over 100 days in to therapy, seeking feedback

[Mike L]

It seems to be a given now that if I increase pressure than CA go up, lower pressure goes down. Unfortunately I forgot the SD card in the computer last night so no data :


However I went to pressure 5 with EPR 1, and that got me AHI 1.5, Total AI 1.1, Central AI 0.7  Woke up feeling a 100 times better than yesterday, but yesterday sucked. 

So far I haven't had OA come back at lower pressure. 

I'm trying to understand how heart rate fits into all this, I have some distinct patterns and wonder if others have them too. Here is last night imported into Oscar without the CPAP data if this is of interest to anyone. 

   
   

[Mike L]

also this is a more zoomed view of the "bad" night in a rough period with pressure at 10 and EPR 3. (The data on the left indicates my new settings because I was messing around trying to activate the User Flags 1/2 and deleted that days data and then reloaded in from the SD Card)

   

[Jadazu]

Mike,

For what it's worth, I have had similar breathing patterns. For me, they have happened at high treatment pressures and at low pressures. As my therapy has improved, the episodes of periodic breathing like that have diminished, over a several weeks of time. Also, for me, the pulse rate isn't significant, but the SpO2 percentage is a good indication of respiratory function, or lack of it. Compared to mine, your SpO2 levels are good...  As was mentioned, sleep quality is paramount. I guess that the larger fluctuations in SpO2, the large 'saw teeth' in the SpO2 graph, are somewhat disruptive to my sleep; If (when) I wake up from them, I am uncomfortable and somewhat distressed. Reducing those episodes has improve my sleep quality, so far as I can determine.

You don't have the flow limitations or the leak rates displayed in your last screen shot. What were the values of those? 

FWIW, also, I have just been told by an experienced sleep tech that towards your waking time on the report, maybe the last hour or half hour of your regular/expected sleep duration, that kind of periodic breathing occurs more frequently. 

I hope that helps,
Jim

PS: I haven't done it yet, but I'm planning to try the 'increased effective rebreathed volume' (it's called by an initialism like 'EERS', or something else) and it is a change in the mask venting to slightly increase the amount of air that is rebreathed. This should slightly increase the blood CO2 concentration, to damp the respiratory drive oscillations. There is a thread about this on the boards. I hope someone can correctly identify it...

[Gideon]

Let's not hijack this thread with an EERS discussion. Start a new thread for it please.

[Mike L]

Back to the significance of heart rate changes- I can see the HR spikes up, then down line up with tidal volume spikes down, then up. Any significance to that? Or should I start another thread for that as my topics are getting scattered here? I'm wondering if that is causing an arousal. 

thanks

   

[Gideon]

Therapeutically I can see where heart rate may increase where spO2 drops significantly so that the O2 in the blood is delivered 'quicker' though I do not know the mechanism that would drive this.
I see no arousals in this chart. Maybe possibly at 00:13, the view is not tight enough to make that call.

[Mike L]

I really appreciate the feedback. I'm an engineer so I guess I find looking at data about my own "systems" and trying to sort out how it all fits together rather fascinating. Switching gears yet again I was reading a lot of the threads on UARS and references to medical journals and I see it can be a debated topic and how the machine may or may not count flow limitations and RERAs. So I was wondering if this flow wave form is typical of normal CPAP support (if there is such a thing) or if it stands out as having a UARS component to it. Thanks again for taking the time to look and comment on what must feel like the same questions being asked over and over by the newbies. 

   

   

   

[Mike L]

I got my hands on an ASV and gave it a go last night using default settings for ASVAuto. I did notice that I forgot to change the mask from full face to pillows. Anyway I'd say I slept good overall. When I was first drifting off I think the breathing "help" startled me maybe two times, after that I don't recall noticing anything at all. I feel really good this morning. Maybe that's some placebo action so time will tell, but I'm pretty encouraged by night 1 on the ASV. I did notice more flow limits are flagged and at much higher value than I ever had on the Autoset.  If any of the gurus are still interested and care to comment on anything to keep an eye on or potential tweaks I'm all ears.  Thank you!!!