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What may account for these suddenly longer periods of elevated pulse rate
#1
What may account for these suddenly longer periods of elevated pulse rate
Setting: I have a rate adjusting pacemaker set to a minimum of 60 to prevent bradycardia (that did dip below a HR of 40).  Paced  sleeping and resting HR has always stayed close to 60 except for motion or large amplitude bursts in FR. 

Thanks to my finding AB and seeing and getting spot-on titrating advice here at AB (and to my high tolerance for self-imposed, drastic measures to seal lips and stop supine sleep) my three month AHI is 0.1, one year 0.2. Those after a rough and poorly advised start with the great AutoSet that was prescribed--no complaint there except for the fixed 7 cm pressure--in 2015: severe OSA (RDI nearly 60 and an early period with total time in apnea of up to 36% (42% one night) and lots of >60 second OAs up to more than 2 minutes). My OSA was, fortunately, much easier to treat than what so many PAPers deal with. 

I will see my (vascular) cardiologist in three weeks after getting his newest stent placement on July 10; he had me wear the ZIO monitor for the two weeks before the new stent and it did record episodes of the new longer periods of elevated HR and the report back from iRythm should now be in his hands. I expect he will go over it with me. I had questioned him about the Subject of this post and it may have been a factor in his prescribing the ZIO monitor. I don't know if he had doubts about the electrophysiologist cardiologist's monitoring the pacemaker or about the pacemaker itself.  

To my Subject: Can anyone suggest why my 4 1/2 years of "shark fin"-like rises of HR suddenly (June 2020) changed to a more bar like or square wave like pattern ("SW") as is highlighted in yellow? The years of fin like rises (marked with green dots) have almost always been coincident with motions during sleep. The SWs rarely are singles; mostly they are groups of 3 or more and those almost always occur after the bathroom break if they appear. The graph shows a long period of elevation right after the break and then much more later. I believe I fell asleep during that first elevated time period after the break.

As depicted and in other SW episodes from time to time since June, there are no accompanying motions. I don't often recall dreaming and think I might have been dreaming where the maroon mark is (SpO2 irregularity and the several concurrent but "stranded" bunch of small FL) . A sleep report about 4 years ago (or  was it  the one 10 years ago?) mentioned my having little deep or REM sleep. Aside from any possible RERA like arousals that I would not recall, I believe I sleep soundly. Any trouble I have with falling asleep sometimes comes after a bathroom break and four or more hours of sleep--unless my mind is  still gnawing on some nerdy problem I had been working on or had spent too much time at the computer screen or coffee cup before turning in.

Many thanks for any suggestions.

2SB
   
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#2
RE: What may account for these suddenly longer periods of elevated pulse rate
I really don't know what to make of it. The flattened areas appear to be longer time spent at elevated rates opposed to the shark fin blips. I think you got the right idea, let doc know about it.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: What may account for these suddenly longer periods of elevated pulse rate
(07-21-2020, 09:39 PM)SarcasticDave94 Wrote: I really don't know what to make of it. The flattened areas appear to be longer time spent at elevated rates opposed to the shark fin blips. I think you got the right idea, let doc know about it.

Thanks, SarcasticDave94, you see the issue and what I must and will do. My very first impression--seeing no clue in FR variations, but with my uninformed-patient wheels turning--was that ejection fraction might have fallen for those limited periods, but if it was that simple one would think SpO2 would clearly have fallen for somewhat similar periods. It must be something going on in the CO2 and O2 sensing, breathing and HR control loop mixed in with rate-step levels in the pacemaker. Will revisit this thread and post what the MD reports.

Those eruptions of flattened peaks of continued elevation without any bases in bodily motion are entirely new and a concern I hoped someone here would/will show knowledge of--so I can pose the best questions for the MD.

Given this opportunity to reply I should make a point I omitted in the OP clear. Both kappa and I have found the Somnopose data import feature very helpful in allowing us to integrate with usual OSCAR graphics both sleep position and bodily motion graphics.  The "Orientation" window in the graphic is easily understood as indicating sleep position, but the "Inclination" label--applicable to the Somonopose device--is confusing if that window is used for presenting other data and left unexplained to the reader. In my use the Inclination window represents the combined effects of gravity and bursts of bodily motion on all three (x, y, z) axes of an accelerometer when the device is attached to my body as it moves from time to time during sleep. The cross hatches on the horizontal line vary in vertical height according to how sharp or intense the burst of motion is.  The width of the burst, of course, indicates the duration of the whole burst-wave string. Most of the graph is a horizontal line without crosshatches, indicating stillness.

One can see that there is motion concurrent with the "fins" early in the sleep session, but no motions concurrent with the SW's. I should have marked the green dots at the motions giving rise to the fins--ilkewise, should have marked in yellow the total absence of motions concurrent with the SWs. (The cluttering busyness of the red grid lines enables seeing such relationships.)

2SB
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#4
RE: What may account for these suddenly longer periods of elevated pulse rate
short response: most of the hr blips look to be associated with inclination (movement) and tidal volume. the later ones, not all but especially 8:15 - 8:30, look to be associated with flow limitations. nothing you haven't already noted and I don't know what to make of it; just that it appears there might be more than one thing going on there.
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#5
RE: What may account for these suddenly longer periods of elevated pulse rate
I had an appointment with the Medronics (pacemaker) tech at my cardiac electrophysiologist's office today. He interrogated the PM and reported that the change I saw in graphs from SpO2 assistant were wrong. 

There was no indication the PM was at fault. Since I could not and still cannot see clear correlations of those wide and flat-topped pulse rate increases with SpO2 level changes nor see any of the typical correlations of PR spikes with bodily motions (per accelerometer graphics) I need to rest in the belief the CMS50I has failed. One night it seems to be fine, the next night, those new, prolonged periods of false PR increases are prominent. The device is my second one since September 2015 and has been used nearly every sleep session. They last about 2 to 3 years. 

I need to consider getting a different wrist worn device that is compatible with OSCAR. I'd get the ResMed device, assuming it is OSCAR compatible, if there was any real justification for its high price, i.e. there is no good alternative. Suggestions would be appreciated. I don't yet use or know how to use Bluetooth and am not interested in any device OSCAR will not import. Sensor needs to be the typical finger boot or another type that will stay in place with, at most, easily applied tape. Those pinch clamp things used in MD's offices are too bulky and probably do not record data. The CMS50I would record a total of about 56 hours in whatever number of sessions; multiple session recording capability is desirable, but could be foregone.

Many thanks to all who read the OP and offered or will offer their thoughts.

2SB
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#6
RE: What may account for these suddenly longer periods of elevated pulse rate
Please read this review on the Resmed Oximeter http://www.apneaboard.com/forums/Thread-...-10-SERIES
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: What may account for these suddenly longer periods of elevated pulse rate
Thank you SR. srlevine's review was excellent, very well done as so many have noted. After reading it I called and left a message but have not heard back from vendor 19. Maybe GA has it shut down for Covid. 

Will bide time and indications here are one would benefit from talking to Mr. Cooper before making any decision on (now) my third oximeter purchase.
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