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What is this breathing pattern? Regular inhale, almost flat exhale
#1
What is this breathing pattern? Regular inhale, almost flat exhale
New to CPAP and interpreting OSCAR data.

I've been titrating to figure out the minimum pressure needed to prevent OA and using nasal pillows.

On Jun 16 and 19, the regular inhale/almost flat exhale is followed by a short period of tiny inhales and exhales then arousal. Those tiny ones have historically shown up with some OA events, so I assume they show an obstruction, especially being followed by arousal. This is why I increased the pressure. (Please correct me if I'm wrong about the tiny ones!)

June 16, pressure 8, no chin strap.
[attachment=66056]

June 19, pressure 9, chin strap.
[attachment=66057]

On Jun 20 and 21, those tiny inhales/exhales did not show up so I assume it successfully prevented what I presume are the OA events, but the regular inhales/almost flat exhales are still there.

June 20, pressure 10, chin strap tighter.

[attachment=66059]

June 21, pressure 10, chin strap same tightness, full mouth tape.
[attachment=66060]

Are those regular inhales/almost flat exhales also indicative of an obstruction (thus warranting increasing pressure)? I don't imagine that it's mouth breathing because it happens whether or not I use the chin strap and mouth tape, which are still fully secure in the morning.
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#2
RE: What is this breathing pattern? Regular inhale, almost flat exhale
Would you be able to repost directly in the web page? It looks like you formatted things outside the browser and pasted it into the window. I am colour-blind and cannot see the text. I do see the images.

Based on the subject line I expect you are asking about the flat exhales. Nothing to worry about as the 0 line does not show up. You have a -5 in place of the zero. We have many folks who are very well versed in OSCAR and can tell you how to fix it.

I see nothing surprising in any of the images. Typical sleep breathing with some arousals. Both the 9 and 10 pressures look acceptable to me. 

I would like to see a night with a range to titrate and find the best pressure. Consider trying something like:

Mode APAP
Min pressure 8
Max pressure 15
EPR 2 full-time (or 3 if you prefer)
no ramp

That should zero in on what would be the best fixed pressure, if that is the path you choose to follow.
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#3
RE: What is this breathing pattern? Regular inhale, almost flat exhale
Whoops! Here's the post again with the 0 line on the flow rate chart:

New to CPAP and interpreting OSCAR data.

I've been titrating to figure out the minimum pressure needed to prevent OA and using nasal pillows.

On Jun 16 and 19, the regular inhale/almost flat exhale is followed by a short period of tiny inhales and exhales then arousal. Those tiny ones have historically shown up with some OA events, so I assume they show an obstruction, especially being followed by arousal. This is why I increased the pressure. (Please correct me if I'm wrong about the tiny ones!)

June 16, pressure 8, no chin strap.
   

June 19, pressure 9, chin strap.
   

On Jun 20 and 21, those tiny inhales/exhales did not show up so I assume it successfully prevented what I presume are the OA events, but the regular inhales/almost flat exhales are still there.

June 20, pressure 10, chin strap tighter.
   

(continued in next reply due to 3 attachment limit)
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#4
RE: What is this breathing pattern? Regular inhale, almost flat exhale
June 21, pressure 10, chin strap same tightness, full mouth tape.
   

Are those regular inhales/almost flat exhales also indicative of an obstruction (thus warranting increasing pressure)? I don't imagine that it's mouth breathing because it happens whether or not I use the chin strap and mouth tape, which are still fully secure in the morning.
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#5
RE: What is this breathing pattern? Regular inhale, almost flat exhale
No worries. Something folks do not always consider, but easy to fix. Thanks!

Looks like I was correct in my assumption. What I said stands. Give it a whirl and let’s see where things go.
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#6
RE: What is this breathing pattern? Regular inhale, almost flat exhale
I do think you should bump up pressure a bit as your tidal volume is low. I was thinking you may be a wee lass physically which would account for the low tidal volume or you possibly had some lung issues going on, but I did not want to jump to any conclusions.

if you allow the machine to titrate you, it may end up with a higher pressure that will help with the tidal volume. If not, we can add some more pressure when we know the proper setting for a fixed pressure, if that remains your choice. I typically suggest a 95% for fixed pressure to those that want to try it.
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#7
RE: What is this breathing pattern? Regular inhale, almost flat exhale
Also I previously did some nights of APAP to figure out a starting fixed pressure.

After this night I decided the minimum pressure should be 8.
   

After this night I've generally set the pressure to a fixed 9 or 10. This is the same night as the first attachment on Jun 16, where I saw the tiny inhales/exhales at 4:29:30.
   
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#8
RE: What is this breathing pattern? Regular inhale, almost flat exhale
This is the conundrum many face. You can have a great AHI at lower pressure, but your sleep quality is not what it could be. You can have few flow limitations showing up in the counters, but still have it show up in your flow rate. 

As you seem to prefer fixed pressure, consider starting with a pressure of 9, then slowly going up by 0.2 every 2-3 nights. If you see things going off the rails, stop there and back off by the same increment. Stay there for a few more nights and see how it feels. 

One thing I would like you to try as well is keep EPR at 1 or 2. Having it at 3 seems to be too much and causes centrals. They may be treatment emergent, but lets keep it simple for now.

Ask questions and post charts when you have anything you want to discuss. You seem to have a good grasp of things already. We will do what we can to help.
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#9
RE: What is this breathing pattern? Regular inhale, almost flat exhale
Will do, thank you.

EPR 2 at pressure 9 was fine, when I increased to 10 it felt harder to exhale so I adjusted it to 3. My plan was to gradually reduce the EPR as I get used to it, but if I'm starting at 9 pressure I should be good at EPR 2 and decreasing it eventually to 1 or even 0. Overall I'm not too worried about most of the centrals, when I go through the data closely a lot of them are position changes.

I may be open to trying APAP again but early on it was causing me to wake up a lot. I suspect it would be easier on me with the 9 minimum pressure and a smaller range.

So to confirm--those mostly flat exhales are normal and nothing to worry about unless they are actually at 0, is that right?
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#10
RE: What is this breathing pattern? Regular inhale, almost flat exhale
Correct. Given your low tidal volume and I:E ration of 1:1, it is not unexpected. 

Note that when we see an I:E ratio of 1:1 or inverted as yours gets at the 95% and 99.5%, it typically means there are flow limitations that are not sufficient to trigger the counter. More EPR and pressure should help correct that, but if you are feeling well rested do not dwell on it. Things should get better over time.

Your logic around increasing EPR as you increase pressure is sound. Well done, young Jedi…
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