Fired My Sleep Doctor

[Paper_Nanny]

1) Do you feel as though you are doing a lot of tossing and turning on some nights? Is restlessness during the night a problem? Are you waking up frequently or having trouble getting back to sleep when you do wake up? If so, did this start around the time your AHI started to creep upwards?

No. I go to sleep and sleep soundly all night. Occasionally, I will wake up to go to the bathroom. I fall back to sleep quickly after getting back in bed.

2) Has anything changed in your life or health other than the deteriorating OSA problem? Are you under more stress at work or in your private life? Any new medical diagnoses? Any changes to medication?[/quote]

The only change to medication was with the medication pump. The pump was replaced in December. The dose was changed.

Finally, have you had any luck in getting the sleep doc to look at the flow rate data your machine records?

No. I don't think he looks at much of anything and doesn't want me to look at anything, either.

I will get the graphs you asked for posted later today.

[Paper_Nanny]

paper_nanny,

Another thing that really jumps out in your data is the amount of time being flagged as "timed breaths". On four of the five nights you posted, you spent almost the entire night in "timed breaths". The only night without a lot of "timed breaths" is the night with the lowest AHI. All of that points to the hypopneas being central in nature rather than obstructive.

Yes... That happened when the BPM was changed from 5 to Auto. Would it be worth setting it back to 5?

I also noticed that my Patient Triggered Breaths decreased when the BPM was changed to Auto. From past struggles with getting my machine adjusted, I know that I do worse on nights with lower Patient Trigged Breaths. Since I almost never have a problem with large leaks on my mask, I wonder if moving the Patient Triggered Breaths graph up would give people more information to work with or if leaving the leak graph there is a more useful option.

[robysue]

paper_nanny,

Another thing that really jumps out in your data is the amount of time being flagged as "timed breaths". On four of the five nights you posted, you spent almost the entire night in "timed breaths". The only night without a lot of "timed breaths" is the night with the lowest AHI. All of that points to the hypopneas being central in nature rather than obstructive.

Yes... That happened when the BPM was changed from 5 to Auto. Would it be worth setting it back to 5?

That's a question for Pale_Rider and others who use ASVs. I don't have any experience using them.

I also noticed that my Patient Triggered Breaths decreased when the BPM was changed to Auto. From past struggles with getting my machine adjusted, I know that I do worse on nights with lower Patient Trigged Breaths.

Worse in what sense? In the AHI data? In how you actually feel upon waking? Or both?

Since I almost never have a problem with large leaks on my mask, I wonder if moving the Patient Triggered Breaths graph up would give people more information to work with or if leaving the leak graph there is a more useful option.

Given that you are on an ASV with a diagnosed problem with central apnea AND you say that you do worse on nights with lower Patient Triggered Breaths, I think the Patient Triggered Breaths graph would be much more useful for us.

[Uncle_Bob]

People that are giving out bad advice should be knocked back into their gopher holes. It can be very difficult for newbies to separate the chaff from the grain.

I'm sure the newbies will be fine. It seems you are having more of a hard time in not being able to moderate someone else's internet forum

[palerider]

could you re-do that screenshot with the left panel pulled up, to see what the event totals are?

[Paper_Nanny]

So I have a request: Can you go through your data and find a stretch of breathing on a night when your CAI was above 10 and zoom in on a 5-10 minute stretch of time so that we can see the individual breaths with the CAs flagged in them? Then zoom in on breathing for the data from 4/17 focusing on the time frame between 10:00 and 11:00. Post a couple of 10-minute stretches from that bad hour. The data has to be zoomed in enough to see the individual breaths. If there is not much similarity in the breathing pattern from the night wrere the events were labeled as CAs, then that points to it being reasonable to assume that your current hypopnea problem has a higher chance of being obstructive in nature. If the breathing pattern with the Hs looks almost identical to the breathing pattern with CAs, that raises the distinct possibility that your current problem is with central hypopneas rather than obstructive ones.

