Strange Flow Charts

[Rubicon]

Then I would think about if EPR is really creating an issue.

Seems to me the reporting of EPR on these graphs isn't quite as helpful as it could be. It only reports what's set, not when it's actually active (or more important, when it's suspended).

Just sayin'.

[Rubicon]

Here's some irony. The guy that's trying to explain EPR is the one that doesn't understand it:

https://myapnea.org/forum/not-understand-epr-setting

Is effective pressure reduced? Totally wrong.

Hyperventilate patients? Really doubt it as PS of +3, although maybe it is a little bipappy, would simply reduce work of breathing, and only a tiny bit at that.

Now FRC might be another thing...

[Rubicon]

..as well as a propensity for apneas at EPR pressure, especially if you're a NED.

[Rubicon]

In a kind of a "duh" experiment, these guys set up an AirSense 10 at 10.8 cmH20 w/EPR @ 3 cmH2O and a machine to generate apneas @ 9.0 cmH2O.

Lo and behold, apneas appeared!

Who woulda thunk?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773618/

Wonder why they just didn't use 11.0 cmH2O?

[Miss Emerita]

T&t, I'm looking forward to seeing a chart with your revised settings. In the meantime, I might mention that some of the jagged appearance of your flow rate is probably due to what is called a cardioballistic effect or artifact. (I have it too.) This is not a cause for concern; it just means that your heart beat is telegraphed just enough to your airway to show up as a little bit of variation in your flow rate. The CB traces appear most commonly during the pause between exhalation and inhalation, but they can sometimes show up during exhalation and inhalation.

I'm not sure, though, whether all of your jagged stuff is CB.

Following up on a remark by Rubicon, it's worth asking whether you're feeling daytime sleepiness or daytime tiredness or fatigue. A lot of people use these terms interchangeably, but sleepiness would mean you feel an urge to sleep; tiredness or fatigue would mean you don't feel like moving around or doing much of anything. Which fits your experience better, would you say?

[Treatedandtired]

Rubicon and Miss Emerita,

Thanks for all of the comments.

I went to 11.4 fixed last night and it felt like it was fighting me from the get go. Breathing felt really unnatural as I was trying to fall asleep. Odd as I’ve been at 11 before. Maybe it has something to do with some margaritas with friends last night. I eventually adjusted it down a bit. Wasn’t a good night of sleep at all. I’ve also noticed that with higher pressure, I tend to feel sinus pressure/mild headache the following day.

As for my symptoms, sleepiness is rarely an issue. It’s more about feeling zoned out, lacking ambition, concentration and energy.

[Rubicon]

Maybe it has something to do with some margaritas ...

Nah.

That would only happen if you were taking antidepressants.

Like cymbalta.

[Treatedandtired]

And since I’m no longer taking them….

[Treatedandtired]

Regarding the CB artifacts, might they have the potential to trigger inhale/exhale cycle changes in EPR, causing the jagged inhale/exhale cycles shown on the chart? I sometimes notice feeling my heartbeat while trying to go to sleep, especially while on my left side (my dominant sleep side).

[palerider]

Then I would think about if EPR is really creating an issue.

Seems to me the reporting of EPR on these graphs isn't quite as helpful as it could be. It only reports what's set, not when it's actually active (or more important, when it's suspended).

Just sayin'.

Don't the two pressure lines show you that? green and red, EPAP and IPAP? Of course on Resmed you can look at the mask pressure line and see what was measured.

[palerider]

Here's some irony. The guy that's trying to explain EPR is the one that doesn't understand it:

https://myapnea.org/forum/not-understand-epr-setting

Is effective pressure reduced? Totally wrong.

Hyperventilate patients? Really doubt it as PS of +3, although maybe it is a little bipappy, would simply reduce work of breathing, and only a tiny bit at that.

Now FRC might be another thing...

it's all explained by 'Where I work'

[Miss Emerita]

Rubicon and Miss Emerita,

Thanks for all of the comments.

I went to 11.4 fixed last night and it felt like it was fighting me from the get go. Breathing felt really unnatural as I was trying to fall asleep. Odd as I’ve been at 11 before. Maybe it has something to do with some margaritas with friends last night. I eventually adjusted it down a bit. Wasn’t a good night of sleep at all. I’ve also noticed that with higher pressure, I tend to feel sinus pressure/mild headache the following day.

As for my symptoms, sleepiness is rarely an issue. It’s more about feeling zoned out, lacking ambition, concentration and energy.

Could you post the chart, even though it was a crummy night?

[Rubicon]

Then I would think about if EPR is really creating an issue.

Seems to me the reporting of EPR on these graphs isn't quite as helpful as it could be. It only reports what's set, not when it's actually active (or more important, when it's suspended).

Just sayin'.

Don't the two pressure lines show you that? green and red, EPAP and IPAP? Of course on Resmed you can look at the mask pressure line and see what was measured.

Good idea. In reviewing some of the original discussions, seemed like once ResMed added FOT, they no longer suspended EPR during apneas:

[palerider]

Good idea. In reviewing some of the original discussions, seemed like once ResMed added FOT, they no longer suspended EPR during apneas:

That's my impression.

[Treatedandtired]

Here's last night...