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Vauto, PLM, FL & Mixed Apnea - Printable Version

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RE: [split]Vauto, PLM, FL & Mixed Apnea - mper6794 - 11-14-2019

(11-14-2019, 05:25 PM)mper6794 Wrote:
(11-14-2019, 05:04 PM)mper6794 Wrote: Hi, Dave ...(and Fred)...
 I have got the feed back an feel somewhat disapointed with myself at this moment. I would not have needed to be harsh to make my points.
Apologies if anything i have said sounded mady or ofensive. Moreover, please, give some bias on my backyard English.
Now, for all of us think about,  not know about PLMS, but the cases of UARS keep impressing myself, i think i could count some  one a day come in to the Forum.
All the best.

....I am afraid i made a mistake here: It would not not be one New UARS  case/ day, rather one case on the today's posts!
All the best.

RE: [split]Vauto, PLM, FL & Mixed Apnea - sheepless - 11-14-2019

thanks Dave. appreciate the support. feel free to jump in if anything occurs to you. as far as I can tell, these are relatively uncharted waters.
2 minute screenshots will have to wait til tomorrow...

RE: [split]Vauto, PLM, FL & Mixed Apnea - SarcasticDave94 - 11-14-2019

No prob. If something sets off the lightbulb, I'll post up.

Good eve.

RE: [split]Vauto, PLM, FL & Mixed Apnea - sheepless - 11-15-2019

I forgot to put the sd card back into the machine last night so I have only summary statistics.

vauto.  11/14/19.  ps 5.6 over 7.6-13.2.  ahi: 3.40; cai: 1.0. leak: 6. tv: 500. rr: 17. mv: 8.8.  IE: 1:1.8.  spont: 96.5%.

some 2 minute screenshots attached of the waxing/waning csr-like periodic breathing that's different from the pattern associated with my periodic limb movement.  these crop up in spurts, usually no more than a few minutes in duration.  with a history of ca, it could be recovery breathing after a respiratory slow down.  could be a variation of my more typical plm pattern.  I prefer to assume, with no basis one way or another, that it's not csr.  IDK if there's a build up to csr and this might be a precursor.  interested to hear what others think.

RE: [split]Vauto, PLM, FL & Mixed Apnea - bonjour - 11-15-2019

Only the last example shows the waxing and waning that is typical of CSR except for there is no central separating the groups. There is not enough of them to be a 'problem'. I take it as saying that you are near the CO2 threshold for breathing and therefore to keep an eye on it. Action if worse would be the basic Central Apnea responses of decreasing EPR or PS and lowering pressure.

RE: [split]Vauto, PLM, FL & Mixed Apnea - sheepless - 11-15-2019

thanks for taking a look bonjour. yes, it's really hard to see at 2 minutes. I had to scroll at 7 or 8 minutes to see the waxing/waning, then zoom in for the screenshot. I'm glad you don't think it's csr. I had some flagged a couple years ago with apap but you all felt at that time it was pb but not csr. I wasn't aware of plm and the plm pattern in my flow rate at that time. with asv, the beginnings of a sleep session would often look similarly csr-ish, then settle down as the machine evened out my breathing. for now, my inclination is to think of it as precursor ca less than 10 seconds followed by recovery breathing. I figure I'll just monitor it. I'm remembering now that there was some concern expressed about heart issues when I moved to asv without the heart test. of course I don't know this, and I figure neither is a danger, but I also figure there's less chance of such problems on vauto than asv. however, I'd be more comfortable with a little more info and a little less speculation on my part. largely just feeling my way around.

RE: [split]Vauto, PLM, FL & Mixed Apnea - bonjour - 11-15-2019

It does look like the warning about LVEF < 40% for ASV looks like it will be rescinded BUT that is not currently the state so you are likely 'safe' with that, time will tell.

RE: [split]Vauto, PLM, FL & Mixed Apnea - mper6794 - 11-15-2019

Thanks, Fred, by your observations. They are always wellcoming.

Hi, sheepless
What a pity on the card!
It looks to me nothing new on these 2-minutes strecthes, which show PLMS each 30 secs, well reflected on TV RR and Leaks as you move, everything as by the scripts. Intercalated, there are some flow reductions < 10s in general (some flat top or decreasing foreward, and even H).  As I said before, independent what comes first, luckily could be  improvement on PLMS by improving respiration, as by literature and my case (I think).
As your graphs had been suggesting plenty of room to increase PS, I think we could take the risk and move to EPAPmin: 7.6 PS:5.8, IPAPmax: 13,4. I think with these new settings (EPAPmin-PS: 1.8) we would be bordering to stop increasing PS for while, and decide whether or not going to increase EPAPmin, pending on outcomes on RR, ideal FLmax <0,10, general aspects of your waveforms, leaks, hYF, etc. 

As I have been saying: first goal is decrease your number of respiratory-driven arousals/awakenings, by adjusting to ideal, fine-tuned, your EPAPmin and PS. After this, it would come tackle remaining PLMS with your doctor. Again, there are chances of improvements of PLMS by bringing your FL/RERA-awakenings to an optimum (not necesserarily perfect, but the best we can).

good luck

 P.S: you pretty much can reproduce what happenings in your 2min-windows by layind down, tweaking your feet by 10sec, strecthing your body/ maybe groaning/moaning some times, and then relaxing. For some three nights I have audio-recorded this kind of things and following closely later on the waveforms. You can eventually try it.

RE: [split]Vauto, PLM, FL & Mixed Apnea - sheepless - 11-15-2019

I suppose I ought to get off my fat dumb and happy and get a video camera. obviously I'm hoping for some improvement with vauto but I am pretty much convinced that plm is the source of my residual fatigue and nothing short of adequately treating the plm will produce the results I need. still, I'm interested in continuing this until we feel the vauto is as tuned as best possible. then reevaluate. thanks for bearing with me.

I'm keeping the same settings as last night for tonight since I don't have data for last night. not feeling great today; much better yesterday. in addition to my usual ~5 mask off events, last night I was aware of lying awake more than usual with mask on. the difference between 1 and 3 ahi is quite noticeable in terms of how tired I am the next day.

RE: [split]Vauto, PLM, FL & Mixed Apnea - mper6794 - 11-15-2019

...that's fine! Maybe more adviced based on what you said.
.....hopefuly we would be approaching your tailored numbers on Vauto, and your body is giving the signals. Let us see.
All the best