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flow limits, periodic breathing and unflagged events
#1
flow limits, periodic breathing and unflagged events
i sent the text below along with my sleepyhead data to a professional but i'm hoping the amateurs here will be willing to provide feedback particularly if the professional's feedback is substandard. 

i hope you can take a look at the cpap machine data and come up with a general analysis. Additionally I would like to hear from you about what I have noticed.
1) the inhalation wave form peak is almost always flattened. raising the pressure from 9 to 12 has not affected it.
2) there are usually at least half a dozen disturbances each night that don't get flagged as events but look like they might coinincide with awakenings.
3) there is usually a subtle periodic breathing pattern.

background:

age 54
height 5'7"
weight 75 kilos
coronary artery disease, stent, heart attack 2015, no clinical damage to heart
When i was a child, i never took naps. after adolosecence a three hour nap in the afternoon would be something i did whenever i got a chance.  if i didn't I would feel tired. doctors weren't involved until shortly after the heart attack when i was prescribed a sleep study after complaining that my nose would get stuffed up depending on which side i was sleeping on. i had a surgery to open things up but that didn't have any discernable effect. the first sleep study showed excessive leg movements but no apnea, that was three years ago. The second showed an AHI of 22 and the third was a titration where they raised the pressure to 9 at which point the snoring and apnea were significantly reduced.  after a few days of using the machine i noticed i was waking up without headaches and more refreshed. nightmares, bizarre dreams, and sleep talking/movements also became much less frequent. i have used the machine for 20 months. I am currently feeling particulary low energy and unrefreshed after sleep and have, over the past few weeks, been looking at my data in sleepyhead and reading forum posts. given how i feel and what i see in the sleepyhead data, i feel my sleep quality could improve.

the first attachment is a screenshot of whole night, last night. its pretty typical, AHI 0.90. Notice there are more blips on the flow chart than events flagged. 

   

the second is from 4:00 to 4:20 and has a couple unflagged events. you can also see the periodic breathing pattern and the chopped off inhalation waveform peaks.

   

and the third is a closeup of the same period of about 20 breaths, all of which have some quirky, chopped of top.

   

perhaps someone can help me with the uploading of sleepyhead data. it feels klutzy.
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#2
RE: flow limits, periodic breathing and unflagged events
i posted three of the same close up image. let me try again.

this should be the whole night.

   

and this should be between 4:00 and 4:20am

   
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#3
RE: flow limits, periodic breathing and unflagged events
Welcome to the forum

Please post with the left sidebar minus the pie chart and calendar. An F12 with OSCAR does this.

OSCAR has corrected literally hundreds of bugs found in SleepyHead.

The flat tops are flow limitations that should be corrected. That means to set EPR=3 fulltime. The close-ups also show some very minor expiratory mouth breathing. And yes, in general a plateau typically indicates mouth breathing, but not always.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#4
RE: flow limits, periodic breathing and unflagged events
Hello, alembica. I think it'd be worth your time to download Oscar and migrate your data into Oscar from Sleepyhead. You'll see instructions if you click on the Oscar link at the top of the page.

In addition to showing the side panel, could you show these graphs in one screenshot:

Events
Flow rate
Pressure (even though it's fixed)
Leaks
Flow limitations
Snores.

You can fit them into one screenshot by grabbing the horizontal gray bars that separate the graphs and pushing them up.
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#5
RE: flow limits, periodic breathing and unflagged events
We can help you optimize your therapy, but you didn't even include pressure data. As Fred said, the left side chart will show us the settings and range of pressure you experience, and you really need the updated OSCAR software. I'm certain you need to turn on EPR (exhale pressure relief) on your machine and we can help you identify your current optimal pressure range.
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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#6
RE: flow limits, periodic breathing and unflagged events
thanks for all the attention. I downloaded oscar and transferred the data. ill repost the images but with the sidebar included. i assumed my machine doesn't have epr but lo and behold, it does. was off, set to 3. i had changed the pressure a dozen times but never scrolled down. also i changed the language from spanish to enlish and "epr" replaced "ape". no more monkey business...

I always tape my mouth shut. currently the tape doesn't cover a small space on the corners of my mouth but I don't think much air goes by.

this is the same event but at a slightly different zoom. I squashed all six graphs to fit in one screen

   
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#7
RE: flow limits, periodic breathing and unflagged events
Good job on the chart (and nice bilingual joke!). Set the EPR to 3 tonight, as Bonjour suggested.

Tomorrow please post your chart with the EPR of 3, and also post the chart above zoomed all the way out, for comparison purposes.
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#8
RE: flow limits, periodic breathing and unflagged events
Let's start by turning on EPR full time and setting pressure to 10.0. That will produce a bilevel pressure of 10/7 (IPAP/EPAP). This will relieve the flow limitations, RERA and hypopnea, and may help with mask leaks. I think you're going to find it amazingly more comfortable. We need to look at your results after a night and see if the pressure needs raised for obstructive events from lowering your exhale pressure.
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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#9
RE: flow limits, periodic breathing and unflagged events
I wasn't able to use the machine the night before last but last night I did and with the new settings. I also loosened the mask a bit. I was optimistic but other than having trouble falling asleep and sleeping in it was a typical night - chopped wave form peaks, periodic breathing and I counted four unflagged disturbances not counting those near flagged events, waking up or falling asleep. In terms of how I feel also typical for the past few weeks. light desire to sleep more, very light headache.

The other thing I did different but I don't think affected my sleep was a lumbar belt that prevented me from sleeping on my back. I think it made me wake up after dreaming more but wasn't uncomfortable. It was supposed to help with lower back pain I have after a nights sleep and that improves as the day goes by. My back hurt as usual but I'm pretty confident that I didn't sleep on my back.

   
   
   
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#10
RE: flow limits, periodic breathing and unflagged events
It'd be helpful to know why there are those two long breaks between sessions, and also whether you were truly asleep during the first one. Could you let us know?

With the EPR of 3, your flow limitations were definitely improved! The additional information I've requested should help to determine whether changes in your pressure are warranted.
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