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is this PP? plz help interpret flow graph
#1
is this PP? plz help interpret flow graph
After a year and usage of CPAP/BiLevel, MAD device, a UPPP(removed uvula, epiglottis, upper palate shaving) and a parial base of tongue shaving(15mm), i am still having arousals in sleep causing a defragmented sleep and drowsiness through the day..

I have recorded last night sleeping with the minimum pressure to check the flow rate graph and see if i can catch what is happening, i am using EPAP 4/PS 0/max IPAP 4 and nasal mask.

the screenshots are for flow graph right before i get an arousal where i turn off then on the machine to mark it.

Do you see Palatal Prolapse in these graphs? is the little flat line in expiratory curve a PP or is that normal ? the reason i am suspecting it is because my audio recordings (samples below) show a clicking noise or groaning noise only in expiratory breath before i wake up with a RERA. 


[Image: qtULKZD.png]

[Image: lNCWuL6.png]

[Image: 7mb4FxH.png]

[Image: IYn2qfk.png]

[Image: 8FmYzhX.png]

[Image: Iop4WJC.png]

before a RERA
[Image: jcaIltH.png]

[Image: 8BKKx3X.png]


3 Audio recordings:
-----------------------
clicking noise before a rera:
https://drive.google.com/file/d/1KfzywoB...sp=sharing

groaning noise before rera:
https://drive.google.com/file/d/1jz66Ogg...sp=sharing

just rera on exhale breath:
https://drive.google.com/file/d/1skMUFK0...sp=sharing
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#2
RE: is this PP? plz help interpret flow graph
That is not PP. With PP you would be exhaling through your mouth which would show up in the leak rate. Also the inhale and the exhale in the flow rate are as close to equal as I can visualize. This backs up the above..
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#3
RE: is this PP? plz help interpret flow graph
(10-16-2019, 02:31 PM)bonjour Wrote: That is not PP.  With PP you would be exhaling through your mouth which would show up in the leak rate. Also the inhale and the exhale in the flow rate are as close to equal as I can visualize.  This backs up the above..

I forgot to say I tape my mouth, bc if I don't air leaks of my mouth. 
Without mask at all I wake up catching my mouth open.

I don't know if that new info would change your conclusion or not.

If you still don't think it's PP, what so you think is causing the arousals based in graphs and recordings?
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#4
RE: is this PP? plz help interpret flow graph
(10-16-2019, 01:34 PM)sleepyzzz Wrote: is the little flat line in expiratory curve a PP or is that normal ?

Hi sleepyzzz,

I think the flat line in the Flow curve right before start of inhalation is a natural pause we all tend to have after we are done exhaling.

RERA is an arousal caused by respiratory effort during inhalation, and I think RERAs are often successfully treated by increasing the pressure setting for inhalation (IPAP) so it will be higher than for exhalation (EPAP), such as by increasing the Pressure Support setting if using a Bilevel machine, or by increasing together both the Pressure and the EPR if using a machine with EPR. 

Take care,
—Vaughn
The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#5
RE: is this PP? plz help interpret flow graph
You are exhaling through your nose. That means it is not PP.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#6
RE: is this PP? plz help interpret flow graph
(10-16-2019, 04:27 PM)bonjour Wrote: You are exhaling through your nose.  That means it is not PP.

Got it! So that little flat line before inhalation curve is normal? 
If my breathing is normal، and there is no OSA or Hypopnoea or CA, what is waking me up ? If you hear the recordings, I'm waking up with an involuntary deep inhaling, u could see it in the graphs as well
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#7
RE: is this PP? plz help interpret flow graph
(10-16-2019, 05:22 PM)sleepyzzz Wrote:
(10-16-2019, 04:27 PM)bonjour Wrote: You are exhaling through your nose.  That means it is not PP.

Got it! So that little flat line before inhalation curve is normal? 
If my breathing is normal، and there is no OSA or Hypopnoea or CA, what is waking me up ? If you hear the recordings, I'm waking up with an involuntary deep inhaling, u could see it in the graphs as well

Hope someone could answer me about this!
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#8
RE: is this PP? plz help interpret flow graph
my layman's impression is that your charts look great, your ahi looks great, your apnea is well treated and the fragmentation is probably related to something other than disordered breathing. IDK what to suggest other than working on sleep hygiene. cognitive behavioral therapy is also frequently recommended. the gaps in your full night flow rate graph are quite short. is there a reason why you're turning the machine off? my sleep has been very fragmented. initially I turned my machine off before realizing it. then I did so in order to measure and document the fragmentation. over time, I'm sleeping a bit better and I'm learning to leave the machine on to try to quickly fall back to sleep. I'm still awakening but if nothing else my sleep sessions look longer as a result. I say that tongue in cheek but I do think it helps train me not to wake up so often or at least shorten the duration of the waking periods. lately I've been waiting at least a few minutes of lying awake before turning the machine off. often, falling back to sleep takes less time than I'd otherwise spend with machine off.
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#9
RE: is this PP? plz help interpret flow graph
my charts ALWAYS looked great, but something is "closing" my airway and waking me up. it's just the machine is not registering it. the reason i am closing the machine is to MARK each time i have an awakening. so i can check the graph later. so you can see i woke up around 7-8 times "consciously" 

my initial sleep study before all the surgeries showed 23 arousals / hour NO OSA, 16.6 Hypopnea / hr and 6.5 RERA/hr, so something is narrwoing my airway causing my brain to wake me up thinking i will suffocate. problem is the machine does not show the hypopneas now because i wake up as soo n as it happens. 
i'm trying to understand the graphs and the audio recordings and all i could think of is it's something to do with expiration maybe my throat closes? and when expiring, air flow is narrow it makes a noise as a side effect, and my brain due of the closing wakes me up to open the throat muscles again ?
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