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[split] Amerikiwi1 - elevated respiratory rate
#1
[split] Amerikiwi1 - elevated respiratory rate
[This thread was split from a therapy thread by Budor where a similar problem was discussed http://www.apneaboard.com/forums/Thread-...atory-rate ]

Not intended to hijack Budor's thread but here is my screenshot taken a couple of nights ago. It happens 2 or 3 times a week, for about 20-40min and 2-3 times per night. I just thought it was REM sleep?


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#2
RE: [split] Amerikiwi1 - elevated respiratory rate
Amerikiwi1's post has been split into its own thread.
Crimson Nape
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#3
RE: Random periods of elevated respiratory rate
Amerikiwi1, that is not REM and it is not cardioballistic
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#4
RE: [split] Amerikiwi1 - elevated respiratory rate
Ok thanks. It just seems to coincide with RR, leaks, pressure and flow limit as attached.


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#5
RE: [split] Amerikiwi1 - elevated respiratory rate
Another most interesting flow rate pattern you have, Amerikiwi1. Some conjectures:

But first, please consider posting 2-minute wide views at 00:45 and 02:45, referring to your latest graph, and do two other similarly zoomed views from your first graph's all night session: one during a troubling episode with high flow limitations and one apart from those high flow limitations.

It seems to me you may have markedly flattened inspiratory flows with coincident low-level, short leakages in your first expanded view--those two detriments along with a cardiogenic wave superimposed over all. In addition, there may be an unflagged, fairly persistent, inspiratory flow limitation [IFL] during these (possibly position related) episodes.

If IFL is there, your airway vacuum is higher than for normal inspiration so the cardiogenic effect may be magnified and show up during most all the inspiration half wave. (It's easiest for a heart beat wave to dent a still rounded but resilient tube that is under a vacuum.)

In my case, cardiogenic effect is most visible for 2-3 beats as the expiration curve rises back to the zero line before another inhale starts. At that point both my breath intake (external intercostal muscles?) muscle tension and my airway-vs-bedroom-air pressure difference is at minimum. My almost-paused breathing system is close to being like a soft basketball, which holds its shape but is then most easily deformed by a finger punch. Similarly, the cardiogenic ballistic effect then would become most visible under conditions during the ending of expiration.
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.  (Disclaimer use permitted by sheepless)

 
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#6
RE: [split] Amerikiwi1 - elevated respiratory rate
(03-23-2021, 02:40 AM)2SleepBetta Wrote: Another most interesting flow rate pattern you have, Amerikiwi1. Some conjectures:

But first, please consider posting 2-minute wide views at 00:45 and 02:45, referring to your latest graph, and do two other similarly zoomed views from your first graph's all night session: one during a troubling episode with high flow limitations and one apart from those high flow limitations.

It seems to me you may have markedly flattened inspiratory flows with coincident low-level, short leakages in your first expanded view--those two detriments along with a cardiogenic wave superimposed over all. In addition, there may be an unflagged, fairly persistent, inspiratory flow limitation [IFL] during these (possibly position related) episodes.

If IFL is there, your airway vacuum is higher than for normal inspiration so the cardiogenic effect may be magnified and show up during most all the inspiration half wave. (It's easiest for a heart beat wave to dent a still rounded but resilient tube that is under a vacuum.)

In my case, cardiogenic effect is most visible for 2-3 beats as the expiration curve rises back to the zero line before another inhale starts. At that point both my breath intake (external intercostal muscles?) muscle tension and my airway-vs-bedroom-air pressure difference is at minimum. My almost-paused breathing system is close to being like a soft basketball, which holds its shape but is then most easily deformed by a finger punch. Similarly, the cardiogenic ballistic effect then would become most visible under conditions during the ending of expiration.

2sleepbetta I am just 55 days into APAP therapy so very new to all this. Here are screenshots from the same night at 00:45 and 02:45 as you asked. Not sure what you mean by the other two views as they are the same night.

I get very few flagged events which is good. I have been experimenting with mouth tape which seems to eliminate these crazy looking flow rate episodes.


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#7
RE: [split] Amerikiwi1 - elevated respiratory rate
Amerikiwi1,

First, my bad for not noticing your 3 OSCAR graphs were for the same night and were enough showing two main conditions in the same night.

I've looked about on the web and found some material that may apply or at least help you/us understand and pursue the matter with others. Though not at all certain about it, I continue to believe (have confirmation bias) my earlier conjecture about what is going on for you in those troubling episodes. Let's hope someone else can offer better ideas, which would be welcome. 

The graphic below depicts two things: Above, your 02:45 flow rate curve; below, a graph from an American Thoracic Society (ATS) "Questions" and "Answers" web feature that promotes MD education. Their Q & A item deals with and is titled "Artitfact in the Airflow". 

The link is to to the web page with "QUESTION | ANSWER" tabs near the top of the page. The link is to the question part. You must click the ANSWER tab to see the answer part. https://www.thoracic.org/professionals/c...hannel.php 

In the piece, three sentences stood out for me (my emphasis and bracketed insertion added):

"It is most often observed during exhalation and during central apneic events...."

"One further speculation is that transmission of cardiogenic oscillations to the airflow signal may be influenced by the degree of respiratory muscle tone. When there is high muscle tone during respiratory effort, the transmission of the pulse wave is diminished...."

"Additional recommendations included avoidance of supine sleep and [of course] counseling regarding adverse consequences of sleepiness on driving."


