variable breathing rate

Can anyone explain the variable breathing rate data on My Encore? I usually range 19-25%. Last night I was at 13.2%. Is the lower number better? How is the rate determined? MY AHI was 0.9 last night. Thanks for your input.

It apears the variable breathing rate data, doesn't mean much, It means your breathing rate was changing or labored, go figure.

What I look out for is AHI, Pressure, and length of and Avg Apnea events.
Jim

alwealwe, I just found your answer to Variable breathing.....

Variable breathing, per Respironics patent and Derek is:
"defined as the situation when a person is not undergoing the quiet steady breathing of several stages of sleep. In particular, according to the Respironics patent ' it happens during wakefulness, distress, and REM sleep. This chart may be taken as an indication of how 'peaceful' a night was. Since REM sleep is a desirable state, some variable breathing is obviously a good thing."

I have been researching Variable Breathing and found this as about the best explanation, except that distree and REM are opposites. So if you have fifty to sixty percent Variable Breathing on your chart.....you are either having a GREAT night (REM) or you are having a horrible night (distress).

Does that help? Your 13% seems low and does not appear to be good. If it were ALL REM sleep, it seems low to me, but every human body is different with different needs.

Bottom line? Who knows. I hope my fifty to sixty percent is good. And I hope your thirteen percent is good.

If variable breathing occurs in Rem sleep, does that imply that if you are not variable breathing you are not in Rem sleep?
Jim

VB is certainly an indicator of REM. That said it's not for sure. I am guessing that VB of 20-25% may be in the normal range over time.

I checked my Variable Breathing for the last two weeks. This past week I avg
about 20-25 per night, the previous week, I averaged about 45-50.

IF VB is either REM or Distressed...how come mine dropped this week? I am very stressed over some medical issues. Last week I had REM sleep and my numbers were high. This week I am in distress, why aren't the numbers still high?

It makes no sense. Think about it. You are happy in June, therefore in REM
sleep the whole month with numbers in the 50s.

In July you are distressed ALL month, shouldn't the numbers also be in the 50s?

IF VB measures both??? We need more info on VB in order to make a logical decision.....no?

dllfo wrote:We need more info on VB in order to make a logical decision.....no?

I still doubt whether it would tell us very much.
(as per my remarks in the other thread: "Encore Pro V. MyEncore Variable Breathing")

I think it's "relative" for each person. I know that when I increase my pressure, my VB average increases slightly.

Den

Maybe an indicator or whether it is REM or distress might be how we feel the next morning. If you feel great, rested and remember a good dream, it was probably mostly REM.

Conversely, if you wake up wasted, irritable, your body hurts, etc, then I would think it was the distress stuff.

Yeah, I think you can search forever and not find out what a particular variable breathing (VB) value really means. Right off the bat, you've got:

Normal variation (REM sleep, normal wake periods)
Abnormal variation (insomnia, wake/1 transition, arousals from non-respiratory events)
Whatever the VB criteria actually is.
Criteria when it can't kick in (the algorithm hierarchy seems to say that if there are leaks, snores, or apnea/hypopnea, you can't enter Variable Breathing Mode (VBM)(I just made that up, too)(the acronym, not the hierarchy).

VB is not necessarily related to variable breathing per se, but rather the machine is in VBM. It has seen some erratic breathing and has suspended titration mode. Whether the erratic events are continuous or not is not known.

The basic goal of VBM seems to move the patients back to the setting that was in effect before the onset of erratic breathing. In both APAP and AutoBiPAP, this is accomplished slowly, at a rate of 0.5 cmH2O/minute, up to 2.0 cmH2O (using IPAP in AutoBiPAP, affecting EPAP only if an IPAP change would necessitate an EPAP change because of PS restrictions). Also, pressure changes are tempered based on the presence or absence of snoring prior to the initiation of VBM.

Being able to analyze a patient's VB Mode more closely would be extremely helpful. And not only when VBM is in effect, but perhaps ticks identifying VB triggers. This would show if the events were isolated or continuous.

REM sleep in adults is generally pretty stable, at least stable enough that if you see 25% VB you shouldn't think it's all REM. I mean, there may be a little variation, but I think the point of considering VB in REM is that you don't want to poke at it at all with unnecessary pressure changes.

You may already have a clue, tho. Dig up your sleep study (or studies) and find out the sleep efficiency, spontaneous and PLM arousal indices and REM%. You may be able to draw some conclusions from those.

Or, if you already know your sleep architecture is a wreck, then that could be the most likely culprit.

Course, I suppose some people could sit there, awake, like a rock and not have VB. For hours. Gad. Long night.

If there's a way to get a graph of VB vs time, then you can match it up with your sleep architecture histogram, and that might show something (we'll have to figure out exactly what later).

I wonder what a CHF/CSR patient (but I'm thinking not a CSBD patient) would do to the VB algorithm.

SAG (elsewhere) wrote:(There's a) laundry list of decision criteria.

Although not too bad, coupla shirts and a pair of pants. In a basic edit of the mechanics of VBM ("VBPC Lite")(and this might not even be what's in there now):

Variable Breathing Pressure Control

Once the variable breathing controller has been granted control of the pressure support system, it takes some initial action based on the action the auto-CPAP controller is taking. After this initial action, it performs an independent pressure control operation.

A prior pressure that is flat will cause the pressure delivered to the patient to remain at that level.

A prior pressure that is increasing will cause the variable breathing controller to initially decrease the pressure delivered to the patient at a rate of 0.5 cmH2O per minute. The magnitude of the decrease is dependent on the magnitude of the increase in prior pressure. The pressure decrease is intended to erase the prior pressure increase that possibly caused the variable breathing. However, the total decrease in pressure drop is limited to 2 cmH2O. After pressure decrease, the variable breathing controller holds the pressure steady.

A prior pressure that is decreasing will cause the variable breathing controller to initially increase the pressure delivered to the patient at a rate of 0.5 cmH2O per minute. The magnitude of the increase is dependent on the magnitude of the decrease in prior pressure. The pressure increase is intended to erase the prior pressure decrease that may have caused the variable breathing. However, the total increase in pressure is limited to 2 cmH2O. After pressure increase, variable breathing controller holds the pressure steady.

The pressure curve is provided for 5 minutes or until the variable breathing condition clears. Thereafter, the pressure is controlled according to the following:

The pressure is either maintained at a constant value, or it follows a decrease and hold pattern. The decision to hold the pressure or to decrease the pressure is made by comparing the current pressure with the snore treatment pressure. It is to be understood, however, that this duration can be varied over a range of durations.

If there is no snore treatment pressure stored in the system, which will be the case if the snore controller has not been activated, the pressure is held constant. If there is a snore treatment pressure, and if the current pressure is more than a predetermined amount above this snore treatment pressure, such as more than 2 cmH2O above the snore treatment pressure, the variable breathing controller decreases the pressure to a level that is a predetermined amount higher than the snore treatment pressure and holds the pressure at the lower level. The pressure decreases to the snore treatment pressure +1 cmH2O.

The duration during which pressure is provided according to the paradigms discussed above for region is set to 15 minutes or until the variable breathing condition clears. It is to be understood, however, that this 15 minute duration can be varied over a range of durations.

SAG