help understanding my graphs

[Tino2You]

Hi All,

Am 90 days into my treatment. Feel like I am doing well, on the whole. A few days I wake up a bit tired. Yesterday was one. Felt like I was back in the fog too. Anyway, I pulled the data from my machine and discovered an interesting cluster. I catch a Hypopnea at 1:32:55, followed by a OA at 1:36:33 and then a CA at 1:37:21.

I am a bit worried because it is an ugly bunch of cluster and to my knowledge, this was not one of my awake times. My leaks are not bad, snoring is almost non-existant and my pressure is below my upper limit. Thoughts?

[Xney]

It looks to me like your machine is spending a lot of time at the top end of its pressure range. You may want to raise the minimum and possibly the maximum pressure by 2-3cm.

Also, watch for more centrals at higher pressure (after a while)

[gertrude]

That may be good advice about raising the pressures -- I don't have the experience to know. But it doesn't explain his mixed cluster, which occurred at lower pressures.

[Xney]

Seems like there's more events at <11-12cm than above it. (or that's how it seems to me)

It's kind of odd in that his titration test should have caught it if the pressure was too low. But that's what I would try.

Sometimes in sleep studies they just prescribe a wide-open auto even if the sleep study shows titration needed at a certain level.

[BasementDwellingGeek]

Did your sleep study say anything interesting about REM? From my own experience with ZEO, the Resp rate looks like mine in REM. I also do a a bit of crescendo, breathing in REM. Check out Period Breathing. viewtopic/p725904/What-does-your-normal ... -like.html

[Pugsy]

It's kind of hard to see which colors of events you are having in that little cluster but some of them appear to be central or clear airway and the machine isn't supposed to increase the pressure for those.

Don't know what happened during that time frame but unless it is a frequent visitor and happens often I wouldn't be changing anything if I am sleeping well. It could maybe have been a little mini awakening thing. The machine didn't seem to want to increase the pressures much at all during that time frame. We know it won't respond to centrals. The only thing left is obstructive event precursors and maybe you just didn't have any of them with this cluster. They could have maybe been frank apneas that occurred out of the blue with no warning...they could also be a little mini awakening that got the machine confused with semi awake events being flagged.

Sometimes we just have odd ball stuff show up that we don't know what happened.
I wouldn't change anything based on a rare odd ball thing that I couldn't explain if the rest of the night looked great and I felt I was sleeping well most of the time.
Though it probably wouldn't hurt to raise the minimum pressure just a bit as long as I was comfortable doing so.
Especially since it appears you are using EPR. Maybe a little more minimum to compensate for the slight reduction during exhale that comes with EPR. I would be more apt to do it for the general appearance of the night with the other events spread out than I would just to solely try to do something about that lone cluster.

[Tino2You]

Thank you Xney and Gertrude,

Xney, my pressure range is 9 to 15.6 every one of those clusters occurred less than my upper limit of 15.6. So raising the upper would not help. They also started with my pressure near 11 so raising the lower wouldn't help either. I've been toying with raising my lower pressure to 9.5 maybe 10 as I am at that level a small percentage of the time.

BasementDweller,

It may very well be me in REM. From my Sleep study "There were 0 REM Sleep periods" during the diagnostic phase and "18.5 minutes of REM sleep in 2 REM sleep periods" during the treatment phase. No Periodic Limb Movements , No Bruxism.

It may very well be I was just dreaming, but the 10 to 15 second Clear and Obstructed airway events clustered like that made me want to know more.

-tino

[Tino2You]

Maybe a little more minimum to compensate for the slight reduction during exhale that comes with EPR. I would be more apt to do it for the general appearance of the night with the other events spread out than I would just to solely try to do something about that lone cluster.

Thanks Pugsy, I agree with all you said. The more I thought about it today the more I am leaning towards a awaking or dream event. I added EPR 1 to my machine when to make exhaling a tad easier. It works. My next change will be to raise my min to 10. I am only at <10 briefly, my median is 12.5 and I always seem to go to 15.6 every night but not often and not for long. So I think the upper number is where I need to be.

