[CPAP] Help Identifying This Waveform? +tips on minimizing nonflagged RERAs

[matt314159]

Hi folks!  This is my first post here, but if I may be so bold as to just jump into it, I'd like to pick your brains.  

I've been on PAP Therapy for about seven months now and I'm getting the hang of things.  AirSense 11 Autoset currently running 10cm in CPAP mode with EPR of 2.  F&P Solo mask, the cradle version not the pillows.  

I'm using this example from two nights ago in the attached screenshot: sleephq[dot]com/public/86b4dae5-cfe4-431c-8f54-7e7aba29e87f

Overall, I feel like my therapy numbers are pretty great. I should start mouth taping again to get rid of the last of the leaks and hopefully tamp down the flow limitations the leaks are apparently causing, but aside from that I'm feeling great and feel like I'm doing quite well with the therapy these days.

But my flow rate graph is still kind of spikey. Zooming in, I have this particular waveform pattern that pops up time and again. It seems to be a big deep breath, followed by a bunch of smaller breaths that almost flatline that was too short to flag as an event, but I'm quite certain it's a RERA of some kind.

I just don't get why that big breath to start these? In my mind, logic would dictate the deep breath would be after, not before. It's not what all my disturbances look like but it's a pattern I see over and over, and I'm curious about it.
Any ideas?

I'm at a point now where looking for ways to smooth out the flow rate graph even more to minimize RERAS even if they're not big enough to flag as an event. And this signature in particular stands out to me.

And, if you know what it's called, any advice on minimizing them?

[Dormeo]

Welcome, and congratulations on doing so well with your PAP therapy.

Looking at the snippet, along with some zoomed-in views of your Sleep HQ graphs, I think what we're seeing is arousal breathing. It tends to be deeper and messier-looking than regular asleep breathing. (That "messiness" sometimes earns a flow-limitation tag.) Because arousal breathing is deeper, it can wash out a little CO2 and briefly diminish your urge to breathe. Then after the diminution, you might breathe more deeply to catch up, which may in turn cause another diminution. This means you may have a period of somewhat unstable breathing.

There's nothing to worry about in any of this. Arousals are a normal part of sleep; it's only when they're very frequent that they become a problem. I think as you solve your leak problems, you'll see fewer arousals.

[matt314159]

Thank you, that's encouraging!  What would define "very often" as?  I just scrubbed through last night's graph zoomed in and count 16 or 17 instances.

[super7pilot]

What you had on that chart was a low Co2 event. Like dormeo said. That deep breath cleared enough Co2 that your blood chemical detectors and your brain got together and said. Ok, take a break from breathing or like in your case breathe lightly.

It’s normal.

[matt314159]

Thank you!  

I don't think I have ability to share links yet but here's my SleepHQ account share link --if there are any recommended changes any of y'all have, I'll be glad to hear them.  Specifically, the last two weeks are where I really hit my stride after a rather rough patch.  I feel like I'm more or less 95% there but could polish things up a bit I'm sure.

https://sleephq[dot]com/public/teams/share_links/4e0f945a-cad2-4977-9008-7c675d6bf951