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koy23 - Flow Rate Analysis
#31
RE: koy23 - Flow Rate Analysis
(01-10-2022, 10:22 PM)Geer1 Wrote: Have you tried lowering trigger? I can tell it is an issue from the examples posted because you can see how the mask pressure is being triggered prematurely in some cases. Some times it is even causing a double pressure peak per breath. Being out of sync like that isn't ideal and I think dropping to high will probably fix it (if still seeing I would try normal).

No I have not, I'll lower it! Could you show me how you noticed that? I'm looking at the graphs trying to see what you just explained!
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#32
RE: koy23 - Flow Rate Analysis
Koy23, I was amazed at the assessment by Geer1 as well, mostly because your profile shows an Airsense 10 Autoset as your machine. Sometimes I forget to look deeper, so it helps if your profile is accurate. http://www.apneaboard.com/forums/usercp.php

Anyway, Geer1 never ceases to amaze recently.
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#33
RE: koy23 - Flow Rate Analysis
It was the odd shaped breaths that caught my eye and then I noticed how you had periods of double peak mask pressure. I looked at a couple like the attached one and realized that you were getting an initial IPAP increase prematurely. 

I didn't see any obvious cardiogenic oscillations etc to trigger the increase so was slightly surprised but assumed you must be using a very high trigger sensitivity which you have now confirmed. Lowering this setting will help avoid premature pressure increases and keep machine in sync with your breathing which will hopefully improve sleep quality.

In short there should be one good pressure wave per inhale and it should occur at the time of inhale, if you are seeing multiple pressure waves or they are out of sync with flow rate then it is a potential issue.


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#34
RE: koy23 - Flow Rate Analysis
(12-12-2021, 04:42 PM)sheepless Wrote: 'jerking awake' may have nothing to do with pressure.

with vauto, min pressure support is the setting to address flow limitations. some people are more sensitive to flow limitations than others but yours are so minor I don't think it's your problem. with fixed pressure I don't see how pressure changes can be a factor. if you've experienced arousals after a bump of .2 cmw, my guess is that it's the result, not the cause of your arousal. both screenshots are really good charts but higher pressure produced more mouth leaks so why not leave it lower.

to figure out why you're awakening, make a note of when you wake. stop flow for a minute, spike a huge breath or leak, speak to a voice activated audio recorder, use a video camera... then you can scroll through your flow rate at various view scales (I suggest 10 minutes and 3 minutes) looking for clues, especially in the few minutes leading up to the awakening. you're looking for disordered breathing, events, pauses that are less than 10 seconds, big flow limitations, leaks and repetitive patterns.

Thanks for all the info!
So I changed trigger and cycle both to medium, I have adjusted the settings for 3 nights to little lower pressure as my lungs feel "over stretched with higher pressure since covid.
The problem is, I keep waking up!
the advice in the forum is don't worry too much about the numbers , see how you feel in the morning, right I feel horrible, while the numbers are even better than before!
I keep waking up each time I'm dreaming, and when i'm awake I can't feel suffocated or anything! just awake! 
sometimes my heart is racing, and i remember each dream.. so each time I woke up last night i restarted the machine and posting the graphs..
I hope you ( or anyone here ) can tell me how to reduce the arousals! because the more times i'm awaken through the night the more i feel worse in the morning, sleepy and not a clear head.

thanks
           
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#35
RE: koy23 - Flow Rate Analysis
some more
           
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#36
RE: koy23 - Flow Rate Analysis
some more again
       
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#37
RE: koy23 - Flow Rate Analysis
I'll go out on a speculative limb because I really don't know what's causing your awakenings.

your flow rate looks to be full of unflagged flow limitations. the darker areas at or below the zero line look like some kind of hitch in your breathing, could be snores, grunts, throat clearing, floppy palate, etc. leaks may be disturbing you. we can see some huge spikes in the the all night pics indicating labored breathing. individually, none of these shout 'problem' but maybe together they add up.

video might shed some light on the matter.

meanwhile, I'd take advantage of the vauto's pressure support to try to even out flow limitations, areas of waning flow, maybe some of those darker areas.

min ps of 4 is pretty standard. you can move it up incrementally or at once. depending on how you react, you might need to reduce min epap if too much pressure.

idk if it'll help but we might learn something.

maybe others will have better insight.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#38
RE: koy23 - Flow Rate Analysis
(01-16-2022, 07:15 PM)sheepless Wrote: I'll go out on a speculative limb because I really don't know what's causing your awakenings.

your flow rate looks to be full of unflagged flow limitations. the darker areas at or below the zero line look like some kind of hitch in your breathing, could be snores, grunts, throat clearing, floppy palate, etc. leaks may be disturbing you. we can see some huge spikes in the the all night pics indicating labored breathing. individually, none of these shout 'problem' but maybe together they add up.

video might shed some light on the matter.

meanwhile, I'd take advantage of the vauto's pressure support to try to even out flow limitations, areas of waning flow, maybe some of those darker areas.

min ps of 4 is pretty standard. you can move it up incrementally or at once. depending on how you react, you might need to reduce min epap if too much pressure.

idk if it'll help but we might learn something.

maybe others will have better insight.

Thank you sooo much for taking the time , I think you are really close at your analysis,  because if I try to take a nap, as soon as I drift to sleep my throat jerks and I wake up , I EVEN DID MY OWN LARYNGOSCOPY a year ago, trying to capture it on video, this is the moment of spasm:
https://youtube.com/shorts/wM-QPT-27Ao?feature=share

This has been so frustrating with countless doctors and surgeries but still unresolved so I'm back to where I started with the xPAP machine as I don't see anything else that can help me, I'm trying to figure out if there is a way to adjust the machine that minimize the awakenings. 
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#39
RE: koy23 - Flow Rate Analysis
have you posted that video before? it's triggering a vague sense I've seen it or something a lot like it. have you searched this site for anyone with similar issues?

I imagine you're way past this but I'd be remiss if I didn't ask: you must have looked into & decided it's not something like sleep-related laryngospasm? idk a thing about it but a search on throat spasms at night produces a lot of information.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#40
RE: koy23 - Flow Rate Analysis
To me your data looks better, in the close up views your breaths appear more normal now. There is the odd little flow limitation but nothing that stands out to me as an issue. You could try higher PS but I would go to 3 before considering trying 4.

Only thing that stands out on the full night view are the periods of leak which could be interfering with your sleep quality.

I too remember your video from before but to my untrained eye it does not show a breathing issue. If I had to guess I would say the symptom you describe is a hypnic jerk which is for the most part normal although for some people they can occur too frequently and disturb sleep. In the past I spent some time on a facebook group for them and for some people it seemed to be stress and insomnia related (there is some literature saying they occur more frequently due to lack of sleep), a few members on that group appeared to benefit from topical lidocaine creams but I don't understand why and haven't followed that group in a while to see if they figured anything more out.
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