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What could be going on here?
#1
Can anyone posit what might be happening in these flow rate graphs? There are no event flags and the breathing looks pretty normal right before the rate change but then it looks like I am gasping for air (some are worse/longer than others). Does this seem like something typical like turning over in bed or something or is it something I need to address in terms of it affecting my health. Thoughts? Thanks!!!

   
   
   
   
   
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#2
Are you changing sleeping positions?
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#3
I am just speculating here.

It may be RERAs. It is typically seen as a progressive decrease in breathing waveform amplitude followed by a large breath at the end (which is typically caused by the RERA). A few RERAs in the night may be acceptable but too many can disrupt your sleep architecture and make you feel like crap in the morning.

Your machine doesn't flag these RERAs. How does the flow limitation graph look at these breathing wave patterns?

You can probably take care of these with a modest increase in pressure (0.5cm - 1cm).
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#4
Thanks for following up! Not sure about changes in position as I typically don't wake up when I have the change in breathing. But they happen fairly regularly throughout the night so not clear if I would be moving around this much. Wanted to see if anyone else has experienced this issue on their graphs to see if it was a typical issue. My main concern was to see if it could potentially be some kind of unrecorded airway blockage that was causing me to gasp. Thanks again.
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#5
I doubt you have any problem since the flow rate varies due to various reason in a normally healthy person. Something as simple as swallowing your excess saliva, raising up to check the time, changing sleep positions, taking a sigh of relief and the list goes on. Your brain monitors several inputs as well as the O2 saturation level to determine how deeply you should breathe while asleep. Trust it to do the right thing or you won't ever get any good sleep. Bottom line...how do you feel? If you feel well and have no problems during the day related to insufficient rest, you need not over analyze your data. On the other hand, if you have good AHI ratings but still have problems during the day that indicate insufficient rest, you should pursue the matter and perhaps get a doctor's help.

If it help any, your flow rate graph looks much more uniform and peaceful than mine. Wink

Dude
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#6
Thanks for the info. I have been feeling really exhausted, which is one reason I was asking about the graphs. I was on fixed pressure for 6 years until 1 year ago and always felt great and then switched to variable by docs order. I have been extremely exhausted since that time. I did a sleep study and everything was pretty normal (no RERAs, no centrals). Two days ago, I went back to fixed pressure and the exhaustion went away (I could tell the difference immediately). I just wanted to ask about the graphs because the fixed pressure trial was on my own since the doc said I should be on variable since it is "better." I need to get an appointment with them to discuss how much better I feel on fixed pressure but wanted to make sure things are good in the meantime. I checked and I do not have flow limitations during or within 10 seconds of these breathing patterns. My AHI has always been less than 1. Thanks again.
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#7
OKbayareacpap, Thanks for the fill in that tends to show that you understand the therapy and have a good idea of what to say to the doctor about your issues of late. If he doesn't arrange to get you back to CPAP, where you were well treated and felt great, you can do it without any help other than what you can get right here and from getting the clinician manual for your S9 machine. Doing your own adjusting is easy. I have the same rig as you and have always performed my own adjusting, since I bought my equipment without any insurance company's interference.

Some people can't tolerate having the pressure changes that APAP renders. You seem to be in that group. By all means, return to CPAP at the previous setting even if you must set the machine up yourself. Ask your doctor why he changed you from CPAP to APAP and see if he doesn't agree to reverse that decision. The S9 can very easily be to set for CPAP operation.

Dude
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#8
(09-16-2015, 06:03 PM)bayareacpap Wrote: Thanks for the info. I have been feeling really exhausted, which is one reason I was asking about the graphs. I was on fixed pressure for 6 years until 1 year ago and always felt great and then switched to variable by docs order. I have been extremely exhausted since that time. I did a sleep study and everything was pretty normal (no RERAs, no centrals). Two days ago, I went back to fixed pressure and the exhaustion went away (I could tell the difference immediately). I just wanted to ask about the graphs because the fixed pressure trial was on my own since the doc said I should be on variable since it is "better." I need to get an appointment with them to discuss how much better I feel on fixed pressure but wanted to make sure things are good in the meantime. I checked and I do not have flow limitations during or within 10 seconds of these breathing patterns. My AHI has always been less than 1. Thanks

If you were doing great on straight pressure and it was a modest pressure (< 12cm) then there is no need to go variable.

I also had the same issue when I was on APAP (AHI < 1 but feeling like crap). As soon as I went to straight pressure, the fog lifted. There is a research paper on pubmed that talks about microarousals due to pressure changes. It found that 18% of test subjects had them on APAP. A microarousal is when you are knocked out of a deeper sleep stage to a shallower one. If this happens multiple times, you will spend less and less time in deeper sleep stages and more in N1 and N2. And you will feel unrested in the morning.

My advice is stick to what has worked well. You may tweak the straight pressure up or down, even use exhale relief if needed.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#9
Your graph is more settled than mine. And i run under 1 ahi 98 percent of the time.
My suggestion is stay apap, with min set at your fixex pressure and max at 3 cm above that just to let the machine deal with any clysters you may occasionally get.

If nothing is happening itll just run on the min pressure anyway.
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#10
I'm with Ghost1958.

That will work.

Smile
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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