Maybe the fog is just me getting old ... nahhhhh can;t be

Thanks again,
-tino

[Xney]

Xney, my pressure range is 9 to 15.6 every one of those clusters occurred less than my upper limit of 15.6. So raising the upper would not help. They also started with my pressure near 11 so raising the lower wouldn't help either. I've been toying with raising my lower pressure to 9.5 maybe 10 as I am at that level a small percentage of the time.

Yes I think your minimum needs to be higher. I don't know about the upper - you're getting into a range where CPAP starts to not be fun at the top there - bipap might make more sense then, if it needed to be higher. Based on your graphs so far, I don't think it the max needs to be higher.

[avi123]

see below

[BigLou]

Tino....just curious as to whether or not you consistantly use your chin strap? Your snore line looks a little ratty. I just ordered the same chin strap as you have in your bio (ruby) and use nasal pillows also. My snore line is not as high as yours but I am trying to eliminate my leaks when my machine starts to rise to my max pressure....only 11.4 now. Not sure if the pillows are leaking or if I am mouth breathing during this time. Thanks and good luck fellow papper!

[Tino2You]

Tino....just curious as to whether or not you consistantly use your chin strap? Your snore line looks a little ratty. I just ordered the same chin strap as you have in your bio (ruby) and use nasal pillows also. My snore line is not as high as yours but I am trying to eliminate my leaks when my machine starts to rise to my max pressure....only 11.4 now. Not sure if the pillows are leaking or if I am mouth breathing during this time. Thanks and good luck fellow papper!

Hey BigLou,
Yes I wear my chin strap every night almost all night. Once or twice I didn't shave that day and it gets scratchy. I've been playing with my mask and chin strap tightness. Trying to find that happy balance between comfort and effectiveness. For the past 90 days my AHIs average 2.3, the past month has been 2.1 so I am not too worried about the occasional snore. Pre-CPAP I could raise the roof (so I am told). The chin strap now is a gentle reminder for me to keep my mouth closed.

Hope this helps.
-tino

[BigLou]

Thanks for your encouragement Tino. I hope the strap keeps my mouth shut. We'll see.

Lou

[avi123]

I also have those CAs as you do. I think that I'll lower the max pressure by 1 cm.



But in ResScan it shows more normal:

(a cluster while waking up)




Also, my Stats are normal:

[Todzo]

Hi All,

Am 90 days into my treatment. Feel like I am doing well, on the whole. A few days I wake up a bit tired. Yesterday was one. Felt like I was back in the fog too. Anyway, I pulled the data from my machine and discovered an interesting cluster. I catch a Hypopnea at 1:32:55, followed by a OA at 1:36:33 and then a CA at 1:37:21.

I am a bit worried because it is an ugly bunch of cluster and to my knowledge, this was not one of my awake times. My leaks are not bad, snoring is almost non-existant and my pressure is below my upper limit. Thoughts?

Hi Tino2You,

The flow waveform strip you show looks to be times of severe periodic breathing and some full fledged Cheyne-Stokes respiration (see: http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration ). The minute volume waveform moves rather rapidly between 5 liters per minute (lpm) and 15 lpm. The actual range could be greater since the calculations on the flow waveform are complex.

This breathing instability you show is hard on your heart! If you see much more of it I would go to the doctor, probably a cardiologist specifically.

It may mean that you are a candidate for Auto-SV CPAP. I would not increase any pressures except you might eliminate EPR which should make for less snoring and less apneas.

In the mean time:

Reduce Stress
Do moderate exercise (walking is great!)
Stay away from violent media
Eat well and include anti-oxidant and anti-inflammatory foods.
Keep hydrated.
Reduce sugar intake specifically near bedtime.
Reduce carbs specifically near bed time.
Take the time to enjoy and appreciate the things you love.
Learn to breath quietly – at all times – and train to do so with your PAP during the day and while going to sleep at night. The instability will always be and is in your charts preceded by a time of increase air use. I often use a pulse oximeter to find the breathing rate which yields the lowest heart rate with exertion held constant. I also often do this with my machine. Breathing reflexes, I think, can be trained but it does take a lot of time and effort.

And indeed do have some fun!

Todzo