1 sigma?, I can't remember anymore) value above the "mean" (average) of the population values?  If not, what does it represent?  I'm thinking "Mean ± 2 sigma" where this value is the +2 sigma value (or +1 sigma value).

3) Statistically the "mean" and the "median" may not be the same because of skewing of the data population -- that's my understanding.

I humbly apologize if I've upset anybody.  I know you're trying to help me and I'm trying to learn what's going on and I'm very thankful for the information you have shared with me over the years.  I have a hard time accepting the idea that I should be in a nursing home at this time (especially while I'm changing the blade drive belt and sharpening the blades on my rider mower -- using a heavy pneumatic impact wrench to remove and replace the blades) and that has upset me tremendously.  I don't think I'm quite ready yet for a nursing home although I know it's coming (that and much worse) someday.

Thank you!, I hope I haven't burned my bridges and I apologize but thoughts of nursing homes do not sit well with me at this time of my life.  They are very scary!
Carl/Tubaman
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
Gosh, I wasn’t suggesting you should go into a nursing home! I want to flag something for you to discuss with your doctor. Abnormal values for all kinds of medical things deserve follow-up so we can stay as healthy as possible for as long as possible.

Median is the value such that half of whatever you’re looking at is higher and half is lower. Mean is the average, where you add up all the values and divide by the number of whatevers.

In Sleepyhead, the 95% number means that 95% of your numbers were at or below it. For example, if my flow limitation 95% value is .13, that means that 95% of my FLs were at or below .13.

I’ve enjoyed learning a little about your tuba instrument and your playing in your posts. Isn’t it wonderful to have been in a music group?
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RE: May be Too Late for Me Too
MS Dormeo:
I am very sorry for being so grumpy.  Comes with old age, along with a lot of bitterness because everything that was fun is now behind you.  Just like the "Grumpy old Men" movies, I think.

Thanks for the clarifications on Mean, Median & the SH 95% value.  I was correct on Mean & Median but I missed the 95% value.  I was thinking in terms of statistics where in a normal distribution 95% of the data statistically falls between the mean ± 2 sigma (I think it's 2 sigma -- been over 25 years since I used that equation so I'm unsure).  As you can see, that is not the same as the SH 95% data encompassing value.  I appreciate the clarification.

I just stepped through most of my SH data and I sometimes had periods where I went into the 26+% levels since June 2016.  Only once, other than a few days ago, did I go above 27%, however (I actually hit 28% a couple of days ago with my 'bug').  Most of the rest of my numbers were in the 23% to 24% range, some 25%, some 21%.  I don't think I had anything below 21%.  Kind of demonstrates what congestion can do to the numbers.

I'm quite a bit better now so it appears to have been a simple cold that my dentist shared with me.  Nice of him. ☹

I think I'm somewhat more energetic lately (1st time in years) so I can credit that to ajack and his excellent advice -- which I'm still trying to apply, albeit slowly.  When I originally started CPAP therapy I was told I would feel more energetic within weeks but that never happened.  This is the 1st time it actually has happened in almost 3 years (Thank you ajack!).

I played in quite a few bands "back in the day".  When I was going to college I could make more $$$ in one night on a weekend that the other folks were making working in the dorm's kitchen, etc., all week.  And I enjoyed what I was doing (I don't think they really enjoyed what they were doing in the kitchen).  When Nikita Khrushchev was in Iowa at the Garst farm (summer of 1959, I think), the band I was playing with (Six Fat Dutchmen) was playing a square dance about 50 miles away.  It was a very enjoyable period of my life and cannot be recovered/repeated, ergo, much bitterness on my part.

Thank you for your replies.  I am still learning a lot from you folks and have a lot to learn about CPAP!
Carl / Tubaman
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
The bridges are fine my end. I wasn't overly concerned at 23. When it rapidly went to 28, with the possibility of further increases, I was concerned. If it was my father, I'd think it needed looking at and a possible medication change, for lung inflammation and to dilate the airway.

I think you look after your lung, with spo2 readings and such. Your daytime 94% is good, you just breathe a bit hard to do it. The average for an elderly male is 20, so the 23 you had wasn't that bad. Medication may easily give a 15% better daytime lung function and get under 20. I thought a bpap might give a bit more tidal volume and decrease the night time rate a bit. As well as improving night time o2 to discontinue the supplemental o2.
There may have been a reason why the pulmonologist, didn't further treat your lungs with meds, when your rate was 25. I would ask your normal doctor.

It probably wasn't the clearest or best link to put up. I'm 65 and nursing homes are scary to me too. I just googled looking for breath rate for the elderly. I read it as, they want to have a buffer. If you are in the community, up to 20 breaths is normal and will allow the time to see a doctor if it rises too much. If they are under 24/7 care, then they raise the rate to 25, because they are able to monitor and intervene appropriately.

1. Med is median and refers to the SH AHI column next to the charts. It gives the median pressure, it's labeled Med, so it's easier to use that term.
2. 95% is the pressure you are at or under that for the night. You don't exceed the pressure for 95% of the night. Max of course is the largest pressure you use.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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~
The attached is a FYI.

