pls review graphs for asleep@thewheel

In the meantime mr asleep already got his graphs reviewed by the Gurus of Cpap, but nevertheless here are the long awaited graphs. Feedback requested.

This thread is a follow-up to: I need Yoda ! Please help me read my s9 report

asleep@thewheel wrote:It looks like 3 central apneas per hour. no obstructive, no hypnoapnea.
min pressure at 12
max pressure at 15

Should I lower the max pressure? if so to what?

asleep@thewheel wrote:original raw sleep study of AHI 150
originally 7 cpap 2 and half years ago w/ average ahi of 8
went up to 10 ml cpap a few months back, felt better, then spiraled,
switched to APAP 2 months back 11-13 have gotten down to 1.4 ahi
now 12-15 they appear to be clusters to me. I am sending my report down to stanford first thing tomorrow.

terrible allergies/sinus issues going on and now I suspect this silent reflux issue, but I haven't verified it yet. Needless to say I am a ball of wax. the wife wants to trade me in.

Thanks on behalf of mr asleep

p.s. I cannot for the life of me figure out how you can read any of this data, it all just runs together! And what the heck is a negative flow anyway?
I am so spoiled with my 420E Silverlining software.

I presume that these are the same graphs for which Dr. CG concluded that the centrals were actually due to leaks. Correct?

Yes they are except for the detailed graph from today. I switched to the smaller cushion on my hybrid liberty last night. it seems to have helped.

Since NASA is going out of business, I want to buy an astronaut helmet and pressurize it. Back in my self-medicating days,we used to hotbox our friends motorcycle helmets. Now I can't even handle a sip of wine.

Thank you very much Echo!!! I like the detailed approach. that was very kind of you.

It feels good to be in a room with people who get what you are going through as opposed to the denial from the well rested.

personally, I would give myself more of a pressure range on the lower end.

The pattern of all centrals is a bit strange. Some of these are fairly long.

Your leak line is also unsually flat.

If indeed, you have leak lines that good consistentlly, you are very lucky!

If the centrals persist at this level, it is something to discuss with your doctor next time you see him.

Would you describe yourself as a light or heavy sleeper? These may very well be 'sleep onset centrals', which a certain amount of is normal. But if you are a heavy sleeper, then these may need some additional study.

echo wrote:And what the heck is a negative flow anyway?

Exhalation. Flow is negative (or positive) relative to baseline.

Muffy

I was hoping that MBJ (who spent an AWFUL lot of time in working on the leak portion of the event identification algorithm) would have posted to comment on the reporting of respiratory events during the supposed areas of excessive involuntary leaks, but he must be busy.

Certainly, the events that you have presented in this DL are not leak-generated. Can you (or echo) post the DLs sent to Stanford that claimed that the respiratory events were artifactual?

Muffy

Hey, echo, you also noted somewhere that OutaSync had alpha intrusion. Where did you see that (I thought she actually had beta "intrusion", but perhaps more on that later).

Muffy

I do consider myself a heavy sleeper and at the late stages of sleep it is the leaking that is waking me up.
I start off sleeping on my back due to a bilateral disk herniation in my neck. I sleep on 30 degree wedge pillow so I am now finding myself in the morning lying on my left shoulder pushing the mask into the pillow thereby creating a leak. The fact that I can lye on my shoulder at all is an amazing step forward since I am a prime time candidate for fusion surgery which is now far in my rear view mirror since all of the "referred" pain is gone for all of you fibro people out there. I am going to try the Maskfit "ground control, to major Tom," to see if I can improve with that.

Last night I went back to using the boomerang chinup strips to help keep my mouth closed as well. According to my data it seems to have helped. Shorter leak durations. If the leaks persist, I will definitely ask Stanford for another study, but it is kind of hard to argue with the one guy who gets it and who invented "AHI." They want my AHI under 2. I know I have read other discussions that mentioned 5 and under is acceptable. The difference of 5 compared to 2 is night and day.

My Silent Reflux, sinus, allergies, and related asthma are getting in the way of good APAP therapy. Lately I am literally the boy in the bubble since the outside environment is such a pain in the but when the sun is out. I am on my way back to Florida on a steam vacation this Sunday where I am hoping I can once and for all take the allergies out of my equation. If that is one of the culprits, relocation will be in order.

As for the silent reflux, Does anybody have that feeling they are being strangled during the day? The pressure in my left ear just nags at me. The only relief I get is when I put the Mask on or put my mouthpiece in which shifts my lower jaw forward. I am also scheduled to see a GI when I get back to see what kind of damage I have done to my airway all these years?

I am trying to "work the problems, and not let them work me." harder said than done.

Muffy wrote:Hey, echo, you also noted somewhere that OutaSync had alpha intrusion. Where did you see that (I thought she actually had beta "intrusion", but perhaps more on that later).

Muffy

Hm, I think it was discussed in her TBT a while back, perhaps a year or 6 months ago. Boy I hope I didn't just make that up or confuse her with someone else.... beta intrusion?? I don't remember that term. lemme see if I can dig it back up....

asleep@thewheel wrote:They want my AHI under 2. I know I have read other discussions that mentioned 5 and under is acceptable. The difference of 5 compared to 2 is night and day.

I wonder if people are using the '5' number because that is the diagnostic cut-off--under 5, and you don't have OSA.

In any event, I've noticed the same thing you did, that 2 is usually better than 5 in terms of how I feel. Ultimately, for me that's the issue--how do I feel, how much energy do I have?

echo wrote:beta intrusion?? I don't remember that term....

More appropriately, it would called something like "excessive sleep spindling", a common occurence with drugs such as zolpidem and the like. The appearance can be very similar to alpha intrusion (but it's a little quicker). We could have/should have talked about it in bev's thread. TBT discussed blizzardboy's alpha intrusion (and he has TONS).

Mufy

Muffy wrote:

echo wrote:beta intrusion?? I don't remember that term....

More appropriately, it would called something like "excessive sleep spindling", a common occurence with drugs such as zolpidem and the like. The appearance can be very similar to alpha intrusion (but it's a little quicker). We could have/should have talked about it in bev's thread. TBT discussed blizzardboy's alpha intrusion (and he has TONS).

Mufy

My bad (big time), I wasn't thinking of Bev but Country4ever, she has Fibro and alpha intrusions were noted during sleep study, causes fragmented sleep, she also mentions in an old post that the changing pressure of APAP was a problem. Sorry!! (she mostly calls it alpha wave intrusion if anyone wants to do an advanced search on it).

I am still on page 35 on BB's thread and the most recent pages, I didn't notice his alpha intrusions mentioned, interesting (from an academic point of view, not so much for him I guess).

Also I couldn't find Bev's thread back, and I cannot even remember how long ago it was. Would you happen to have a link handy?

Sorry, I cannot add more to the technical discussion here, especially in relation to the effects of the drugs, it is out of my scope but am interested to see where this leads...

Edit: thanks for clarifying the negative flow Muffy. I am not used to evaluating those graphs and didn't think long enough about it.

Asleep@the wheel - if you have other graphs to post just send me another email.

Updated graphs from this past weekend....

Saturday's graphs




Friday's graphs



asleep, I cannot see a direct one-to-one correlation between leaks and the central apnea's on the graph from Saturday (and friday's timeline is too condensed to make sense of, for me anyway). Your leaks are not *too* bad but you should try to tweak some more to get it flatter and closer to zero.

It could not hurt to lower your bottom pressure, as per your initial question. No major obstructive apnea's seem to be getting by (though this could be masked by the leaks), so going lower may not be too dangerous, and you've already tried lower pressure before. What about a range of 10-15?

What do others think?