[Symptoms] What happened between 04:40 - 05:00 ?

[edgnoj]

           

I had a good, quiet night in itself. However, when I looked in Oscar I saw a very strange deviation in the respiration rate between 04:40 and 05:00.

I zoomed in to show the start of this attack

And this is the end of this attack (figure 3)

These attacks come and go. Some nights I only have I think cardiogenic echoes, but this is something else I think.

I have some heartproblems. (congestive heartfailure, cardiac arrhythmias and have a 3 lead ICD)

What was happening between 04:40 and 05:00 am?

Please excuse me for using bad english

[edgnoj]

Edit:

Sorry about this mess. The third picture is the overview. Please look at the Respiration Rate at 04:40 - 05:00

The second picture is at the beginning of this attack, after cardial echoes I think

The third picture is at the end of this attack

[Sleeprider]

Edgnoj, we see this pattern in some individuals and it always correlates to an unusually high respiration rate. This makes it really easy to spot if you are looking at other nights of therapy. We don't fully understand it, but it seems to be an arousal or flow limitation marked by cardiogenic oscillations in the expiratory flow chart http://www.apneaboard.com/wiki/index.php...cillations When the oscillations are this pronounced, the CPAP machine erroneously records a breath cycle which is why the respiration rate is so high. We have not found a consistent way to deal with this form of respiratory instability, however we have often seen it in people that have ultimately treated it with resolution of flow limitation or where central apnea is present, ASV.

In your case we can see an obstructive apnea immediately before this event started at about 04:38. This event may have triggered a release of adrenaline to increase your breathing and heart rate. The breaths leading into the event at 04:38:45 show flattened tops indicating flow limitation or upper airway restriction. At 04:39:15 you have a dysfunctional respiratory flow with numerous oscillations. There is no effective airflow so that would be "felt" as an apnea by your body, but the CPAP just erroneously recorded a high respiration rate. This begins the unstable, very flow limited breaths accompanied by a pounding heart rate that shows up in the flow rate. Normal respiration resumes at 04:46. I think this event is a combination of airway restriction, possibly positional, and the effects of a good shot of adrenaline.

[cathyf]

This is my thread about me seeing this in my data: http://www.apneaboard.com/forums/Thread-...-your-data

Look at your Mask Pressure curve while this is going on. You will see that the machine is completely confused and can't figure out when you are exhaling and inhaling.

This started happening to me 6 years ago, and when using the autoset machine I would see an attack of it several times per week. Since I have had my vauto I have only seen it twice, and it is very very puzzling.

I think that it might be about a particular position in that there is frequently a flow rate pattern that looks like I moved at the beginning and then another one at the end. I am trying to work on getting a camera set up to record me sleeping to see if I can observe something that's happening during this that's different from the rest of the time.

This seems to be very rare, in that just a few of us here see it. Your experience is very valuable to figuring out what the common features are among all of us. For example, the graphs that you posted do NOT show movement at the beginning or end, they just start and stop suddenly over 3-4 breaths.

[Crimson Nape]

cathyf tripped a thought that is probably completely off the wall. I've seen both my wife and my pets exhibit a sudden oscillating breathing pattern during sleep. My wife later told me that she had dreamed of a stressful event prior to waking up after this occurrence. My pets would bark in their sleep like they were chasing something, or being chased. (Who knows?)

[cathyf]

Yeah, Crimson, but everybody does that! If it were something that common, then most all of us would see it in our data. And the ResMed engineers would have seen it in their testing and would have put in some algorithms to correctly figure out when people are inhaling and exhaling during this episodes.

It's got to be something unusual...

[desaturator]

I have a similar, falsely-reported respiratory rate fairly frequently. I'm not sure I'm seeing the same thing as the OP, though (see attached). I assumed that my false readings were caused by cardioballistic artefacts, since my reported respiratory rate rises to be about the same as my heart rate, which is usually about 50-55 at night.

In any event, I've assumed that these are just artefacts of measurement, and ignored them.

Sorry if I'm muddying the waters, and what I see is unrelated to the OP.

BW, DS

[edgnoj]

In your case we can see an obstructive apnea immediately before this event started at about 04:38.  This event may have triggered a release of adrenaline to increase your breathing and heart rate.  The breaths leading into the event at 04:38:45 show flattened tops indicating flow limitation or upper airway restriction.  At 04:39:15 you have a dysfunctional respiratory flow with numerous oscillations. There is no effective airflow so that would be "felt" as an apnea by your body, but the CPAP just erroneously recorded a high respiration rate.  This begins the unstable, very flow limited breaths accompanied by a pounding heart rate that shows up in the flow rate.  Normal respiration resumes at 04:46.  I think this event is a combination of airway restriction, possibly positional, and the effects of a good shot of adrenaline.

04:38:45 Are that flattened tops indicating flow limitations or are this dents on top of the curve caused by this heart oscillations? The Flow Limits are not very high

[edgnoj]

cathyf: I think it has something to do with expiration relief.
Since 2020 I have a Resmed Autoset10. Like everyone else in the Netherlands, my Autoset was counted as CPAP, with a pressure of 7.6. This made my sleep a bit more peaceful, but never quite ok. After finding out Oscar I found out why I didn't sleep very well. look at the first pictures. This was a normal night for me then.

Pfffft I wish my english was better  

After changing the settings to auto AND pressure relief to 3 this was the result. (third picture) My sleep was a lot better after that. Now perhaps once every month I have a small attack, thats it.

When more picture are helpful please ask

[cathyf]

Looking at your pictures, yes, that definitely looks like what I see in my data!

And I see that it is also related to EPR (which is called "pressure support" on a ResMed bipap.) I got a ResMed vauto machine in July, and I run pressure support of 4.0 on that machine.

What I see:
-- On the airsense autoset, EPR of 3 is better than EPR off, but I still get this breath pattern with EPR at 3, just shorter and less often.
-- On the aircurve vauto, PS of 4.0 and trigger sensitivity of "medium" is fantastic -- I've only seen this breathing pattern twice under those settings.
-- On the aircurve vauto, if I set PS=0.0, it's not as bad as EPR=0, but worse than EPR=3.
-- On the aircurve vauto, PS of 4.0 and trigger sensitivity of "very high" looks very much like EPR=3.

One of the things that you see on your graphs is that when this is going on the mask pressure graph shows the machine thinks every one of those tiny peaks and valleys are separate inhales and exhales, and keeps trying to take the pressure up and down to follow every one, and it can't change fast enough.

On my aircurve vauto with trigger sensitivity set to medium, if you look at the mask pressure it's not so confused:
   
That close-up is kind of interesting in that there is this spot right in the middle of the bad breathing where it goes back to normal (for me) breathing for a few breaths.
Here's that whole night
   
(the vertical green line is in the same place in both pictures.)
From the whole night you can see that it's a much more isolated incident.

What's also interesting from the zoomed-in view is that when I had those few normal breaths in the middle there are significant cardioballistic effects on the normal breaths (I have a lot of that) and I think that the jagged breaths are a lot more than that.

Also, my oxygen doesn't drop at all during these spells, while an apnea or hypopnea will make me desaturate. So I'm not thinking that we can classify these as some sort of apnea.