Here are some graphs from nights where my CAI was over 10:









And from 4/17:

[robysue]

People that are giving out bad advice should be knocked back into their gopher holes. It can be very difficult for newbies to separate the chaff from the grain.

I'm sure the newbies will be fine. It seems you are having more of a hard time in not being able to moderate someone else's internet forum

+1

[Paper_Nanny]

I also noticed that my Patient Triggered Breaths decreased when the BPM was changed to Auto. From past struggles with getting my machine adjusted, I know that I do worse on nights with lower Patient Trigged Breaths.

Worse in what sense? In the AHI data? In how you actually feel upon waking? Or both?

As far as I remember, it was both.

[robysue]

So I have a request: Can you go through your data and find a stretch of breathing on a night when your CAI was above 10 and zoom in on a 5-10 minute stretch of time so that we can see the individual breaths with the CAs flagged in them? Then zoom in on breathing for the data from 4/17 focusing on the time frame between 10:00 and 11:00. Post a couple of 10-minute stretches from that bad hour. The data has to be zoomed in enough to see the individual breaths. If there is not much similarity in the breathing pattern from the night wrere the events were labeled as CAs, then that points to it being reasonable to assume that your current hypopnea problem has a higher chance of being obstructive in nature. If the breathing pattern with the Hs looks almost identical to the breathing pattern with CAs, that raises the distinct possibility that your current problem is with central hypopneas rather than obstructive ones.

Here are some graphs from nights where my CAI was over 10:

I sure hope PR looks at these graphs. He's got a much better understanding of central apnea stuff than I do.

Having said that, I will say that those Hs look like they may be central Hs to me. If I were you, I'd take PR's advice and open up your ASV machine settings to see if it can do a better job of preventing the breathing instability that leads to the long chains of central events in the first place.

[Paper_Nanny]

could you re-do that screenshot with the left panel pulled up, to see what the event totals are?

[robysue]

Question for Pale Rider about Paper_Nanny's last data:

Why is her machine NOT raising the IPAP pressure very much between 4:45 and 5:45 even though there are gobs of hypopneas and the machine is also triggering something like 2/3's of Paper_Nanny's breaths during that stretch of time? Would a higher min EPAP help at all?

[palerider]

could you re-do that screenshot with the left panel pulled up, to see what the event totals are?

thank you... could I ask you to do another thing, zip up your entire sd card, so, all the files and directories, into one zip file, and upload it to
:
https://www.dropbox.com/request/0LalWvEsijRIgX8sdM7H

that way I can just look through the different days and hopefully get a better idea, instead of asking you for a bunch of screenshots.

[Paper_Nanny]

Having said that, I will say that those Hs look like they may be central Hs to me. If I were you, I'd take PR's advice and open up your ASV machine settings to see if it can do a better job of preventing the breathing instability that leads to the long chains of central events in the first place.

They look like centrals to me, too. There don't seem to be a lot of vibratory snore or flow limitations in there when the hypopneas are occurring. It seems like they would be there if it were obstructive. Maybe not, but it seems logical.

If they are centrals, will sleep position make any difference? I do sleep on my back sometimes. But I have only heard about that being a factor if they are obstructive events.

[Paper_Nanny]

could I ask you to do another thing, zip up your entire sd card, so, all the files and directories, into one zip file, and upload

Let me know if it didn't work out the way you wanted.

[palerider]

could I ask you to do another thing, zip up your entire sd card, so, all the files and directories, into one zip file, and upload

Let me know if it didn't work out the way you wanted.

you did fine... I'm looking at it now.

if you feel like trying it, set the minps to either 2 or 3 tonight, and see if that makes a difference. I'll let you know if I can figure out anything more from the old data... though it might be better to just go ahead.

please clarify something for me, you felt better before, or after the backup rate was changed to auto? and when it was changed to auto, the number of timed breaths increased greatly?