Can't get AHI below 38

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OkyDoky
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Re: Can't get AHI below 38

Post by OkyDoky » Mon Jul 06, 2015 8:37 pm

clearyt wrote:I am so sorry. I am getting lost in the conversation! What can I do that will help you all see what you need to see? I so want to get to the bottom of this and see results from the aggravation of the machine!
I knew we needed to dig a little deeper but dropped out of the conversation because I didn't have any answers. You have a good team looking at it now and hope you find your way to much better therapy. Keep asking your questions and don't get discouraged.
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Pugsy
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Re: Can't get AHI below 38

Post by Pugsy » Mon Jul 06, 2015 10:09 pm

Quick update.

Morbius...working on getting a zipped copy of the SD card and when I get it I will put it in my dropbox for you to get. In terms of meds...many meds for the heart stuff but no meds that are known to be bad in terms of suppressing respiration like opiates.
It will probably be tomorrow before we can get a copy of that SD card.
Original diagnostic sleep study was a home study of some sort where something was put over the head like a cap of sorts.

I did suggest that maybe they look into getting a recording pulse oximeter to see what is going on with the oxygen levels while all that ugly stuff is happening.

I also suggested that they start the ball rolling for getting seen by a doctor whose main focus is sleep medicine...and not a pulmo doc dabbling in sleep stuff because apparently that pulmo doc is getting reports from the SD card and saying that this is as good as it gets.

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Morbius
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Re: Can't get AHI below 38

Post by Morbius » Tue Jul 07, 2015 2:47 am

Pugsy wrote:In terms of meds...many meds for the heart stuff
clearyt, ever have an echocardiogram? If so, find the ejection fraction (EF). If it's <45%, there may be an issue in formulating a plan.
Original diagnostic sleep study was a home study of some sort where something was put over the head like a cap of sorts.
Something like this?

Image
I did suggest that maybe they look into getting a recording pulse oximeter to see what is going on with the oxygen levels while all that ugly stuff is happening.
Can't hurt, but (and?) I'm hoping this is pCO2-driven and we won't have to worry about that.

Too much.

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Morbius
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Re: Can't get AHI below 38

Post by Morbius » Tue Jul 07, 2015 5:26 am

OkyDoky wrote:Can anyone explain why the machine is'nt going higher?
The Non-Responsive Apnea/Hypopnea (NRAH) Logic is activated. 3 up, 2 down, wait, then bail.

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OSAHell
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Re: Can't get AHI below 38

Post by OSAHell » Tue Jul 07, 2015 6:07 am

Hy clearyt,

Just to add some thought based on my personal experience. The screenshot you post with an AHI of 35.72 look a lot like mine when I was on CPAP/APAP with a similar AHI. When I zoomed in to a 10 min windows of breathing I could clearly see CSR and/or strong PB where my events was clustered. But in my case (with a Autoset) my event was mostly CA with some OA and Hypo every now and then in those clusters. For example a night with an AHI of 37.11 would break down in 34.99 CA, 1.46 OA and 0.67 Hypo. So there was no much doubts in my case... In your case all those OA are very puzzling but one thing that could happen is that your apnea start as central and then your airway close (a mixed apnea event) and your machine flag it as an OA. Maybe Morbius can comment on that since he seem to know pretty well those machine's algorithm.

I've you been able to figure out how to zoom in your Flow Rate in Sleepyhead yet? If yes, can you post a zoom in of your Flow Rate from 4:20 to 4:30 of the night you already post to give us a better idea of your breathing pattern?

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Last edited by OSAHell on Tue Jul 07, 2015 8:13 am, edited 1 time in total.

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Pugsy
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Re: Can't get AHI below 38

Post by Pugsy » Tue Jul 07, 2015 7:16 am

OSAHell wrote:I've you been able to figure out how to zoom in your Flow Rate in Sleepyhead yet? If yes, can you post a zoom in of your Flow Rate from 4:20 to 4:30 of the night you already post to give us a better idea of your breathing pattern?
Either I or Morbius will likely share the flow rate graphs once we can get the SD card data.
OP was kinda overwhelmed with list of chores to do.
Morbius wrote:Can't hurt, but (and?) I'm hoping this is pCO2-driven and we won't have to worry about that.

Too much.
It would be really nice if that was the case because having a sleep study done in a lab setting is way down on the "I want to do" list. Can you PM me for a few more details that I can't/won't share publicly until I get the OK from the OP?

