AirFlow reduction ???

[palerider]

You still have a much bigger problem than 'are these 'real' hypopneas?

clearly they are, but look at the rest of your breathing!

[Bobo97272]

You still have a much bigger problem than 'are these 'real' hypopneas?

You mentioned that earlier, but didn't say what the bigger problem is. Can you tell me now?

[palerider]

You still have a much bigger problem than 'are these 'real' hypopneas?

You mentioned that earlier, but didn't say what the bigger problem is. Can you tell me now?

The fact that you have regular waxing and waining breathing patterns implying a CO₂ instability (too much EPR/pressure support maybe), or neurological issues, or cardiac issues.

How long do those periods last?

[Rubicon]

I'll have to go back to Oscar to collect the tidal volume values during the windows.

For why? Event determination is based on flow, not volume. Nobody cares what the tidal volume is doing.

And anyway tidal volume is based on a 5-breath average. Since an event can occur with a change in only one or two breaths, the rolling average probably wouldn't even drop enough to score an event. With an 8 second short term ventilation window a 5-breath average is worthless. Less than worthless. Like negative-worth.

[Bobo97272]

And anyway tidal volume is based on a 5-breath average. Since an event can occur with a change in only one or two breaths, the rolling average probably wouldn't even drop enough to score an event. With an 8 second short term ventilation window a 5-breath average is worthless. Less than worthless. Like negative-worth.

Rubicon, Sorry, that was my mistake, I had thought that it was you who needed to see the tidal volumes, but it was Palerider.

So from your perspective the flow rate data versus tine is what I need to examine, right?

Now by the way, what does AASM consider as a baseline for evaluating a flow reduction?
I do understand that we can’t apply the AASM guide to CPAP devices that don’t monitor oxygen saturation, but I was just interested in what AASM considers the appropriate look-back segment.

[Rubicon]

Now by the way, what does AASM consider as a baseline for evaluating a flow reduction?

A reduction in flow that does not qualify as a hypopnea and results in an EEG arousal would be scored as a RERA (respiratory-related arousal). If there's no arousal then it's nothing.

In the DIY CPAP World, one would see if FLs lead to a Big Mess Breathing Pattern which one would then assume is/has an EEG arousal.

That said, most people just chase FLs whenever the appear.

[Bobo97272]

I've had discussion with my doc previously and I came away with this understanding.
Home Cpap machines do the best they can to approximate the AASM guideline for hypopneas, but because the home machine does not measure oxygen saturation, they have to rely on reduction in flow to identify hypopneas. AASM guidelines for hypopneas is a 30% reduction in air flow from a baseline and an associated desaturation. Home machines can't identify desaturations so your Resmed machine relies only on a airflow reduction.

When I asked him about "reduction from what", What value is the denominator to calculate a % reduction, he had no answer. That is the reason I'm asking here.
So your answer above for the Resmed "rules" is very helpful.

I was only inquiring if you had any idea about what AASM means when "they" refer to a baseline (or some prior segment used as the denominator) as the basis for the comparison.

Thanks for your time, appreciate it!

[Bobo97272]

How long do those periods last?

Resmed IDs these Cheyne-stokes lasting 23 to 45 minutes.

[Pugsy]

Is your doctor aware of these periods of Cheyne Stokes Respiration?
If not...he should be.

[Bobo97272]

Interesting that you should ask.
I pointed out these Cheyne Stokes episodes to my cardiologist and he said to discuss it with my sleep doc. In general, he seems to be dismissive of testing that is not conducted by certified-creditable labs.
"You have no indication of heart failure"- his words.

When I discussed it with my sleep MD, he said that I should talk with my cardiologist. He saw no indication of Cheyne Stokes in either of my two prior at home sleep studies (2020 and 2022. He also is skeptical of Resmed's analysis.

So, I'm basically on my own to follow-up on Cheyne.

Are we venturing off topic now? (I know how you hate that) Should I consider a new topic devoted to just my personal Cheyne-Stokes

[Miss Emerita]

Is your doctor aware of these periods of Cheyne Stokes Respiration?
If not...he should be.

Please pay attention to this! Make an appointment with your doctor soon, and show him or her several samples of these flagged waxing/waning episodes. Print them or take your laptop. The level of zooming in the one you posted is just right. Be sure to tell him or her roughly how many minutes per night you spend with these episodes.

Just saw your reply. Fire those doctors. As for the sleep doctor: have these episodes cropped up since the time of your last sleep study? If they have, that's a point you'd need to make if you follow up with him or her. Do you have a good primary care physician? Maybe that's the right person to talk to. You may need a referral to a pulmonologist or a neurologist.

[Pugsy]

Are we venturing off topic now? (I know how you hate that) Should I consider a new topic devoted to just my personal Cheyne-Stokes

No....please don't go starting another thread/topic.

My off topic warning is generally given to others who start a pissing contest about something totally unrelated to original topic.

Your CSR stuff is more on topic than you might think.