I was awake from ~0830 until 0933 this morning (insomnia reigns supreme) when I gave up trying to sleep.  My CPAP's autoramp decided I went back to sleep about 0852.  I did not!  I was looking for another "Agatha Raisin" audio book on my phone / public library at the time and definitely was not sleeping.  Stories about Agatha work well to help me go to sleep.  Autoramp then prematurely (as usual) started increasing my pressure from its current 6 cm H2O setting (I upped the setting from 5 to 6 last night) to the regular CPAP setting of 14 cm H2O).  Autoramp takes about 8 minutes to ramp up from 6 to 14 cm H2O at these settings.  For a change, I only logged one 'H' apnea event after ramp-up this morning (even though I was definitely awake).

I think my awake respiration rate shown @ 12.12 breaths / minute is an OK daytime rate.  I wasn't even thinking about breathing while futzing with my phone so the SH graph shows my slow-down from my sleep rate of 24.20 to ~12.12 is quite normal, obvious and accurate.  I think elsewhere in these postings somebody said I should be around 15, or so.  I am well under that rate.

FYI, and thank you!
Carl / Tubaman
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
Those awake numbers are better than good, excellent for your age. My mistake, I should have asked what your daytime rate was. I assumed you were on o2 because there were more issues. Now I think your lungs are fine and there's no reason why you can't getting off o2

I think wait till you get over your cold and see the doctor. I didn't get too deep into your setup, It was just to get your o2 up, as I thought the doctor would order a titration and get sorted. Depending what the doctor wants to do now. You might want to start at the beginning. Perhaps not all the basic stuff was checked in the last 20 pages, like your chart looks like a nasal mask with mouth leaks, but your stats say ffm.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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RE: May be Too Late for Me Too
Thank you.  I rarely look at my awake stats but that particular chart gave a nice indication and we were talking about breathing rates -- so I looked and the breathing stats looked OK to me.

I guess I don't fit into any statistical 'box' for various reasons.  The human body is frequently unpredictable using statistics, far more than an ongoing, high-volume manufacturing process (which I am more accustomed to).

Sleep tests don't work for me -- unless they can be done at home.  This is largely because of my weird sleep schedule -- I can't get to sleep at 'normal' times such as around 2300 -- especially in unfamiliar surroundings.  The last times they gave me sleeping pills but that didn't help much (I still didn't go to sleep until 0300 - 0400).  Their sleep technician's shift ended at 0800 and the test itself ended around 0700, ergo, I didn't sleep long enough to complete their tests.  So far the only sleep test they let me do at home was the %SpO2 test (they would not believe my %SpO2 data, of course).

All my CPAP data is sent to them wirelessly so they should have access to what they need to evaluate me when I go in May.  Please correct me if I'm wrong on this assumption???

As my forum bio states, I use full face sleep masks (I'm currently using 2 of them, one is being cleaned / resting in a bowl of baby shampoo while I use the other one until it appears to need cleaning).  I have a well advertised ozone based CPAP system cleaner (I dare not mention the manufacturer's name for fear of the forum's wrath descending upon me).  I really think that cleaner may have been a big waste of money but I use it 1ce or 2ce a week -- more often recently because of my current cold bug.  I try to use a mask harness until it loses its elasticity and I cannot tighten it any more.  I pull the harness as tight as I can endure.  When the CPAP pressure approaches 20 cm H2O the masks usually leak, noisily, frequently awakening me with the noise and feeling.  I use a mask until it becomes too worn out -- that hasn't happened yet (I don't know how to determine if a mask should be tossed).  I finally threw one of them away about 6 months ago 'just on principle'.  New mask or old mask, they all seem to leak about the same amount with higher pressures.

Anyway, it's about 0410 here so time to try to sleep, I think.  Maybe some better stats tonight.  I reduced my minimum pressure to 12 cm H2O for 'tonight' to see if that is more comfortable for me and if I can sleep a little better.  I know you think I should raise it to 16 cm H2O but my gut feeling tells me that may not work for me at this time.  Sorry!  You're probably correct but I must try the 12 setting to see what happens before going to 15 or 16, and possibly higher (if that's possible?).

Thank you!  Carl / Tubaman
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
The section from 6:30 for a half hour does resemble mouth breathing with a nasal mask. There is the inhale, but the exhale seems reduced. Later you may want to zoom in and see what it happening along the night. To see if anything stands out and get some opinions.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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RE: May be Too Late for Me Too
I have never used anything other than my face masks.  If I'm somehow exhaling through my mouth (as in a nasal mask -- which I'm unfamiliar with how that functions), I have no idea how that's happening.  My mouth is never dry any more.  Maybe something wrong with my CPAP machine?  Other people have told me that I have different air volumes between inhale and exhale and said that is not possible so I don't know what is happening.

Attached is a blow-up of the time period you are mentioning (I hope).  Please let me know if I should post any other part(s) of that chart...?

I've always been weird in one way or another.  This is just another weirdness of mine, I guess.  I sharpened my mower blades yesterday and finished servicing my mower.  I was too tired to get online (I went to bed at a more normal time and actually slept the entire night with only one trip to the sandbox).  12 cm H2O minimum pressure seems to be more comfortable for me.  Sorry.

Thank you again!
Tubaman/Carl
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
That is zoomed in enough to see that there is an exhale breath below the 0 line. I would zoom in further in a few sections and count the breath per minute, to make sure the machine isn't miscounting them.

12 is fine as a treatment pressure, if that is what feels right. The machine will self adjust to what it needs. It needed about 15 as a median and 19 as a 95%. As in the last chart. The higher treatment pressure was to increase your o2. If it's fine at 12, there is no need for more.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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