koy23 - Flow Rate Analysis

[SarcasticDave94]

A guess about lidocaine: uses are to relieve pain and to do so has a numbing effect on skin, this makes irritation, sense of touch, etc. less noticable thus reducing arousal, hypnic jerks are less noticable, etc.

[Ratchick]

That video was something else... how on earth did you a) take it and b) even get close to falling asleep? Wow.

[koy23]

'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.

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.

yes that was me, i don't thing anyone did their own laryngoscopy here before
and yes I did check laryngospasms, here and on google, there was one person who suggested very high triggger and PS of min 5 but i'm not able to acheive that yet.

the thing is I think the spasms may not be happening at the throat level, but at the diaphragm level and hence those spikes you can see repeating in my flow rate.
When this started and I was awaken, I would have a sudden inhale as soon as i'm awaken that I could not control ( my diaphragm would weirdly inhale then exhale) , but the crazy docs all went into sleep apnea route. Now i'm thinking maybe I should check with pulmonlogist, but i have already been so disappointmed with doctors ( more than 150 visits past 3 years) that I am trying to see if i could circumvent it using the Aircurve.
I'm thinking to increase trigger to v.high , increase Timin to 0.8 according to my respiratory rate. cycle to low and maybe keep PS 4 or 5 if my lungs can accept higher pressure.
Attaching my last night ( i kept waking up more, when Increased EPAP, apneas started for some reason)
also these spikes I'm talking about
[attachment=39034][attachment=39035][attachment=39036]

[sheepless]

are the spikes associated with the spasms (do you have that many)? i imagine you've ruled out hiccups?

this strikes me as not pap related but an in-lab sleep study focused on the specific problem rather than apnea might enable the right doctor to diagnose it (not sure what specialty that would be).

I'm also not sure i understand how vauto timing controls would affect this but what are your present settings for cycle, trigger, ti min & max?

one other thing I see is that your expiration time is quite a bit longer than inspiration time. generally that's good but your gap is longer than most (more than double in at least one screenshot).

I may not have an understanding sufficient to comment on your timing settings but hopefully someone will.

edit: i see you already answered my question about spikes & spasms. do these occur every 10 minutes all night? any pattern(s) you can discern regarding timing, potential triggers, anything at all?

[koy23]

That video was something else... how on earth did you a) take it and b) even get close to falling asleep? Wow.

Tbh, I'm still not sure how it worked! It was almost endless 72hrs of trying.

Got the thinnest endoscope from ebay, used a nasal stent plastic insertion tube ( for something called Alaxo nasal Stent that didn't work for me) , connected the endoscope to an iPhone that mirrored the video onto a bigger monitor.
Used a bedside table to place all that equipment while the endoscope camera would be laying down from the right table height. Slept right underneath the table, and inserted the tube into my nose.

Wife stayed hours trying to hold the thin endoscope li e as in one second saliva would blur the image. Sometimes have to take it out and reinsert as the endoscope camera would turn inside the plastic tube toward the wrong angle, inflamed nose airway made.it harder to insert it so many times. 
Then trying to fall asleep, with diaphragm moving the image up and down!
Wife again trying to stabilize the endoscope softly without interfering in my trying to sleep.
Fail and retry as I said 72 hrs till one of the trials worked and I fell asleep for like maybe a minute. 

I was almost sure that once I show to the "doctors" what is really happening- bc they kept saying they don't know as it happens while I'm sleeping - they will figure it out and fix it !

I have that video now for the memory

Neither I or my wife are medical professionals which is what amazed them the most.

[sheepless]

you mentioned diaphragm, which brings hiccups to mind, but I imagine that would've been of the of the first things considered. I know nothing of the mechanics of hiccups but my sense is that might bring digestion into the picture?

I hope you'll let us know when you figure it out.

[koy23]

you mentioned diaphragm, which brings hiccups to mind, but I imagine that would've been of the of the first things considered. I know nothing of the mechanics of hiccups but my sense is that might bring digestion into the picture?

I hope you'll let us know when you figure it out.

It's not a hiccup , it's like an involuntary/ uncontrolled sudden inhale that is very swift, then immediately a fast exhale. It matches the spikes in the graph.
I don't feel them while asleep, but I feel it when it happen right before I'm awaken. I'm not sure if it is the cause of the awakening but it might be.

[Geer1]

Pretty much everyone has those spikes in data (myself included) and they can be caused by numerous things. At worst they are micro arousals without awakenings, at best they aren't even affecting sleep (you can see how breathing remains stable because you continue sleeping).

Our body naturally takes little swallows to clear saliva. That could be what is going on and explain the spikes in data. I have wondered if it is the cause of my similar spikes.

[2SleepBetta]

Wow, koy! You, a troubled but thinking and determined sleeper, may have broken ground for careful UARS sufferers' DIY pes tests. The links below are a quick grab explaining "pes" from a simple search. I cannot vouch for the site or its info, but think it gets the basic ideas and some pros and cons across in a few paragraphs.

Frequently Asked Questions About Sleep Problems (csma.clinic) 

Slide 1 (csma.clinic)

A graphic at right in the second linked item hi-lights a swallow. Does that connect with your conditions at all? Another lower graphic there hi-lights paradoxical breathing (of interest to others, if not you Koy).

[koy23]

'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.

Wow, koy! You, a troubled but thinking and determined sleeper, may have broken ground for careful UARS sufferers' DIY pes tests. The links below are a quick grab explaining "pes" from a simple search. I cannot vouch for the site or its info, but think it gets the basic ideas and some pros and cons across in a few paragraphs.

Frequently Asked Questions About Sleep Problems (csma.clinic) 

Slide 1 (csma.clinic)

A graphic at right in the second linked item hi-lights a swallow. Does that connect with your conditions at all? Another lower graphic there hi-lights paradoxical breathing (of interest to others, if not you Koy).

thanks for sharing