Crazy Breathing Event (Waveform included)

[ScrewtapeJenkins]

bwexler, How can I read the leaks on the graph? Again, this is the first time I've ever looked at the data from this machine.

JustMongo, you asked about my oxygen levels. I'm looking over my original sleep study. Apparently, during that sleep study, I stopped breathing for 44 seconds at one point. But the study says my minimum oxygen desaturation was 88%. But that sleep study was conducted maybe 2 years ago at this point.

[justMongo]

90% (or 95%) is 90 percentile. It's a statistical construct. For a given parameter, such as pressure: the 90 percentile pressure is the pressure at which the delivered pressure is equal to or less than that pressure for 90% of the time.

Your Auto pressure range (from your profile) is 10 to 20. That's plenty of headroom for pressure to increase in response to events.

The question still remains: What's going on during those approx 60 second zero flow episodes? What is the pressure at that time? If obstructed, pressure cannot open a closed airway. The purpose of xPAP is to prevent airway collapse. Your arousal from sleep is needed to open the airway.

[vsheline]

Thanks, vhsine. But are those long apneas particularly dangerous? I've looked at a few waveforms here and I've never seen one that long. It looks like I stopped breathing for a full minute, which is kind of terrifying.

I've already increased my minimum from 4 to 10. I was working with a 10 minimum on that waveform. The weird thing is, my 90% is 11.5. So, I start off with a pressure that's pretty close to what I need. And my max is at 20, which is the highest pressure my machine can give.

Sorry, if it's not already obvious, I'm new to trying to read these graphs.

The Flow and Pressure are both plotted in each row, and the pressure scale is shown on right hand edge of each row.

So it looks like the RERA events were during the Ramp period, before the pressure reached 10?

60 seconds for an apnea is definitely concerning, but maybe not alarming. If you can, email the report to the doctor and ask what to do.

Some patients have 90 second or longer apneas.

A big question is how low is your oxygen getting, so I suggest getting a comfortable recording Pulse Oximeter (one worn on the wrist like a watch, with separate finger sensor cup, which puts less pressure on the finger than the type where the whole thing clips onto the finger). Good to have a Perfusion Index data being taken by the Pulse-Ox, too, to help see whether the Pulse-Ox was mounted well enough to see enough blood flow for accurate measurements. Supplier #19 sells these and has a good reputation. (Link to Supplier List is given at top of all forum pages.)

A SpO2 reading higher than about 96% or so may be too high and could cause problems. 94% to 96% is commonly considered ideal. Less than 90% or 89% is low. Less than 75% is severely low. I think life threatening would be quite a bit below 50%.

But best thing to do may be to make sure you are not rolling onto your back while asleep.

[bwexler]

If you look at the legend above the graphs, it defines LL=Large Leaks by a grey bar. Do you notice the grey bar over the flat line period. It also shows the red Presure Pulse indicator, which is part of how it detects what might be occuring. Then the Green bar for Periodic Breathing, which is NOT displayed in your graph.
So the large leak simply means your mask was leaking so much that the machine had no idea weather or not you were breathing.
It is likely the leak disturbed your sleep, maybe blowing in your eyes. that might account for your not feeling well rested.

[ScrewtapeJenkins]

I don't have any data about my oxygen. Again, the lowest oxygen level from my sleep study was 88%, and that was probably during a 44 second event. Is 88% okay or is that pretty bad?

[justMongo]

You had a brief break in your graph, followed by a large leak, coinsiding with your flat line.
You may have temporarily removed or dislodged your mask, causing a major leak. The large leak prevents the machine from properly recognizing what is or is not happening, other than the lesk.

Doesn't explain what happened at 02:34:30. No large leak scored there.

You're looking at end of the trace where he likely removed the mask.

Herr Zonk und Frau PaulaO2 wo bist du?

[ScrewtapeJenkins]

If you look at the legend above the graphs, it defines LL=Large Leaks by a grey bar. Do you notice the grey bar over the flat line period. It also shows the red Presure Pulse indicator, which is part of how it detects what might be occuring. Then the Green bar for Periodic Breathing, which is NOT displayed in your graph.
So the large leak simply means your mask was leaking so much that the machine had no idea weather or not you were breathing.
It is likely the leak disturbed your sleep, maybe blowing in your eyes. that might account for your not feeling well rested.

I'm pretty sure I stopped breathing in the event displayed on the graph. I woke up feeling like I hadn't been breathing for a while. Sort of lightheaded with tingly extremities.

I did have a periodic breathing event in my graph for the whole night. But just one, and not during any of the flat line events.

[bwexler]

I did not even notice the first event at 02:34:30.
If I had to offer an escuse for it I would say he was waking up and would have to call it Sleep Wake Junk.
Or maybe there was a leak just below the threshold for a large leak (79 vs 80) and the machine could not detect what was happening.
Or maybe he realy did stop breathing during that period.

Or maybe we need to wait for someone smarter than me to come along and tell us what is happening. there are at least several such folks around here.