Using the S9 Autoset w/ Centrals... Suggestions appreciated

I'm still on CPAP mode on the S9 using a setting of 10.6cm without EPR, once again, in an effort to emulate the settings on my M-Series Pro. It makes sense to me to attempt to compare what I've been dealing with over the last three years with a machine that can give me an idea of what I must have been going through with more data. I think I might try going on APAP tonight. If I attempt to go over 11 on CPAP, I get aerophagia enough to wake me up. Under 9cm, and I feel like I'm being asphyxiated. Should be interesting. If anyone has settings suggestions for what they'd do under similar circumstances, I'd be grateful.

The stats show an AHI of 1.6, Central Index of 1.5, Hypopnea Index of 0.1.

While I'm not asking for 'diagnosis', I'd sure like to get feedback from those who have some experience reading these kinds of things. I know the AHI is really low, but that's the average over the entire night. My apneas seem to cluster primarily after the bathroom break as I'm trying to fall back to sleep. I seem to do pretty darned well for the first part of the night. I wonder if staying up for an hour or more before going back to bed would be better for me. This is the full night with a closeup of the main clump of central apneas.


Here are some new graphs and thoughts about what I'm seeing. FOT starts at about 5 seconds after you stop breathing. A lot of my breaths are just under 10 seconds apart for this night after the bathroom break. I took a picture of random sample nowhere near any apneas. There is also oscillation in the amplitude of my breaths with a period of just over 5 periods per minute. Not knowing what's normal for others, I'm curious if this an indication of periodic breathing.


Here's another image near a cluster of apneas. I'm curious why I have only one hypopnea, and what makes that one any different from other similar waves that are longer.


I'd sure like to see others' breath-by-breath five-minute examples so I can compare whether what I'm seeing really could be Cheyne-Stokes.

If the apneas are when you are still awake, then I wouldn't count those as issues--these machines are not good at evaluating awake breathing. I set a settling time of 20 minutes so that it would not count the time falling asleep in the data. In cpap mode you would instead use ramp--I wonder if it would work to have the same starting ramp pressure as your normal pressure?

jmelby wrote:If the apneas are when you are still awake, then I wouldn't count those as issues--these machines are not good at evaluating awake breathing. I set a settling time of 20 minutes so that it would not count the time falling asleep in the data. In cpap mode you would instead use ramp--I wonder if it would work to have the same starting ramp pressure as your normal pressure?

That makes sense. I'm not sure what counts as 'awake'. Usually I'm dozing off, complete with dreams, only to find myself awake again for lack of air. I didn't really get into a solid sleep pattern until 6:30. In a way, it feels like I'm awake, but I blink, and suddenly it's 6:30, so I'm not sure. It feels almost literally like swimming: I'm at the surface, and part of the time, I'm underwater, part of the time, my head is above water - the waterline being the line between conscious and unconscious. I seem to be in a pattern that won't let me just stay entirely under the surface from the time just after the bathroom break to the forty-five minutes to an hour and a half before I fall into a reliable sleep pattern. Please stand by on the ramp thing... I'll find out.

More images - this time a nap I just took. I've included oximetry. Jmelby - I'm not sure hiding events at the beginning of my therapy is the best thing. I got to sleep here in the first six minutes, but had a serious set of events as it happened. That would have been missed, had I included a 45 minute ramp, right?

Oximetry lined up with S9 data:


A close-up of the five minutes during the event:


A close up of five minutes right after the event. I see reduced pulmonary periodicity for most of the rest of the nap. The window of periodic breathing events seems to be at 'getting into the pool' and 'getting out of the pool'.


Last five minutes of my nap - 'getting out of the pool':

DreamDiver wrote:More images - this time a nap I just took. I've included oximetry. Jmelby - I'm not sure hiding events at the beginning of my therapy is the best thing. I got to sleep here in the first six minutes, but had a serious set of events as it happened. That would have been missed, had I included a 45 minute ramp, right?

Correct, so no probably not a good idea to use ramp at this point. I started doing it when I realized that my awake breathing seems to count as a lot of hypopneas (shallow breaths maybe?) and I knew it was happening while awake. Thus, this was skewing my overall AHI numbers for the night and I wanted a more accurate accounting. You seem to have something else going on here, but far beyond my level of knowledge for me to comment on.

