Help interpreting waveforms

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cby1
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Help interpreting waveforms

Post by cby1 » Sun Feb 18, 2018 4:45 pm

I haven't been feeling well lately upon waking up despite very good AHI/RDI numbers since switching to BiPAP in October. I decided to look at the waveforms in some detail, and noticed what look like some "non-normal" waveforms despite zero FL. The first image shows breaths that look like they're flatter around 0 than they should be - I'd expect more of an upward slope (which I see in other places during the night - but a lot are flat like these).

Image

The second just has what look like spikey waveforms (for want of a better word). Are there issues here, and if there are, and likely to be something more central, since there's no FL? Too much pressure maybe (although no centrals to speak of - some longer flat spots like you see in the second chart that don't quite make 10 sec).

Image

Thanks.

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palerider
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Re: Help interpreting waveforms

Post by palerider » Sun Feb 18, 2018 5:09 pm

The first ones look pretty normal, the second are flow limited.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

USMCVet
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Re: Help interpreting waveforms

Post by USMCVet » Sun Feb 18, 2018 5:10 pm

Here is one thing i have noticed personally with mine..... When they are consistent i know I'm asleep. Some blips are there which i think is normal.

When i have erratic waveforms i know i was awake at that time. Do you know if you were awake for your erratic ones?

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TedVPAP
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Re: Help interpreting waveforms

Post by TedVPAP » Sun Feb 18, 2018 6:42 pm

The flatness around zero is the pause, prior to the start of inhalation. It is normal to have a pause.
Do you have any charts prior to starting bi-pap?

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cby1
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Re: Help interpreting waveforms

Post by cby1 » Sun Feb 18, 2018 6:54 pm

Thanks all.

PR: So there can be levels of FL that the Aircurve 10 doesn't report, or SH doesn't display (Flow Limit appears to be non-existent in the graph)?

Vet: You could have a point - I'll have to pay more attention to wake/sleep for erratic wave forms like these - can't be certain about last night.

Ted: Yes, I'll need to go back and look at those (CPAP wave forms).

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palerider
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Re: Help interpreting waveforms

Post by palerider » Sun Feb 18, 2018 9:52 pm

cby1 wrote:
Sun Feb 18, 2018 6:54 pm
Thanks all.

PR: So there can be levels of FL that the Aircurve 10 doesn't report, or SH doesn't display (Flow Limit appears to be non-existent in the graph)?
Apparently, because those lumpy inhalation curves aren't free flowing, if they were, they'd be nice smooth humps.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

ajack
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Re: Help interpreting waveforms

Post by ajack » Mon Feb 19, 2018 12:03 am

unless there is a specific reason to be on min 18
I'd actually lower your min epap, till you are 1-2 below your epap 95%, so I would reduce to min 16 and see how it went. leave the max where it is.

You know you need to fix your leaks or try another mask.

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palerider
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Re: Help interpreting waveforms

Post by palerider » Mon Feb 19, 2018 12:30 am

ajack wrote:
Mon Feb 19, 2018 12:03 am
unless there is a specific reason to be on min 18
I'd actually lower your min epap
Yeah, that's a great idea, give the OP more events on a baseless guess.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

ajack
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Re: Help interpreting waveforms

Post by ajack » Mon Feb 19, 2018 12:41 am

nothing baseless about it. the epap median, 95% and max are all virtually the same. There is a strong chance it is over pressure. the world won't end with one night on min 16

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Jas_williams
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Re: Help interpreting waveforms

Post by Jas_williams » Mon Feb 19, 2018 10:03 am

Fixing large leaks would also help

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palerider
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Re: Help interpreting waveforms

Post by palerider » Mon Feb 19, 2018 11:28 am

ajack wrote:
Mon Feb 19, 2018 12:41 am
nothing baseless about it. the epap median, 95% and max are all virtually the same. There is a strong chance it is over pressure. the world won't end with one night on min 16
Basing min pressures on the 95% pressure is a rookie move.

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Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

cby1
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Re: Help interpreting waveforms

Post by cby1 » Mon Feb 19, 2018 2:43 pm

Yes I know the leaks are an issue - I've had a hard time finding a FFM that can handle the pressure - the F&P Simplus I have used to work pretty well - now I have leak issues. Nothing changed that I can figure out. New masks/inserts don't help. I use a Gecko pad and still have leak issues around the bridge of the nose. Couldn't get pad-a cheek to work any better.

Any suggestions for a FFM mask that an handle high pressures (20 and above) well would be welcomed.

As far as over-pressure goes, I had a lot of RERAs and Hypopneas with an Auto CPAP set at 17 and 20 - hence the BiPAP. Those went away at the current settings - EPAP 18, PS = 3, max IPAP 25. So I'm loath to mess with that too much.

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ajack
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Re: Help interpreting waveforms

Post by ajack » Mon Feb 19, 2018 5:34 pm

well if you aren't willing to trial different things, you are where you are and will stay there, so be content with your lot.

with bpap titration, the min epap is for OA, the ps is for H. I would check that you aren't over titrated, that's all.
https://www.sleepapnea.com/downloads/10 ... fGuide.pdf
https://www.scribd.com/document/3534028 ... -Titration

@palerider, you should write a paper, you obviously know so much more than these people.
https://aasm.org/resources/practicepara ... rating.pdf
https://aasm.org/resources/practicepara ... rating.pdf
and manufacturers showing how to self titrate
http://cpap.1800cpap.com/manuals/resmar ... manual.pdf

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TedVPAP
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Re: Help interpreting waveforms

Post by TedVPAP » Mon Feb 19, 2018 7:05 pm

Since the OP has been at this awhile, I would want to see the data he already has to better understand why his pressure is set so high.

_________________
Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: AutoPAP 16-20, Ultimate Chin Strap http://sleepapneasolutionsinc.com/
Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

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palerider
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Re: Help interpreting waveforms

Post by palerider » Mon Feb 19, 2018 8:11 pm

ajack wrote:
Mon Feb 19, 2018 5:34 pm
@palerider, you should write a paper, you obviously know so much more than these people.
https://aasm.org/resources/practicepara ... rating.pdf
https://aasm.org/resources/practicepara ... rating.pdf
Given sufficient and reliable data, the clinician could then review the data and decide....
Yes, thank you, that's what I said should be done.
ajack wrote:
Mon Feb 19, 2018 5:34 pm
and manufacturers showing how to self titrate
http://cpap.1800cpap.com/manuals/resmar ... manual.pdf
You might want to go back and see if you can figure out where you misread the recommendations there.

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Mask: Bleep DreamPort CPAP Mask Solution
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Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.