Respiration rate awake vs sleeping

[SingleH]

Hi all,

Should there be any correlation between day time respiration rate and your respiration rate during the night, or are they largely independant?

For example if your respiration rate is 13-14 during the day when breathing unassisted and then when using your machine at night its 18-19 would this be considered problematic.

Ive seen the guidelines suggest normal is between 12 and 20 breaths per minute and the resmed titration guide goes upto 30. If I lower PS below about 6 respiration will start creeping up into the low 20's.

[PeaceLoveAndPizza]

Respiration rate during sleep varies by age and is given in ranges, not a specific number. From the studies I’ve read sleep respiration rate ranges are between 12-28 for an adult depending on age.

https://sleep.hms.harvard.edu/education-...ucation-47

https://www.sleepfoundation.org/sleep-ap...atory-rate

[SarcasticDave94]

Awake versus sleep breathing would be rather independent. When awake, you consciously control it to a point.

Wouldn't a PS of 6 plus on a VAuto be a bit high? If lowering PS is affecting respiration rates, it could be that this PS setting is affecting more than needed.

Note that this comment is based on no info from your therapy thread. So I don't know why your settings are what they are.

[SingleH]

Thanks for links and confirming!

[SingleH]

Hi SarcasticDave94,

Your question about the PS being a bit high is indeed one of the reasons why I am asking, as I have been trying to see if I can bring it down. The reason for it was to stabilise the breathing waveform and reduce flow limits. As the PS gets reduced the waveform tends to just collapse into a mess and respiration rate goes up as PS goes down. To actually get flow limits to a decent number and a good waveform it had to be on a PS of 8 but that caused constant centrals, so around 6 struck a balance of maintaining good figures and a half normal looking waveform.

[SarcasticDave94]

What would a bit higher EPAP and lower PS do for your therapy?

A person like myself would do OK with sometimes higher PS but not always. I have both Central and Obstructive Apnea, then COPD.

Anyway, if you're trying to bring down FL, there's probably 2 ways to attack. That would be increased PS or EPAP. Since higher PS affected breathing in some way, maybe swapping the numbers may help.

[SingleH]

Yes I have tried upping the EPAP and lowering the PS, but unfortunately it always seems to result iin a high leak rate even when keeping the same total IPAP.

I have normally proportioanlly reduce/increase EPAP and PS with the same amount but will probably have to try sacrificing more PS and just raise EPAP slightly.

The pressure support I believe is helping stablising the waveform due to scoliosis creating some restrictive resistatance that normally results in more shallow breathing. I guess the question is could too much PS be causing a problem by trying to overcompensate. I may try lowering the PS slightly and see if the respiration rate stabilises out over time if 28 is still considered normal there is scope to increase. 

You mentioned you have COPD which is another form of restrictive condition, what sort of PS level do you find works for you?

What is typically considered the point at which someone is running a high PS level?

[THEVGE]

Interesting question, I am also struggling with EPAP vs PS with ineffective therapy. My current approach is the following, maybe it is helpful for your insights.

- I also wondered why my sleep RR average is typically higher then my daytime RR average. I believe this is not good and may indicate stress (in my case my nervous system is indeed stressed, working on that).
- I increased PS until I see nice rounded tops in my flow rate. Independent of EPAP I need a PS ~ 5.4. Pretty high when compared to general.
- Theoretically EPAP should take care of AHI, in my case even the lowest EPAP is enough. I tried EPAP 4 - 12 but I have not found a therapy yet that feels good.
- Because my subjective sleep quality sucks at any setting (although some settings, like low PS, make it worse) I am currently relying on measured data.
- Besides OSCAR I rely mainly on my finger oximeter (SpO2 and heart rate data). I just started, but my current KPI's are SpO2 basal (higher is better, trying to be above 95 %), SpO2 events (lower is better, seems high EPAP reduces events sometimes < 1/hour), heart rate events (not sure yet what is good or bad, but lower is better) and RR (I believe lower is better).

Looking back I varied settings to much and too fast. I have learned to sleep at least 1 full week after a change and I keep an extensive logbook.

[SingleH]

Interesting question, I am also struggling with EPAP vs PS with ineffective therapy. My current approach is the following, maybe it is helpful for your insights.

- I also wondered why my sleep RR average is typically higher then my daytime RR average. I believe this is not good and may indicate stress (in my case my nervous system is indeed stressed, working on that).
- I increased PS until I see nice rounded tops in my flow rate. Independent of EPAP I need a PS ~ 5.4. Pretty high when compared to general.
- Theoretically EPAP should take care of AHI, in my case even the lowest EPAP is enough. I tried EPAP 4 - 12 but I have not found a therapy yet that feels good.
- Because my subjective sleep quality sucks at any setting (although some settings, like low PS, make it worse) I am currently relying on measured data.
- Besides OSCAR I rely mainly on my finger oximeter (SpO2 and heart rate data). I just started, but my current KPI's are SpO2 basal (higher is better, trying to be above 95 %), SpO2 events (lower is better, seems high EPAP reduces events sometimes < 1/hour), heart rate events (not sure yet what is good or bad, but lower is better) and RR (I believe lower is better).

Looking back I varied settings to much and too fast. I have learned to sleep at least 1 full week after a change and I keep an extensive logbook.

Yes its best to make changes slowly and log them.

I have not found much to clarify as to why faster breathing can occur at night, other than shallow breathing can cause the body to increase breathing rate to compensate.

If I increase PS to get nice rounded tops and minimise flow limits a PS of 8 is needed which causes loads of Centrals.

With EPAP its either a case of leaving it around 7 or 8 to control AHI's anything lower and the machine is then going back and forward with pressures trying to handle them, which in turn I beleive disturbs sleep quality if their are wild swings in pressure.

heart rate is around the 55 mark on average and Spo2 is pretty much always in the normal range so the high respiration rate doesnt seem to be affecting those figures. Does your heart rate change when your respiration rate goes up?

[THEVGE]

What I typically see:

- While awake with mask on SpO2 is 98 % or higher; the moment I start sleeping I get a huge drop (sometimes 85 %) after which it stabilizes around 95 % on average. Not sure yet why and if this is OK or not, but I do not like this.
- When I combine OSCAR, finger pulse oximeter and my Pixel Watch 3 it is pretty consistent. I can see a RERA in OSCAR, that matches an awake moment on my Pixel Watch 3. Shortly after the RERA there is a measurable SpO2 increase to "awake level". Around this moment I always see a HR increase and a RR increase. The RERA's mostly but not always occur at relatively low SpO2 for me, giving me the feeling my body wants higher SpO2.

So in my case I am pretty convinced my therapy can be improved.

Coming week I am giving PS 5,6 over 7 a try (now PS 5,4 over 7) and the week after I intend going to EPAP 8 with the best PS of upcoming week. I will focus on reduced RERA and less SpO2/HR events with a high basal SpO2.