Here's last nights data in condensed format.
A few things stand out. 42 Seconds in a central? Holy Potato. That's got to be bad.
First, centrals are what I've got, along with what looks like periodic breathing.
Second, central events and pulmonary periodicity seem to cluster mostly at both ends of a given sleep session - as I suggested previously - 'getting in and out of the pool'.
Third, as I suspected, the machine isn't set to make changes based on centrals, so it will always hover around the lowest setting, regardless of how high I set the max. So even with this machine, I'm forced to self-titrate either using CPAP mode or in APAP using mininum pressure as my guide.

I obviously benefit to some extent from straight CPAP, since my AHI seems lowest at 11 and gets higher when pressure is changed to either direction. So for my next sleep session, I'm going to continue using APAP, but set the low to 11, with EPR on, in an attempt to reduce aerophagia. If that doesn't work, I'll set the low to 10.6, where aerophagia seems less likely to occur. Wish me luck!

DreamDiver

Those charts are fantastic. I used to dream about when we would have machines that showed that level of granularity & clarity. I used to get that partially when using a ResLink but that data is so fine that as you show, you can see the FOT pulsing.

It is interesting to see your SpO2 lined up with the machine.

I would now like to see the SpO2 interface data to see if it is as clear as what you managed with your SpO2 device.

Many thanks

DSM

DreamDiver,

One comment I will make is that in some of those charts you appear to be showing a mild waxing & waning of ventilation & during the waning, the machine is doing the most FOT pulsing.

The pattern appears to be within the classic 2 min cycles of Cheynes-Stokes periodic breathing periods but no where near as pronounced as the typical Cheynes-Stokes breather.

Interesting - dunno what to make of it though ! ( #2-well maybe a classic candidate for SV therapy )

DSM

#3 - I just noticed you made the same deduction re CSR - I hadn't seen that comment before posting the above - I merely reacted to what I saw in the charts which is what I read 1st !

The way you illustrate and display your charts is fantastic, DreamDiver! It's all very interesting. I enjoy learning this stuff!

Dream diver, I'm sooooo jealous of that software! I wish that one could plug in the oximeter so you wouldn't have to align the graphs and you could zoom in to areas of interest without having to run 2 software packages. That would be cool!

With regards to the 2 centrals at 3:40 and 5:20 (approximately ) It looks like you had a heart rate spike at the same time. Perhaps you rolled over and got the rate up then had a natural central to increase the co2 to normal levels. I have seen that described in a thread or two.

At what pressure to obstructives appear? It seems you hardly get off the 8cm.

DreamOn wrote:The way you illustrate and display your charts is fantastic, DreamDiver! It's all very interesting. I enjoy learning this stuff!

Absolutely !!!

Prior to the S9 we were not able to do this sort of in-depth analysis as the granularity of the data was just not there & while in the early days some regulars criticized AutoScan (pre ResScan) as being the worst software - the newer ResScan has just got so good that it allows us to do autopsies on each breath from the night before plus as DreamDiver has shown, look for patterns.

Now if we amateurs can do this sort of analysis we should expect the professionals to do a lot better job now that we have this class of machine and software.

DSM

While you have this thread going so well - here is a link to the ResScan clinician's manual.

It may be of interest to some readers. It is the 3.2 guide *but* the overall way it works is the same as 3.10.
I'll post a 3.10 manual when I can get one.

DSM
#2 added 3.10 thanks to DreamOn & Uncle_Bob

3.2
http://www.internetage.ws/cpapdata/manu ... al_3.2.pdf

3.10
http://www.internetage.ws/cpapdata/manu ... l_3.10.pdf

Dreamdiver, on the setting for Sleep Quality ... did you have to set it to ON to get more data or did you leave it on usage?
What is that Sleep Quality thing anyway?

My unit FINALLY arrived after 5 days of waiting for UPS to bring it. It was in town at 5 pm Friday night and no excuse for not bringing it Saturday.
I'm very disappointed in UPS. The tracking quit at 12:40 am Saturday morning with no further updates over the weekend.
Then, when the guy brought it, he just set it in front of the door and rang the doorbell.
By the time my owner got to the door he was gone.
We didn't have to sign for it or anything.