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OkyDoky
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Re: Can't get AHI below 38

Post by OkyDoky » Tue Jul 07, 2015 7:27 am

Morbius wrote:
OkyDoky wrote:Can anyone explain why the machine is'nt going higher?
The Non-Responsive Apnea/Hypopnea (NRAH) Logic is activated. 3 up, 2 down, wait, then bail.
Thanks Moribus. I'm learning here and after reading on NRAH I'm beginning to see the bigger picture.
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OSAHell
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Re: Can't get AHI below 38

Post by OSAHell » Tue Jul 07, 2015 7:39 am

Pugsy wrote: Either I or Morbius will likely share the flow rate graphs once we can get the SD card data.
OP was kinda overwhelmed with list of chores to do.
Thanks Pugsy,

Great, I'll wait to see those flow rate graphs. I've been following this thread since the start, but I kind of figured out that the OP was a bit overwhelme and it's pretty much normal if he never looked at his data before. But I was waiting for the OP to resolv his software problem with the others members and see some screenshot post before adding more infos...

And for the NRAH, I'll do a little google search to learn more about that for sure.

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Re: Can't get AHI below 38

Post by Pugsy » Tue Jul 07, 2015 8:49 am

https://dl.dropboxusercontent.com/u/978 ... Series.zip

Above is a link to my dropbox for the zipped P-Series folder. I was successful with getting the files loaded into SleepyHead. Haven't done Encore yet and don't know if I really need to at this point.

The CSR flagged breathing is definitely periodic in nature but the flow doesn't go totally flat like we see with typical CSR and the events are labelled OA and not central/CA. I will get a couple of images up shortly for those of you who are curious and don't want to download the whole file and run it through SleepyHead.
Give me a few minutes to get those images for you.

Will await Morbius's thoughts on what is going and any options that we might be able to do to improve the situation. Only change that was made last night was reducing AFlex from 2 to 1. No option to turn it off on the fly though I don't know if turning AFlex off would have done much.
It needs to be turned off in the clinical set up menu (if Morbius thinks it is worth trying) and last night OP didn't now how to get to the setup menu but I sent those instructions late last night so should be able to get there today. Changing to AFlex at 1 didn't seem to do anything (though I really didn't expect it to).

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Re: Can't get AHI below 38

Post by Pugsy » Tue Jul 07, 2015 9:01 am

Here's a couple of close ups of the periodic breathing for those of you interested.
I forgot to hide the calendar....oops but nothing on the statistics at this point is particularly helpful so I won't redo it since this was already done but will hide the calendar later.

Image

Image

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Re: Can't get AHI below 38

Post by Pugsy » Tue Jul 07, 2015 10:19 am

Couple of Encore waveform pages ....actually page 2 and 5....showing a little non PB flagged green breathing.
Pages 3 and 4 were all green.

Image

Image

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Re: Can't get AHI below 38

Post by clearyt » Tue Jul 07, 2015 10:40 am

What is the green?

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Re: Can't get AHI below 38

Post by Pugsy » Tue Jul 07, 2015 10:56 am

The green is the breathing that is flagged as periodic breathing/CSR time.

Periodic breathing is a waxing and waning of the air flow. CSR...Cheyne Stokes Respiration is a form of periodic breathing but not the only form of PB.
True CSR looks like this image below. What is seen on these reports is definitely a waxing and waning of the airflow but the air flow doesn't go so flat (the flat line between breaths on this image below).
I don't know the significance of the difference between the flat line of true CSR with Central flags and what we are seeing in these reports. Awaiting Morbius input in that regard.

Image

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Re: Can't get AHI below 38

Post by palerider » Tue Jul 07, 2015 11:30 am

Pugsy wrote:The CSR flagged breathing is definitely periodic in nature but the flow doesn't go totally flat like we see with typical CSR and the events are labelled OA and not central/CA.
remember, there is nothing flagged as CSR, it's flagged as PB, respironics don't call it CSR, resmed as10 does that.

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Re: Can't get AHI below 38

Post by Pugsy » Tue Jul 07, 2015 11:39 am

palerider wrote:remember, there is nothing flagged as CSR, it's flagged as PB, respironics don't call it CSR, resmed as10 does that.
I know...that's why I mentioned Periodic Breathing and gave the official definition and mention that CSR is just one of many forms of PB.
Whatever PB it is...it is still ugly and way too much of it to pooh pooh off at this point.

Spouse reports no snoring to speak of (not that the absence of snoring is a critical thing pointing to OSA) but also reports that for long periods of time the breathing just gets suspended or appears suspended.
No big gasps for air...just no effort to take in full deep breaths like we would expect to see while sleeping.
I don't know how much of a clinical significance the lack of effort is...but just thought I would mention it.
Hence the suggestion to also get an overnight recording pulse ox to see what the oxygen levels are doing with all this weird breathing.

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