Help interpreting waveforms

[cby1]

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).



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).



Thanks.

[palerider]

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

[USMCVet]

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?

[TedVPAP]

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?

[cby1]

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).

[palerider]

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.

[ajack]

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.

[palerider]

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.

[ajack]

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

[Jas_williams]

Fixing large leaks would also help

[palerider]

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.

[cby1]

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.

[ajack]

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

[TedVPAP]

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.

[palerider]

@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.

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.