Nasty-looking cluster

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JeffV
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Nasty-looking cluster

Post by JeffV » Thu Dec 18, 2014 6:22 am

I haven't seen anything like this on my reports yet, and this is the highest AHI I've gotten since I started therapy. Can someone take a look at this and tell me what you see?


Image
Image


Is that possibly just mouth-breathing? Or did I really stop breathing for like 15 minutes?

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Pugsy
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Re: Nasty-looking cluster

Post by Pugsy » Thu Dec 18, 2014 8:57 am

It's NOT mouth breathing. Your leak line doesn't show any large leak during that time...in fact doesn't show much of any excess leak at all.

Something changed during that time frame allowing the airway to collapse because the pressure was insufficient at that time to keep the airway open.
The 2 most likely suspects are supine sleeping or REM sleep..or a little of both.
If you see this happening often then a pressure adjustment is needed. If it's a rare fluke and nothing else looks anywhere near this ugly then you may not want to do anything about it.

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Sleeprider
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Re: Nasty-looking cluster

Post by Sleeprider » Thu Dec 18, 2014 9:49 am

What was the pressure / flow rate doing during those events? What pressure range do you have setup?

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CPAPIST
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Re: Nasty-looking cluster

Post by CPAPIST » Thu Dec 18, 2014 10:00 am

Why did the respiratory rate drop during the cluster?

Just trying to learn a bit about this stuff.
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palerider
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Re: Nasty-looking cluster

Post by palerider » Thu Dec 18, 2014 10:03 am

CPAPIST wrote:Why did the respiratory rate drop during the cluster?

Just trying to learn a bit about this stuff.
if you're not breathing, your rr goes down.

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CPAPIST
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Re: Nasty-looking cluster

Post by CPAPIST » Thu Dec 18, 2014 10:06 am

But don't you huff and puff when the apnea is over and bring the rate up high? I've waken up like that before.
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palerider
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Re: Nasty-looking cluster

Post by palerider » Thu Dec 18, 2014 10:18 am

CPAPIST wrote:But don't you huff and puff when the apnea is over and bring the rate up high? I've waken up like that before.
the huffing and puffing, as it were is right there on the flow chart, as is the lack of breathing. rr is just a moving average of how fast you're breathing, stop, and it goes down.

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CPAPIST
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Re: Nasty-looking cluster

Post by CPAPIST » Thu Dec 18, 2014 10:30 am

That looks pretty sick for about 12 minutes. No wonder he called it a nasty-looking cluster.
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Re: Nasty-looking cluster

Post by palerider » Thu Dec 18, 2014 10:50 am

Sleeprider wrote:What was the pressure / flow rate doing during those events? What pressure range do you have setup?
look at the data on the left side panel before asking questions like that next time.

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JeffV
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Re: Nasty-looking cluster

Post by JeffV » Thu Dec 18, 2014 3:31 pm

I actually had pretty much the same question as CPAPIST regarding coming off of all of those apneas... usually when I have OAs, there's a pretty sharp spike in the flow rate immediately after, with it slowly settling back to normal flow rates (resting flow rate for me is right around or just over 20). This didn't show that at all - I immediately went right back to my "normal" flow rate without any increase at all. (Aren't those called recovery breaths?)

Another thing - it's possible for me to have been mouth breathing without leaking, I think. I catch myself doing it as I'm getting into bed just after I turn the machine on, usually. I'll be breathing through my mouth but not leaking out of my mouth as I'm doing it. (Trust me, I've done both - I know the difference.) Those two things put together are what's making me wonder if this might not be a horrendous bunch of apneas but rather me just opening my mouth and the machine being shut off from my airway. (No idea how that works anatomically, I just know I do it.)

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Pugsy
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Re: Nasty-looking cluster

Post by Pugsy » Thu Dec 18, 2014 3:41 pm

JeffV wrote:Those two things put together are what's making me wonder if this might not be a horrendous bunch of apneas but rather me just opening my mouth and the machine being shut off from my airway. (No idea how that works anatomically, I just know I do it.)
I know what you mean about mouth breathing and no leak showing up...I do it myself. Proved it once by doing it while awake and still on the machine. It did NOT give me a truckload of OAs or hyponeas and in fact no events at all got flagged.

Those ugly events are very likely the real deal unless you were maybe awake/semi awake during that period of time and awake breathing irregularities confused the machine but most of the time when/if that happens the events flagged are normally clear airway. Mouth breathing doesn't block off the airway/airflow like that.

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JeffV
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Re: Nasty-looking cluster

Post by JeffV » Thu Dec 18, 2014 3:59 pm

Ok, fair enough. I guess it really comes down to how "smart" the machine is. What keeps getting stuck for me is - if I've got the nasal passage blocked with my tongue (or however that works - I know nothing about throat anatomy) but my airway is still open and I'm breathing through my mouth, the machine would never know that since it's completely blocked before it even gets to my airway and could well be reading that as a massive apnea.. I know it misreads apneas for me going to sleep - those three apneas it picked up before midnight I know for a fact I was still awake and reading a book. (I always put my mask on first since I tend to fall asleep on my book.)

If I think about it I'll see if I can recreate that going to bed tonight. I'll definitely keep an eye out to see if this happens again, and if nothing else I have an appointment with the sleep doc next week to discuss my pressures (and hopefully avoiding a titration study). I'll point this out to him too.

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Re: Nasty-looking cluster

Post by Sleeprider » Thu Dec 18, 2014 5:31 pm

palerider wrote:
Sleeprider wrote:What was the pressure / flow rate doing during those events? What pressure range do you have setup?
look at the data on the left side panel before asking questions like that next time.
My comment was to point out the missing pressure chart, but good point. Seems 7.0 cmH2O might not be an adequate ceiling pressure to overcome the OSA that caused this cluster for whatever reason. An increase in max pressure is indicated if this pattern returns.

Hopefully Palerider will approve.

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palerider
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Re: Nasty-looking cluster

Post by palerider » Thu Dec 18, 2014 5:39 pm

Sleeprider wrote:
palerider wrote:
Sleeprider wrote:What was the pressure / flow rate doing during those events? What pressure range do you have setup?
look at the data on the left side panel before asking questions like that next time.
My comment was to point out the missing pressure chart, but good point. Seems 7.0 cmH2O might not be an adequate ceiling pressure to overcome the OSA that caused this cluster for whatever reason. An increase in max pressure is indicated if this pattern returns.

Hopefully Palerider will approve.
"ceiling pressure"? given that the machine is set at 7cm in cpap mode, not apap mode, the pressure chart doesn't matter much, in this case.

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Re: Nasty-looking cluster

Post by Sleeprider » Thu Dec 18, 2014 10:05 pm

I guess not.

This post was made by palerider who is currently on your ignore list

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