When FedEx brings a high value package it comes in a special small van and you have to sign for it.
This guy just flopped over $700 down and walked away.
What if we hadn't been home? Just because there were vehicles in the drive doesn't mean we are home.

UPS is gonna get a phone call I think ... not that it will do any good.

Bitching aside it looks like a pretty well made product. I was wondering about washing the Climateline hose but it seems the heating element and sensor wire is on the outside. So washing it seems to be okay, at least the directions say to.

Otherwise everything is very straight forward and not difficult to figure out at all.

First thing I did is make a copy of all the files on the data card so if I ever mess that one up I can easily make a new one. Any SD card will work.
I had been concerned when Dreamdiver couldn't get data from his card after the first time he tried it and looking on Resmed's site I saw they had a custom USB thumb drive for it and I thought " why would they go to the expense of making a custom thumbdrive if any SD card reader is going to work " so I was afraid they had jimmied it so we had to have their special thumbdrive. But, fortunately that isn't the case. WHEW !!!

snnnark wrote:Dream diver, I'm sooooo jealous of that software! I wish that one could plug in the oximeter so you wouldn't have to align the graphs and you could zoom in to areas of interest without having to run 2 software packages. That would be cool!

With regards to the 2 centrals at 3:40 and 5:20 (approximately ) It looks like you had a heart rate spike at the same time. Perhaps you rolled over and got the rate up then had a natural central to increase the co2 to normal levels. I have seen that described in a thread or two.

At what pressure to obstructives appear? It seems you hardly get off the 8cm.

snnnark, dsm,

An oximetry package is available for the S9, but quoting Carolyn:

carolyngoodman wrote:... For S9 Oximetry, you need:

• PN: 36940, S9 Oximeter Adapter
• The ApneaLink Oximeter Kit (contains the XPOD necessary to attach to the S9 Oximeter Adapter)
• 1431002 Oximeter Flex Sensors (3 meters, disposable))
• Rescan Version 3.10 software

By March 15th when ResMed's policy goes into place - we will not be able to sell the software any more. Due to this and their fixed pricing for the internet we are debating whether to carry these oximeter items. We will continue to gauge demand on these products that we would be able to sell and see if customers would want to purchase them even though the software would not be available through us.

We are not likely to see it available unless a number of us show interest. Also, it may depend on the price. I'm also less interested in disposable sensors and more interested in durable reuseable sensors.

As to the spikes - I agree, I probably just rolled over.

I have absolutely no obstructive apneas. I have a central apnea condition, as shown at least by this software, even if it has not been formally diagnosed. I have suspected this from the very beginning, but apparently my sleep docs - or their techs - don't believe in central apneas, or don't know how to detect them. Since the S9 can actually detect the difference, it does not up the pressure at any level, even if it is below the previous standard of 10cm. That's why it never gets far above the mininum auto pressure for me. To that end, with this machine, it means I still have to self titrate like this is a straight cpap. It's probably not the right machine for me. As dsm has pointed out, I may need an SV.

DSM - It's nice to get at least unofficial confirmation of what I suspected. I think the next step is to see a new sleep doctor. I hope the S9 comes in an SV model. I'm not sure I can give up this level of accuracy so easily... And thanks for the link to the old clinician's manual. An old one is better than none any day. There is also a very comprehensive help menu from within 3.10 itself that looks like it's organized much like a written manual might be. It is awesome to see a fifth of a second wave from the FOT in sweet little curves close up. I really cannot stop grinning at how useful this software and hardware really are.

Arizona-Willie - Set sleep quality to ON. Usage only gives you compliance data. It also shows more data on the screen. Set your climate control to Patient, I think. You could set it on Auto, but I think Patient gives you more options without having to go to the clinical menu. Glad it finally arrived!

I'm going to say it again here - I wish this baby had an 8 foot hose. This one isn't even six feet. It's just too short. Give me a 2.5 meter hose, dagnabbit...

These graphs are incredible! I just can't hold out any more. I'm on the phone to buy a S9 now...