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+--- Thread: Looking for some help - almost 5 years and not feeling a lot better (/Thread-Looking-for-some-help-almost-5-years-and-not-feeling-a-lot-better)
RE: Looking for some help - almost 5 years and not feeling a lot better - SarcasticDave94 - 11-06-2020
That's my understanding of the settings as was mentioned by Crimson Nape. I've yet to use any of these as my ASV does not have these. However, an AVAPS mode machine should have something similar, and I'm attempting to learn similar time control concepts, and again, so far it lines up with what I'm seeing.
RE: Looking for some help - almost 5 years and not feeling a lot better - happydreams - 11-06-2020
Ok. So to put some numbers to this... My median BPM = 17.5.
At 17.5 BPM, that gives us 3.43 sec per breath. I just measured a single (median) cycle and found I=1.26 s, E = 2.146 s, this is a ratio of 1:1.7
My awake respiration is about 8.5 BPM. That is about 7.1 sec per breath. Rough I/E = 1.4 I=3.04 s, E=4.22 s
Dreaming/higher BPM is about 23 BPM or 2.6 sec per breath. I/E=1:1.07 I=1.35 s, E=1.45 s
Which breathing rate is used? There are 3. Awake, median rate, or higher dreaming(?) state. Thinking out loud, probably not trying to optimize awake state. So that leaves median and faster rate.
For a sleepy person, (raises his hand,) this isn't making too much sense. I thought I understood this (for a moment) but not any more.
Looking at the table on pg.6, I'd just guess TiMin= 0.7, TiMax =2.4, as it seems to bracket my respiration rates. Still clueless on cycle. I understand the description, BUT, I don't actually know which direction would make sense to try. If I want inspiration slightly longer I would use Low, vs. the Medium setting I have. Question is do I want longer inspiration, or shorter? I lack the experience to judge this. In over my head now...
RE: Looking for some help - almost 5 years and not feeling a lot better - SarcasticDave94 - 11-06-2020
Normally, sleep breathing rate should be slower and more consistent than wake breathing. I'd focus on your median number. And the I:E ratio should be close to 1:2 as in exhale takes twice as long as inhale. For some reason, your breath rate is on the faster side, so take that into account. For a comparison, my breath rate that the ASV records can be 8-10, with a few times up to 12 but it's rare. So my breath rate is a lot slower than yours.
Adding my recent 90 min "nap" in the middle of the night on the ASV. My sleep efficiency is in the toilet right now, as I'm in a fight to get a replacement machine. For compare/contrast purposes. And note that my therapy pressures are via the doctor.
[attachment=27921]
RE: Looking for some help - almost 5 years and not feeling a lot better - happydreams - 11-07-2020
Don't know if normal breathing applies to me... If everything was normal, well, maybe I wouldn't even have apnea.
I'm surprised to learn median sleep respiration rate is supposed to be lower than awake. Maybe I calm down when I put on the mask. (Is that anti-anxiety?) My initial respiration rate seems to be lower than the median, as I transition to sleep, my respiration rate increases.
It seems when at rest my respiration rate is lower and deeper. And at night during median sleep it is faster and shallower. Having measured it, my heart rate does decrease when asleep, like one would expect.
My I/E is less than 1:2, last night near 03:33, it measures 1.375/1.881 which according to my calculator is 1:1.37.
The measurement was taken during median respiration on a single cycle over the whole screen. Whether this cycle was totally representative, hard for me to tell. Maybe I need more pressure support to help increase exhalation time.
All this being said, last night was slightly worse than previous. Started out with a headache this morning which subsided a bit in a few hours. Dragging a bit today.
Last night tried. PS=3.2 over 8.4-13. Trig=High, TiMin = 0.7 (was 0.3), TiMax = 2.4, Cycle = Med.
CA/OA/H/UF2 = 2.03/0.63/0/0.25
Night seemed comfortable, did not wake up breathless.
Mask appears to leak some when head moves. Although there was movement during the night, it seems that most of the movement clearly occurs after the apneic event. (Getting better at reviewing video...) The movement was not as active as previous nights, which is good. Mostly a roll (back to side) or minor leg or arm movements - much calmer. Half the apneic events had no corresponding movement.
There was more clustering last night. I should have my new soft collar tomorrow. Maybe my old one isn't offering enough support.
Might try Trig=Very High and Cycle = High. I think this will maintain inspiry time. Maybe inspiry time was insufficient at Trig=Very High and Cycle = Medium settings? All I know is both times I tried Trig=Very High + Cycle=Medium I woke up within an hour or so distressed.
[attachment=27943]
RE: Looking for some help - almost 5 years and not feeling a lot better - SarcasticDave94 - 11-07-2020
On sleep vs wake breathing rates, when you're asleep breathing should be expected to be slower in most cases. Your actions and activity have slowed and the heart and breathing rates tend downward due to lower demands.
If you want to try edits to the trigger and cycle to see what happens, why not. Just follow up with details on whether therapy is getting better or worse for the changes. You may get a solution to pass on to another forum user.
Here's what I see on trigger, is that it's editing the sensitivity of a trigger signaling to the machine to switch to inhale pressure (higher pressure). Cycle is to edit sensitivity to cycle or switch back to exhale pressure (lower pressure). These may tend to help initiate inhale or exhale actions. So with trigger being more sensitive, it should trigger inhale quicker or more likely to trigger with less inhale indications. Then a similar cycle setting of being more sensitive, it also should more readily switch to exhale even if less exhale signaling is present.
RE: Looking for some help - almost 5 years and not feeling a lot better - Crimson Nape - 11-07-2020
I'm interested in your Flow Rate waveform. Can you provide a 2-minute snapshot, preferably near the middle of the night?
RE: Looking for some help - almost 5 years and not feeling a lot better - happydreams - 11-07-2020
Crimson Nape said, "I'm interested in your Flow Rate waveform. Can you provide a 2-minute snapshot, preferably near the middle of the night?"
Here is a 2 minute snapshot around 3:30am. Closest apneas are 25 minutes away. (However, there was a 2 minute arousal event at 3:25am with no flow limit, no apnea. Body movement was after arousal.)
[attachment=27952]
RE: Looking for some help - almost 5 years and not feeling a lot better - Crimson Nape - 11-07-2020
Thanks, but I was wanting a 2-minute screenshot of the complete (normal screen area) Daily Screen. I am wanting to see how the other parameters are responding for the same period.
RE: Looking for some help - almost 5 years and not feeling a lot better - happydreams - 11-07-2020
Oh. Here's all of it.
[attachment=27953]
RE: Looking for some help - almost 5 years and not feeling a lot better - Crimson Nape - 11-07-2020
My thought is to set your Cycle to "Low". This should extend your inhalation time, rounding your peak inhale waveform and hopefully allowing for more O2 saturation. This might reduce your headaches.
For what it's worth; I'm going to try different settings of the Cycle, just to see how much of an impact this parameter has.