[ozij]

Interesting that you should ask.
I pointed out these Cheyne Stokes episodes to my cardiologist and he said to discuss it with my sleep doc. In general, he seems to be dismissive of testing that is not conducted by certified-creditable labs.
"You have no indication of heart failure"- his words.

So you have a cardiologist. How long has he been treating you? Known the details of you heart's condition? What do you mean by "pointed out"?

When I discussed it with my sleep MD, he said that I should talk with my cardiologist. He saw no indication of Cheyne Stokes in either of my two prior at home sleep studies (2020 and 2022. He also is skeptical of Resmed's analysis.

Did he see the flow chart? Was he skeptical of the flow chart, or of the use of the term?
Did the home sleep studies study your breathing while you were on CPAP?
On this forum, we do trust the wave forms shown by ResMed machines. So then the question becomes: what do they mean, what do they indicate.
The sleep doctor who put you on an APAP can't seriously distrust ResMed's ability to track you breath flow. Because if that is unreliable, so is any automatic pressure adjustment. Therefor he should have put you on constant pressure, after an in-lab sleep study for titration of that pressure.

The fact that you have regular waxing and waining breathing patterns implying a CO₂ instability (too much EPR/pressure support maybe), or neurological issues, or cardiac issues.

"CO2 instability" either means your breathing system has to get used to regulating CPAP supported breath and the problem will disappear, or it could mean you need another type of machine. In both cases, that CSR could be a direct result of the CPAP therapy.
Which, once again, raises the question: did the sleep doc see you sleep charts, and pooh pooh them?

[Rubicon]

...my personal Cheyne-Stokes

You mean your personal "Periodic Breathing".

Cheyne-Stokes cycle time has to be at least 45 seconds and is usually in the neighborhood of ~60 seconds.

Evaluate for TECSA instead.

[Bobo97272]

I'll try to answer each question:
@Pugsy;

Is your doctor aware of these periods of Cheyne Stokes Respiration?

Yes

@Miss Emerita:

Make an appointment with your doctor soon, and show him or her several samples of these flagged waxing/waning episodes. Print them or take your laptop. The level of zooming in the one you posted is just right. Be sure to tell him or her roughly how many minutes per night you spend with these episodes.

I have shown OSCAR charts and similar zoomed sections to both my Sleep doc and my cardiologist as well as my PCP

@Miss Emerita:

have these episodes cropped up since the time of your last sleep study?

I've observed them sporadically after I started with CPAP two years ago, and they have continued sporadically up to and after my last sleep study a year ago, Neither my original sleep study in 2020, nor my sleep study in 2022 reported any CSR or periodic breathing pattern.

@Miss Emerita:

You may need a referral to a pulmonologist or a neurologist.

My sleep doc is a Pulmonologist,

@ozij:

So you have a cardiologist. How long has he been treating you? Known the details of you heart's condition? What do you mean by "pointed out"?

I've been seeing this cardiologist or his partners at least annually for 27 years. Principle reason I decided I needed a cardiologist was because of my family history. Both parents died of heart attacks, both brothers have had heart attacks. I've had stress test and echocardiography in the past 18 months in preparation for other surgeries (eye and colonoscopy). By pointed out I mean that I showed him OSCAR charts that are similar in pattern to the one I posted . He intimated that since he knew nothing about this 'strange software' nor what the reliability of the Resmed machine he was skeptical of applying much weight to it, He left me with the impression unless the pattern is reported and analyzed on "his hospital's" equipment he considered it (OSCAR and Resmed) a consumer toy, much like a smart watch reporting oxygen and sleep stages. (briefly argued that Resmed is not a "toy" it is FDA approved, his counter was that FDA approves it for safety, but FDA makes no claim that home based machines are reliable medical diagnostic tools - they are treatment tools not diagnostic. I realized that I was in over my head, and did not push this any farther)

@ozij:

Did the home sleep studies study your breathing while you were on CPAP?

I seem to recall that the 2020 home sleep study had a nasal cannula, but there may have been some doubt about it accuracy because I tend to mouth breath when really relaxed. I know for a fact the the home sleep study done Dec 2022 did not have anything to measure my breathing/air flow (no mask, no cannula)

@ozij:

The sleep doctor who put you on an APAP can't seriously distrust ResMed's ability to track you breath flow.

The sleep doctor (pulmonologist) seems to have no problem "believing" the AHI values that HE gets from Resmed's cloud (or I should say that's where I "think" he gets them) He told me that none of the data that he gets from Resmed's Airview say anything about "pattern breathing" or CSR. (So, apparently his view is if the data doesn't come from Resmed Airview, it is suspicious)

@ozij:

your breathing system has to get used to regulating CPAP supported breath and the problem will disappear

I would sure hope that after two+ years of CPAP use (at 98% compliance) my system would have become used to CPAP.

@Rubicon

Evaluate for TECSA instead.

What is TECSA? Is that some thing I should press my cardiologist for or press my pulmonologist?

Thanks to all for your help and may you have a Merry Christmas .