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What's with this newbie data?
#31
RE: What's with this newbie data?
(10-14-2017, 12:13 AM)HalfAsleep Wrote: On this one, I am getting air, but not a very robust inhale, since the flow is limited. And besides, just trying to get that inhale is quite a lot of work, as evidenced by the jaggies on the way up.
......

Jaggies are actually at the end of the exhale.

Am I allowed to link a scientific research paper as source?
Per Finnish research cited in an NIH paper, though I guess this is pretty obvious from the Sleepyhead graph. https://www.ncbi.nlm.nih.gov/pmc/article...po=32.7586

3 or more tiny peaks above the line=“Soft tissue vibration during inspiration.”

So, this might be a snore, or it could be a low vibrato or some such. I guess I’m doing opera practice in my sleep.
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#32
RE: What's with this newbie data?
Good questions. I already said that my assumptions about the origin of your CA events was likely in error, so I am going to recant the recommendations for fixed pressure and EPR. I had made the poor assumption in your case that CA was a conventional lack of respiratory effort; it's not, and we should have looked at the details first.

Your questions:
1. There were no snores..... Could there be other vocalizations SleepyHead doesn't capture as a snore?
Yes. The upper airway resistance can cause irregular flows and vibrations that look like snores. This is not a perfect set of data and includes no recording of sound like in the PSG posted above. If you read the Beginners Guide to Sleepyhead in the Wiki, you will see flow limitation and snores discussed there. The signatures of both are present in your graphs; however that is not certain evidence that a snore occurred. How would you know?

2. The night on my 2 minute snapshot above was the night you had me at 8-8 pressure and 0 EPR, so pressure range is not one of the variables that's making this picture.
Yes, my mistake as discussed above.

3. The two CA's (the first with an itty bitty snore) look like typical OA's, hard effort to breathe after an exhale, followed by a successful inhale and some busy-looking follow-up breathing. However,, there's no flow limitation, so they must be CA's?
Maybe. A true CA is an apena with lack of respiratory effort. We typically see breathing just stop. This image shows an exhale, but the jagged line above the zero line is the FOT probe by the machine to determine if the airway is open or closed. In this case the machine determined the airway is open. The machine cannot measure respiratory effort which is the defining characteristic of either obstructive or central apnea. This looks a little more central in nature than the previous example because following resumption of breathing there is a more gradual resumption of breathing. This is repeated in the second CA and we even see some periodic breathing following that that is flagged as hypopnea.
[Image: lb9r6fH.png]

5. Then on this one I'm working all kinds of hard and not getting much of anywhere. There's only 5 struggles long enough to qualify as apneas, but there's additional struggle going on between the first three and the last two.
These are similar events, and we see a reduction of effort without flow limit into the CA, with a more or less gradual resumption of breathing. I'm inclined to agree both of these examples are CA. The last CA in this sequence occurs on inhale with flow limitation and is suspect.
[Image: m04UY65.png]

6. On this one, I am getting air, but not a very robust inhale, since the flow is limited. And besides, just trying to get that inhale is quite a lot of work, as evidenced by the jaggies on the way up.
Remember, some of those "jiggles" are during exhale, and the inhale does not begin until the flow transitions above the red line. Most of the inhalation here has a good strong start but abruptly becomes flow limited. The kinda weird exhale is probably best thought of as an exhale with slight pauses and irregularities as if you might be playing a musical instrument...not what is happening, but it's simply a variation in exhale flow rate.
[Image: yZXmaW3.png]

Next up. What happened before we tried 8 cm fixed and removed EPR? Let's go back and look at some of those results.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#33
RE: What's with this newbie data?
(10-14-2017, 08:03 AM)Sleeprider Wrote: Good questions. I already said that my assumptions about the origin of your CA events was likely in error, so I am going to recant the recommendations for fixed pressure and EPR.  I had made the poor assumption in your case that CA was a conventional lack of respiratory effort; it's not, and we should have looked at the details first.

Your questions:
1. There were no snores..... Could there be other vocalizations SleepyHead doesn't capture as a snore?
Yes.  The upper airway resistance can cause irregular flows and vibrations that look like snores.  This is not a perfect set of data and includes no recording of sound like in the PSG posted above.  If you read the Beginners Guide to Sleepyhead in the Wiki, you will see flow limitation and snores discussed there.  The signatures of both are present in your graphs; however that is not certain evidence that a snore occurred.  How would you know?

2. The night on my 2 minute snapshot above was the night you had me at 8-8 pressure and 0 EPR, so pressure range is not one of the variables that's making this picture.
Yes, my mistake as discussed above.

3. The two CA's (the first with an itty bitty snore) look like typical OA's, hard effort to breathe after an exhale, followed by a successful inhale and some busy-looking follow-up breathing. However,, there's no flow limitation, so they must be CA's?
Maybe. A true CA is an apena with lack of respiratory effort.  We typically see breathing just stop. This image shows an exhale, but the jagged line above the zero line is the FOT probe by the machine to determine if the airway is open or closed.   In this case the machine determined the airway is open.  The machine cannot measure respiratory effort which is the defining characteristic of either obstructive or central apnea. This looks a little more central in nature than the previous example because following resumption of breathing there is a more gradual resumption of breathing. This is repeated in the second CA and we even see some periodic breathing following that that is flagged as hypopnea.
[Image: lb9r6fH.png]

5. Then on this one I'm working all kinds of hard and not getting much of anywhere. There's only 5 struggles long enough to qualify as apneas, but there's additional struggle going on between the first three and the last two.
These are similar events, and we see a reduction of effort without flow limit into the CA, with a more or less gradual resumption of breathing.  I'm inclined to agree both of these examples are CA.  The last CA in this sequence occurs on inhale with flow limitation and is suspect.
[Image: m04UY65.png]

6. On this one, I am getting air, but not a very robust inhale, since the flow is limited. And besides, just trying to get that inhale is quite a lot of work, as evidenced by the jaggies on the way up.
Remember, some of those "jiggles" are during exhale, and the inhale does not begin until the flow transitions above the red line. Most of the inhalation here has a good strong start but abruptly becomes flow limited.  The kinda weird exhale is probably best thought of as an exhale with slight pauses and irregularities as if you might be playing a musical instrument...not what is happening, but it's simply a variation in exhale flow rate.
[Image: yZXmaW3.png]

Next up.  What happened before we tried 8 cm fixed and removed EPR?  Let's go back and look at some of those results.

