Is my CPAP broken?

[Bilbosax]

Hi. I had my sleep study a little over a month ago and have been making adjustment that have helped significantly to get my AHI from 25 down to below 5 thanks to the good people here. But there is an abnormal flow rate in my sleepyhead data that I see every day that I haven't been able to get any answers about. I am meeting with my DME tomorrow to have them take a look at my machine (a Resmed Airsense 10 Auto for Her) but I don't really know what I need to ask them to look for, and to be honest, they don't seem to really be on the ball with a lot of helpful information. Here are images from sleepyhead software that show the abnormal flow rates.

Screenshot (14).png (21.28 KiB) Viewed 720 times

Screenshot (18).png (12.28 KiB) Viewed 720 times

As you can see, my flow rate often times gets very jagged, but very regular in it's "jagginess". At first, I wondered if it might be snoring, but my sleepyhead data shows almost no snoring at all anymore, and if there is any, it is always a blip, nothing that drags on for minutes. But snoring is not so predictably repetitive in it's cadence as these flow rate patterns. To me, this looks like there is a valve or something in the machine that is flapping in the wind. Even though my AHI is just under 5, I am still very tired, and the reason is a lot of random arousals. I am wondering if these jagged flow rates may be startling me awake. I usually arouse, take a couple of deep breaths, and then this improves significantly in the data, but is still always rough, never smooth. If you have ever seen this before or could shed some light on what I might want to talk to my DME about regarding my machine, I would really appreciate it.

Thx

[Julie]

What mask? What pressure settings? And has no one told you that just being under 5 is not good... most like to hover from 0 to 2.

More info needed for sure... do you take any meds? What position do you sleep in? And anything else you can think of that might even remotely affect things...

[rick blaine]

Hi Bilbosax,

In respiratory medicine, there is the phenomenon called a 'saw-tooth curve' when it shows up on the spirometer (the machine that shows doctors a person's breathing pattern), and it turns up in about 12 per cent of those with obstructive sleep apnea.

IMO, what you show isn't a 100 pc match for the typical 'saw-tooth' pattern, but it's close.

AFAIK, it is isn't a sign of anything serious or pathological.

[Bilbosax]

Thanks for the replies Julie and Rick. I am 6'2", 215lbs, so I am big but not enormous. I use a Simplus full-face mask, I take absolutely no medication, I am a side sleeper and NEVER sleep on my back, and I am aware that an AHI of 5 is certainly not ideal but my treatment is still a work in progress. Pugsy and Palerider have given me a lot of great advice and I am still playing with my settings trying to optimize things. Here is my full therapy thread so far if you are interested in reading it:

viewtopic/t174054/Concern-with-Central-Apnea.html

Rick, based on your suggestion, I just read an article called "Saw-Tooth Sign in Upper Airway Disorders", and although the idea is compelling, I don't think it fits me. The waveform anomalies for those people are much more random and faster than mine, and tend to stick around. Mine are very symmetric and repetitive when they happen, only last for a couple of minutes, and disappear after a brief arousal. My machine readings are always a bit rough on the airflow compared to others that I have seen, just not smooth.

Pugsy mentioned in my thread that they have seen these waveforms before, and mentioned that they seem to show up more when EPR is turned off, which mine is. But I am meeting with my DME tomorrow and wanted to get a little more focus and feedback from other people on this subject before I have them check out my machine. I don't know enough about how they work to know what might be a possible cause for it.

So any suggestions or thoughts are greatly appreciated. If it is me, then there is nothing they can do. But the perfectly symmetrical and even spacing of the anomalies makes me think it must be the machine.

[palerider]

Hi. I had my sleep study a little over a month ago and have been making adjustment that have helped significantly to get my AHI from 25 down to below 5 thanks to the good people here. But there is an abnormal flow rate in my sleepyhead data that I see every day that I haven't been able to get any answers about. I am meeting with my DME tomorrow to have them take a look at my machine (a Resmed Airsense 10 Auto for Her) but I don't really know what I need to ask them to look for, and to be honest, they don't seem to really be on the ball with a lot of helpful information. Here are images from sleepyhead software that show the abnormal flow rates.


