Strange Flow Charts

[Treatedandtired]

Good morning. I've been on APAP for almost three years yet have never really felt like it gave me much benefit. My diagnosis was mild apnea, with an AHI of 8, so that may play a role. However, even with treated AHI's of <1.5 more often than not, I continually see large periods of time where my breathing looks really odd and irregular. Could someone with some experience in this stuff take a look and let my know what they think? This chart shows a fixed pressure which I tried for the first time last night in an effort to reduce anything that might disturb my sleep. I generally run APAP between 9 and 14, or some other combination within that range. Thanks!

[palerider]

6.4 is too low and epap for you (pressure between breaths).

bump it up a couple and let's see what it looks like. (9.4-3EPR=6.4)

Also, right click on the words 'flow rate' and set the y axis to override, and -60 to 60. it's all very scrunched with the autoscaling.

[Treatedandtired]

Thanks, Palerider. I did have a run of 11-14cm recently but abandoned as I felt just as poorly, if not worse after 3-4 days. I'll attach some screenshots of one of those nights. Maybe go to a fixed 11?

[Rubicon]

Have you tried throwing the CPAP out the window and seeing how that works?

[Rubicon]

6.4 is too low and epap for you (pressure between breaths).

bump it up a couple and let's see what it looks like. (9.4-3EPR=6.4)

And what's that supposed to do?

[Rubicon]

BTW you should include the rest of your story:

https://www.cpaptalk.com/viewtopic.php? ... 4#p1330064

[GrumpyHere]

6.4 is too low and epap for you (pressure between breaths).

bump it up a couple and let's see what it looks like. (9.4-3EPR=6.4)

And what's that supposed to do?

OP wants to try fixed pressure mode.

Raising the pressure by 2, brings it closer to the median when used in APAP mode.

[Rubicon]

6.4 is too low and epap for you (pressure between breaths).

bump it up a couple and let's see what it looks like. (9.4-3EPR=6.4)

And what's that supposed to do?

OP wants to try fixed pressure mode.

Raising the pressure by 2, brings it closer to the median when used in APAP mode.

I'm not understanding what you're trying to fix.

Point out on his waveform what you're trying to do.

[palerider]

6.4 is too low and epap for you (pressure between breaths).

bump it up a couple and let's see what it looks like. (9.4-3EPR=6.4)

And what's that supposed to do?

See if it makes any difference.

What would you suggest?

[Treatedandtired]

I’ll bump it up a couple cm on a fixed basis and see where that leads. Thanks.

[Rubicon]

6.4 is too low and epap for you (pressure between breaths).

bump it up a couple and let's see what it looks like. (9.4-3EPR=6.4)

And what's that supposed to do?

See if it makes any difference.

What would you suggest?

Well.

Have you tried throwing the CPAP out the window and seeing how that works?

For the same reason.

Then I would think about if EPR is really creating an issue. If I understand how it works the only situation where an issue could occur is when there's an apnea and in that case EPR is suspended. Otherwise, the entire +waveform is being treated by therapeutic pressure. I don't see a problem with his waveform (some FL may be the result of CB but CB is always a guess without having an EKG. That said I think he's got a LOT of CB).

Then I would read his history:

I've been on APAP since June of 2019 after a diagnosis of mild obstructive sleep apnea. My AHI was 8, consisting primarily of hypopneas (28) and centrals (18). I had 109 spontaneous arousals which yielded a spontaneous arousal index of 18.9. I've had brain MRI and MRA, cervical MRA, cervical and thoracic x rays, blood work galore, EKG, ECG and just recently had a bunch of blood drawn to check for autoimmune disorders. This all seemed to begin a few days after hitting my head under a table and hyper flexing my neck a bit. No testing has revealed anything notable other than the sleep study and the cervical MRI which showed some age-appropriate disc and joint problems. Without carrying on too much further, my current symptoms are now and have more or less been since this all began (September 2018): fatigue/tiredness, easy to zone out at work or while driving, dry eyes which impacts my vision a bit and the tinnitus that I've had on and off has become more or less non stop.

I'm a masters swimmer and spin cyclist who exercises at least 4-5 times per week. 6' height and about 180 pounds.

Meidcations:
Levothyroxine to treat mildly high TSH 32.5mg
Valsartan for hypertension 80mg/day
Cymbalta for anxiety brought about by this change in my health 40mg/day

I'll attach some photos of last night's sleep. My AHI generally runs closer to 1 or less but last night wasn't great for some reason. Something I've noticed and have added a zoom shot of is some random spikes in my flow rate. Are these short awakenings/arousals that are disturbing my sleep? Thanks for looking!

screenshot-20191112-155734.pngscreenshot-20191112-155635.pngscreenshot-20191112-155629.png

and ask

"How come he can't use the MF spell check to make sure 'medications' is spelled correctly?"

Then REALLY try to think about the results of the sleep study. I'd get the actual report cause there's a lot of stuff missing.

But using what's available there's probably some fragmentation so those centrals are undoubtedly sleep-onset or post-arousal so irrelevant.

So AHI in re: SBD is more like 4.0.

Then I'd put those hypopneas under the magnifying glass to see if they're really an issue or a product of aggressive scoring.

So looking at the history it's starting to appear that there's not an SBD problem, and perhaps not even a sleep problem (or if there is, is it a medication issue as suggested by some poster called Pug-Z?).

An orange flag (not necessarily a red flag) should go up when somebody c/o of

fatigue/tiredness

instead of "sleepiness".

That said, >100 arousals/night should start to make one consider that they're a cause for sleepiness, but again, the OP didn't say "sleepiness".

[Rubicon]

And in my spare time I would ponder on this:

This all seemed to begin a few days after hitting my head under a table and hyper flexing my neck a bit. No testing has revealed anything notable other than the sleep study and the cervical MRI which showed some age-appropriate disc and joint problems. Without carrying on too much further, my current symptoms are now and have more or less been since this all began (September 2018)

cause you don't get SBD by hitting your head on a table.

[Rubicon]

SBD

Or SDB.

Or SRBD.

Or whatever you guys call it.

[Rubicon]

However, even with treated AHI's of <1.5 more often than not, I continually see large periods of time where my breathing looks really odd and irregular.

Oh right! Your original question!

To me it looks like CB and/or machine chatter (depending on which "odd and irregular" period you're referring to).

[Rubicon]

However, even with treated AHI's of <1.5 more often than not, I continually see large periods of time where my breathing looks really odd and irregular.

Oh right! Your original question!

To be it looks like CB and/or machine chatter (depending on which "odd and irregular" period you're referring to).

So if that's all you wanted to know, forget everything I said and Have A Disney Day!