Oh my gosh, you’re wonderful, and since we both agree that my throat has potential music capabilities.... Wink

I have to go to work, but will post more later. My prescription (and all other graphs) were for 5-15.

I had also recognized my error on the jaggies being on exhale rather than inhale (in a reply rather than an edit), so I got the right lesson, Teach.  Coffee
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#34
RE: What's with this newbie data?
So I have charts for last night. This was 2 nights later than the night above.

Pressure was 5-15, EPR 2. I used no anti-leak creativity.

As far as I can tell, the overall look is not that different from the postings above with the pressure at 8-8.

[Image: L8qLo9Mm.png]
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#35
RE: What's with this newbie data?
Here are some zoomed in charts. I skipped the pressure chart, since the pressure stayed pretty much the same all night.

Egads, I had this mile long OA during a leak:

[Image: FCSBcWdm.png]

[Image: p36Adhlm.png]
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#36
RE: What's with this newbie data?
A couple more days at 5-15; they all start to look similar. High flow limit, a lot of untreated events, steady pressure.

[Image: YrdhaIWm.png]

[Image: Gpi2gPym.png]
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#37
RE: What's with this newbie data?
It's all very interesting, but to this point I have concluded you probably have mild complex apnea that will continue to be erratic with CPAP/APAP. Your results don't really change with fixed pressure, EPR on or off and it is occasionally bad enough to be a concern as shown by your Olympic breath-holding above. This is either going to settle out, or not and the ultimate therapy may be ASV. Not the first time you've heard that, right?

Meanwhile, the objective is to get pressures as comfortable and effective as possible. I can't tell you what to do because there is no right or wrong answer, but we have at least eliminated the simple possibilities.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


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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#38
RE: What's with this newbie data?
(10-14-2017, 07:00 PM)Sleeprider Wrote: It's all very interesting, but to this point I have concluded you probably have mild complex apnea that will continue to be erratic with CPAP/APAP.  Your results don't really change with fixed pressure, EPR on or off and it is occasionally bad enough to be a concern as shown by your Olympic breath-holding above.  This is either going to settle out, or not and the ultimate therapy may be ASV.  Not the first time you've heard that, right?

Meanwhile, the objective is to get pressures as comfortable and effective as possible.  I can't tell you what to do because there is no right or wrong answer, but we have at least eliminated the simple possibilities.

Thanks
That's not exactly prescriptive!

I hadn't had the ASV thing reach my ear yet with any overt highlighting.

"Complex apnea" was what the sleep center ARNP thought I'd have from my symptoms. That was before I had the sleep study. The sleep study missed most everything, as far as I'm concerned. They even had me negative for bruxism (I almost broke my jaw that night)  Thinking-about

----------
Here's how I think I should handle it.... I have my compliance review in 2 weeks. I'd like to be really prepared for it. I might need some help selecting key charts and 3 bullet points or so to focus on. My goal would be to advance my treatment so I can get relief for lack of sleep, 'cos I'm a wreck.

I'll leave my pressure at 5-15 until after my compliance appointment. That way, I don't have to deal with doctor fuss while they evaluate the situation and I wield my bullet points. Plus, I'll be able to see if I have fewer events as treatment settles in.

Does this seem like a productive plan?

-----------------


I've noticed that I get fewer leaks when I'm not trying to prevent leaks. Go figure.
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#39
RE: What's with this newbie data?
Try holding your breath for 55 seconds, then not take deep recovery breaths after. Betcha can't!

You have flow limitations that seem to be associated with both obstructive and central apnea events. Your event occur at any pressure at any time and we've done everything possible to minimize it with positional therapy and cervical collar. The apnea, flow limits and hypopnea you have looks like it would respond to pressure support (auto bilevel or ASV) to maintain a steady flow volume and respiration rate. Like many of your events, imagine if you could hit this event with a strategically placed blast of increased pressure to move the dial on the attempted inspiration...or remove the limitation from all those flow limits all night long. No wonder you're tired. You rarely get a full breath of air. I suspect they will want to try bilevel first, and in your case it may actually work. I could see you using 4-5 pressure support and doing pretty well as long as it didn't cause more CA.

[Image: p36Adhlm.png]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#40
RE: What's with this newbie data?
Thanks, SleepRider....Sounds like you wrote my compliance presentation for me and in a way I can understand! Bullet #1, Bullet #2....

The chart you show.....that's a good example of what I need for evidence? (Exhibit 1?) The wildly uneven oscillations and deformed caterpillars? I thought those were normal.  Thinking-about My charts have a lot of these.....


(Exhibit 2?) A segment of the miles of identical low amplitude oscillations? These aren't good, right, normal would be a lot taller?

(Exhibit 3?) A highly-cluttered flow limit chart

(Exhibit 4?) The several 50+ second caterpillars

(Exhibit 5?) Most of untreated events are centrals.
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