Screenshot (14).png


Screenshot (18).png


As you can see, my flow rate often times gets very jagged, but very regular in it's "jagginess". At first, I wondered if it might be snoring, but my sleepyhead data shows almost no snoring at all anymore, and if there is any, it is always a blip, nothing that drags on for minutes. But snoring is not so predictably repetitive in it's cadence as these flow rate patterns. To me, this looks like there is a valve or something in the machine that is flapping in the wind. Even though my AHI is just under 5, I am still very tired, and the reason is a lot of random arousals. I am wondering if these jagged flow rates may be startling me awake. I usually arouse, take a couple of deep breaths, and then this improves significantly in the data, but is still always rough, never smooth. If you have ever seen this before or could shed some light on what I might want to talk to my DME about regarding my machine, I would really appreciate it.

Thx

I think what you're seeing is discussed in this answer: viewtopic/t174268/Respiratory-Rate-Slee ... 5#p1283619

[Bilbosax]

Thanks for the link Palerider, I appreciate you looking that up. My heartbeat is definitely regular enough to account for the evenness of the artifacts that I am seeing. But I have to admit, it is a little hard to believe that the sensors in the little Resmed are sensitive enough to to pick up both my breathing as well as the tiny little fluctuations caused by my heartbeat, and that sometimes they can see them, but not always, or often.

[palerider]

. But I have to admit, it is a little hard to believe that the sensors in the little Resmed are sensitive enough to to pick up both my breathing as well as the tiny little fluctuations caused by my heartbeat, and that sometimes they can see them, but not always, or often.

Why? They measure airflow., If your heartbeat is affecting the airflow, the flow sensor sees fluctuations.

It's not that the sensor sometimes sees the fluctuations, it's that sometimes your heart affects the airflow.

[djams]

Pugsy mentioned in my thread that they have seen these waveforms before, and mentioned that they seem to show up more when EPR is turned off, which mine is.

I see waveforms pretty similar to what you posted in this thread. Only with FFM and EPR off. I tested the EPR on/off for about a week. During that timeframe, every night with EPR off, I'd get 1 or 2 periods of the irregular waveform shape. EPR on, I did not.

I've spent the past couple of weeks using a nasal pillow mask. For whatever reason, I haven't yet seen the irregular breathing shapes with EPR off. I have been able to drop my min pressure from 12 (FFM) to 9 (pillows). Maybe that has something to do with it. Really doesn't matter, as it's harmless.

Here's what mine look like, if you're interested. viewtopic/t171979/djams-therapy-thread. ... 5#p1276798

[Bilbosax]

Thanks for that djams. That looks almost exactly like mine!! That makes me feel a bit better, as I was afraid my machine was "fluttering" or something to cause me wake-ups. But now I have to actually figure out what else might be causing my arousals I still need to go to my DME to get new filters, etc., so I will ask them to give the machine a once-over just to be on the safe side, but it is likely heart artifacts.

[ChicagoGranny]

But now I have to actually figure out what else might be causing my arousals

If your AHI is around 5, that's an arousal every twelve minutes or so. Most likely, your pressure settings are not optimized, or your leak level is high. Post a typical night's chart (in this thread) using Pugsy's instructions for help tweaking your therapy.

[djams]

Thanks for that djams. That looks almost exactly like mine!! That makes me feel a bit better, as I was afraid my machine was "fluttering" or something to cause me wake-ups. But now I have to actually figure out what else might be causing my arousals I still need to go to my DME to get new filters, etc., so I will ask them to give the machine a once-over just to be on the safe side, but it is likely heart artifacts.

The shapes are remarkably similar, aren't they?

And sure, take your machine in. Whatever it takes to get rid of uncertainty. A couple of weeks into therapy, I'd convinced myself that my machine wasn't working properly (while knowing absolutely nothing about it). A call to my doc's office, and a discussion with the "DME coordinator", talked me down off that ledge. She was able to straighten me out. Point is, I am familiar with the effects of uncertainty about your therapy - it ain't good.

Glad I was able to help in some small way.