More eye glazing ruminations about your troubling flow rate curve, Amerikiwi1:

Again, the graphic below depicts two things: Above--your 02:45 flow rate curve; below--a graph from an American Thoracic Society (ATS) "Questions" and "Answers" web feature that promotes MD education.  

I changed the aspect ratio of your 02:45 segment (by dragging its low drag bar down) to show the frequent and most unrounded upper tips ("M-tips") of the inspiratory upper half of the flow rate curve. Those indicate inspiratory flow limitations (IFL). I suspect those limitations are present in much of your sleep that night (if not always). Note that it is true that there are both IFL and machine flagged flow limits (FL) in your 2-minute view. The latter arise when near continuous IFL becomes critical and causes, somehow, the flow rate (and related flow volume) to vary enough in a short time interval for the machine to flag a FL.

The M-shaped tips are prominent markers of IFL--which is related to flow limits our machines do flag, but different. A single FL reflects a certain number of seconds or breaths (I don't remember which) of breathing when the inflow of air dropped a certain percentage. On the other hand, IFL is often a  continuous condition that can vary some over an extended time period and be episodic too. 

For FL the machine flags, the concept is analogous to a plastic water hose that is kinked enough for a fixed number of seconds (say 12 seconds or 3 breaths) for water flow into a bucket to be reduced a certain amount (say 1 gallon or 3 liters). On the other hand, for IFL it is analogous to kinking, and keeping kinked, the hose for long stretches of time, maybe (for your {?) or my sleep) the whole night through. The latter condition in sleep requires your breathing muscles to work harder to draw in air, like sucking harder on a straw to get air. That tends to awaken many of us frequently, though we don't often remember that.

The ATS question and answer, in this case, shows cardiogenic ballistic artifacts (CBA) deforming the flow rate (FR) curve. The arrow highlighted curve below (ignore the other two lower curves) has similarities and differences from FR curves in your 2-minute view. Similarity is in the CBA "ripple" that shows prominently in two inspirations. Difference is in the base FR wave form that is being deformed by the ripple. The upper edge of the transparent gray bar I inserted (and messed up in the second image) is about where the zero FR line would be in OSCAR. 

In your case, the arrow-highlighted flow rate tip segments are pushed down farther onto and, also, slightly below the zero line. Your curve over the time span of one inspiration shows one most prominent inflow of air plus whatever inflow there is in the parts of the several ripples above the zero line. It seems possible, according to ATS, that some or most of the smaller blips above the zero line are from CBA and could (?) also make a slight contribution to inflow of air.

In my own CBA, it shows up in three or four ripples at the end of an exhalation, just before inhale starts. And my IFL does not flatten my inspiratory curve very much, though it does show up, even much more prominently, than in your "M" tipped curves selected below. 

Note that I have had some equally strange waveforms and do want to understand what is going on in such forms. This is a thought experiment to evoke others' critical thought and better ideas.  Quite possibly all is wrong in my part.

   
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.  (Disclaimer use permitted by sheepless)

 
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#8
RE: [split] Amerikiwi1 - elevated respiratory rate
The inspiratory flow wave with 3 or more peaks, I believe is a Class 3 flow limitation that likely is caused by tissue in the nose or throat vibrating or alternately opening and closing at a fairly high frequency during inspiration. This causes considerable resistance and long inspiration times, and is a serious form of flow limitation. This class 3 flow limitation seems to be associated with chronic flow limitation, but this form occurs intermittently. On Oscar charts this appears as periods of very high respiration rate up to 50 breaths per minute. I have not yet identified a consistently effective therapy approach, however increasing pressure support or EPR seems to help, and I have seen ASV also work to stabilize the condition. The condition is essentially unknown to sleep specialists and a sleep test will not sort this out.

From your charts, you appear to have very low event rates, highly variable flow limitation ranging from nothing to moderate and intermittent periods of this class 3 limitation. You are using EPR at 2. It might be useful to increase EPR to 3, however I don't know how to advise you to have this condition professionally evaluated.
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#9
RE: [split] Amerikiwi1 - elevated respiratory rate
Thanks guys for your very much appreciated look into this.

-I don't know where to go from here.
-What I do know is that I am getting better sleeps since starting APAP 56 days ago.
-I do have narrow/restricted airways and mouth breathe day and night. I have tinnitus, get blocked ears, cannot equalize normally, get allergies, nasal drip most mornings.
-I snore but not once since starting APAP. Snoring is the reason I got the Resmed.
-I get pretty much zero events showing on Oscar.
-I find the best settings for me on the Resmed are 8 min, max 13 and EPR 3. The F20 mask is working better right now. I do like the P10 pillows but I have one nostril that is a different shape and is also more restrictive than the other nostril so I'm not adjusting to it very well.

I have been trying different things and mouth tape been one. Below are two graphs from last night using tape and the F20 mask. My RR becomes more normal but the pressure still goes up at the time when my RR would normally increase without tape. I like the sleeps I am getting by using tape. The 2300 event was because I blew the tape off.

I would assume that by using tape it would not help IFL with someone like me with narrow airways etc, and other possible issues.

I did have rheumatic fever as a child but cardiologists have deemed my heart to be in pretty good shape. I'm 61.


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#10
RE: [split] Amerikiwi1 - elevated respiratory rate
You clearly did not experience the class 3 IFL last night, and as long as it remains an infrequent problem, the answer is to treat the other 99% of the time. EPR 3 looks very good, and your IFL falls within criteria I find well treated. Leaks are not a problem. Your AHI is perfect. If you can isolate the cause of the intermittent inspiratory flow cutoff I’d like to learn more about it.
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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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