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hookedonstitch - Therapy
#61
RE: Angela P Therapy
(08-10-2021, 08:32 AM)Sleeprider Wrote: Central apnea can take a number of forms, but it typically involves a gradually diminished respiratory volume going into the event and following it. This comes from reduced respiratory effort. Your event has the signature of an obstructive event, with flow limitation and respiratory effort leading up to it, and recovery breathing following it.  It simply does not fit the pattern for central apnea we expect to see.  I believe this is either an obstructive apnea, or a pause in breathing from movement or arousal.  Nothing about this event looks like a central to me.  In fact, right after the flag is a big inhale, and a breath-hold, followed by a strong exhale and increased respiratory volume.  This is most likely movement or change in position.

[Image: attachment.php?aid=34573]

Thanks for the description of this event Sleeprider, I can understand it more now.  I will take a closer look at some of my other CA events to see if they are similar to this one.  Why did my machine think it was a CA event though?
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#62
RE: Angela P Therapy
Last nights data shows a huge increase in flow limits, in fact if I am reading this correctly my highest number to date!  The appointment to talk about this with my Sleep Doc is not until Sep 16th.  Is there anything I can do while waiting?  If I ask my GP to send me somewhere else the wait will probably be longer.  

Which # do I need to follow on the flow limits?  Med, 95% or Max?

I tried purging my data and reloading it and still getting the error message.  Pressure is 7.0-.9.0 with EPR 3


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#63
RE: Angela P Therapy
The machine relies on "forced oscillation technique" FOT to determine if an apnea is obstructive or central. It is a 1-cm change in pressure at 4 Hz (4-times per second) and is interpreted by the machine software to produce a result. If flow is detected, the airway is open and the apnea is from CSA. The algorithm uses the resulting flow and pressure (determined at the mask) to measure whether the airway is open or closed. If no flow is detected, the airway is closed from an obstruction. The device responds by either increasing pressure or maintaining current pressure and recording the event for the patient’s apnea–hypopnea index (AHI) report. It's not infallible, and was wrong in this case, however in its defense, there are many reasons an airway may be detected as open during an apnea, but the event is not actually central. It's likely the double-CA event you had later in the night will look very different.
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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#64
RE: Angela P Therapy
If your sleep doc is not familiar with UARS he will simply see a AHI under one and say Awesome, keep doing what you are doing.
The Key is your flow limit chart and the RERAs. RERAs simply because they mean flow limits. Reorder your charts and put flow limits right below events.
Take a laptop with OSCAR in and show hi. How to zoom and scroll. If you don't have one borrow one. Tell him he is welcome to view the data on his tool but this is just reporting what is on the Machines SD card. Tell him your understanding of UARS and flow limits is that increased Pressure Support will go a long ways toward resolving them BUT your machine is limited to EPR/PS of 3. I doubt he will understand that. So before you see him sleep one night with EPR=0 so you can show him the difference.

Basically you want an Rx for a VAuto.
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#65
RE: Angela P Therapy
(08-10-2021, 08:58 AM)Sleeprider Wrote: The machine relies on "forced oscillation technique" FOT to determine if an apnea is obstructive or central. It is a 1-cm change in pressure at 4 Hz (4-times per second) and is interpreted by the machine software to produce a result.   If flow is detected, the airway is open and the apnea is from CSA. The algorithm uses the resulting flow and pressure (determined at the mask) to measure whether the airway is open or closed. If no flow is detected, the airway is closed from an obstruction. The device responds by either increasing pressure or maintaining current pressure and recording the event for the patient’s apnea–hypopnea index (AHI) report.  It's not infallible, and was wrong in this case, however in its defense, there are many reasons an airway may be detected as open during an apnea, but the event is not actually central.  It's likely the double-CA event  you had later in the night will look very different.

This helps so much Sleeprider!  I will attach my double CA towards the end of the night and I can clearly see how different it is.  So these are actual CA events because all I see is a flat line for the entire event duration?


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#66
RE: Angela P Therapy
(08-10-2021, 09:12 AM)Gideon Wrote: If your sleep doc is not familiar with UARS  he will simply see a AHI under one and say Awesome, keep doing what you are doing.  
The Key is your flow limit chart and the RERAs.  RERAs simply because they mean flow limits.  Reorder your charts and put flow limits right below events.
Take a laptop with OSCAR in and show hi. How to zoom and scroll.  If you don't have one borrow one.  Tell him he is welcome to view the data on his tool but this is just reporting what is on the Machines SD card.  Tell him your understanding of UARS and flow limits is that increased Pressure Support will go a long ways toward resolving them BUT your machine is limited to  EPR/PS of 3.  I doubt he will understand that.  So  before you see him sleep one night with EPR=0 so you can show him the difference.

Basically you want an Rx for a VAuto.

This is awesome Gideon except the only issue is that the Sleep Doc (and most of our docs) are only doing telephone consults right now.  They are refusing to see patients in person due to Covid 19.  I was wondering how much of my data she can see, if they are using OSCAR or are they just going by the summary from ResMed My Air?

I will ask if they know about UARS and describe how crappy I am feeling despite sleeping.  I have noticed the past few nights that it seems really easy to breathe in with the machine but my exhale feels weak, almost like I don't/can't quite finish exhaling if that makes any sense.  Does this have anything to do with flow limits or the EPR of 3?
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#67
RE: Angela P Therapy
So I am asking to be switched to a ResMed AirCurve VAuto 10 Bilevel machine? Just want to make sure I get the correct machine this time.
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#68
RE: Angela P Therapy
With most central apnea, we usually see an instability in the respiratory flow. It looks a bit like periodic breathing, and the CA event is just a pause in breathing with a gradual resumption of breathing. This pattern is often repeated as a feedback loop of low and high CO2 follows the respiratory rate.  In your case, we see very even flow-limited breaths separated by a brief pause in breathing, resuming with a normal size inhale.  I think is is more like "sleep-wake-junk", or arousal, rather than a true apnea.
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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#69
RE: Angela P Therapy
I think this is the worst I have ever felt since starting my therapy in January.  It doesn't feel like therapy, it feels like torture!  I am so tired and out of it that I literally cannot move from my chair and I am so over it.  I can barely keep my eyes open, I've had a headache since waking up and I have really severe brain fog.

Any thoughts on what I can do to get back on track?  You know back to when my flow limits were just sorta bad.  If I have to go through another day like this one I am going to throw my machine across the room!


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#70
RE: Angela P Therapy
I just read back through the posts and now that I am not feeling as helpless I understand that the only fix for this is getting the VAuto machine. Sad 

 I think I'm going to sleep without the machine tonight and see how I feel tomorrow.  It's not possible to feel any worse than I currently feel and I just need a reset.
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