Breath Zoom Scroll; OSA flow or something else?

[rkl122]

Hi. I'm planning to show my SH data to the sleep doc in a week or so. After 5 mos., I think I'm zeroing in on effective OSA therapy settings, but my flow graph still looks peculiar, and I don't feel rested in the morning. The link below is a screen capture of me scrolling my flow chart at the breath level.

I'm seeking advice on what points to emphasize with the doc. I think the irregular patterns are SWJ, even with the OA's, but not sure. I guess the big question is are they caused by my OSA, or something else. I have bradycardia, mild hypertension, and mild hypoxia. I had pneumothorax after some broken ribs last fall, but a recent CT scan show no residual pleural effusion. The data in the link were acquired at a constant 8.5 cmH20 (CPAP) with AFLEX off. I was using a ffm, not my usual Dreamware, and, for a reason I also don't understand, the change in mask seems to have increased my RERA's, VS2's, and leaks.

https://youtu.be/7I2a_wqOOQw (Apologies for el-cheapo microphone puffery.)

Thanks for looking, -Ron

[Chevie]

I'm seeking advice on what points to emphasize

And you got the idea to post a five-minute video instead of a screenshot or two from where???

[LSAT]

Chances are, your doctor will have no idea how to interpret your charts and will not take the time to watch your video.

[Jay Aitchsee]

Ron, I didn't really see anything terrible there. A few disturbances followed by an event for the most part. I didn't see any events followed by the increase in flow rate without an increase in front, which would be indicative of a true apnea. I agree it looks like mostly junk.

I hate to beat a dead horse, but if you look at those little bumps you asked about, I think they're the same as the pulse artifacts we talked about in the other thread. If you look at their timing, I think you'll see they are about 1 second apart, a little hard to count on the video, but they are regular. A 1 second period would be 60 bpm, which would be about right for a heart rate.

I have no idea what's causing the disturbances. And it's a little difficult to get a feel for it with the video. Are you conscious of any of these periods that seem like wakes? You might try just a small increase in pressure to see if it reduces the RERA. You also might try a soft collar to keep your chin up. (I'm really reaching here). You can make a collar from a piece of foam or similar wrapped in a bandana and fastened so the foam keeps your chin from falling. Any environmental issues? Lights, sirens, air conditioning, anything you can match to the times of the disturbances? Have you given up caffeine? Increased leaks with a FFM are probably from the mask seal at the face. Do you see a correlation between change in leaks and disturbance? Do you have a video camera you can set up to see what your doing in your sleep? Maybe a Pulse Ox would gives us a clue?

As far as I can see, aside from the disturbances, your flow waves look pretty normal.

We'll see what Pugsy says.

[Pugsy]

Sorry...I won't be watching any videos until after the 11th.
They won't load for me...I am being punished with the equivalent of dial up internet speed since I exceeded my monthly allowance. They don't charge me more but it slows down to a crawl.
Images (like reports) take forever. Videos...impossible right now.

[Jay Aitchsee]

Ron,

I suggest you settle in with a mask/pressure combination which minimizes H, OA and CA, such as you have now. I would also suggest you turn a lot of that other stuff, Vs, RERA, Te, Ti, etc., off and concentrate on the big picture. I don't think you're going to find the answer to your non-restorative sleep in the minutia of your sleep statistics. No doubt, you can make some minor adjustments which might further reduce H and OA, but probably not a great deal. As demonstrated by your posts, most of your events of OA and CA seem to arise from disturbance. You are probably not going to be able to tweak yourself into good sleep by CPAP adjustments alone. After all, CPAP fixes OA and H, but not poor sleep from other causes.

After you have settled on a set up, begin a methodical approach to finding what may be affecting your sleep. If you have H and OA caused by insufficient pressure, adjust accordingly, but if they are related to disturbance, you need to find the source of the disturbance. Could be leak, could be pain, could be asthma, could be meds, could be cardio, could be... and the list goes on. It will take patience to eliminate possibilities one at a time.

You need to review and make sure you are applying all the principles of Good Sleep Hygiene. If you don't, you're just spinning your wheels. You need to keep a sleep log of things that might affect your sleep, like caffeine, foods, meds, exercise, work related stress, bedtime, etc., and then record how you feel when you wake the next day before you look at your AHI. The log doesn't have to be fancy, a few lines for those items that might change daily and a simple scoring system, like 1-5, poor to great. (I found paper and pencil to work better than included electronic logs.)

It's relatively easy to treat sleep apnea, but if that's not the only cause of fatigue, non restorative sleep, or sleepiness (and there are many possibilities), it becomes a challenge to find what the other cause(s) might be.

Enlist the aid of your Doctor, tell him you're not sleeping well, have him review your flow waveform charts, but you'll probably have to use Encore, if he will look at anything. Get your cardio to order a 24 hour holter, tell him you want to review and compare it to your sleep charts. Have a thorough check up which includes all the blood tests for the deficiencies which are often related to poor sleep and fatigue. Practice Good Sleep Hygiene.

J

[rkl122]

............... I don't think you're going to find the answer to your non-restorative sleep in the minutia of your sleep statistics. No doubt, you can make some minor adjustments which might further reduce H and OA, but probably not a great deal. As demonstrated by your posts, most of your events of OA and CA seem to arise from disturbance. You are probably not going to be able to tweak yourself into good sleep by CPAP adjustments alone. After all, CPAP fixes OA and H, but not poor sleep from other causes.

.....................

Jay, I want to thank you for the empathy and assistance. You put in a lot of time. I appreciate it! You are right of course, and I've much to discuss with the docs. (I wasn't going to suggest they watch a video btw; I'll just show them some pics and will know right away if they have insight beyond what I know already.)

I've yet to read up on the ballistics stuff, but it does sound plausible. It's not just that, though, it's also moments such as shown here

where a sizable inspiration appears to have no equally sized expiration (where did that air go?). But as you say, this is minutia compared to the problem I really need to solve.

I do follow most of the sleep hygiene rules. One naughty pleasure is surfing the iPad in bed. Gotta work on that.

Despite the scarcity of truly restorative sleep, I've definitely benefited from the machine and the forums. I know how to distinguish true events from SWJ, minimize the ones from OSA, BP is lower, bathroom breaks are fewer, sleep is sounder for longer from the top of the night, etc.

Time to step away for a longer perspective. Again, thanks Jay. -Ron

[Jay Aitchsee]

where a sizable inspiration appears to have no equally sized expiration (where did that air go?).

Ron, here it looks to me as if you are exhaling through your mouth. The expiratory portions of the Flow Waves are fairly flat. If you are wearing a Nasal Mask the effect is accentuated, but still remains with a FFM. With a nasal mask the expiration can not be measured directly because the sensor is in the machine and it is only attached to your nose which is why the effect is exaggerated with a NM.
Remember, we are looking at a Flow Rate Waveform, so the volume of the flow is that under the curve and the curve itself is being distorted by the Pulse artifact we discussed in that other thread. So in this instance, you have what looks to be a fairly large inhale, but if you look at the exhale, it is long. Maybe 1.5 times longer than the surrounding expiratory periods. So, it looks to me as if you took a deep breath and exhaled it slowly over a longer period of time. Muddled by the artifacts. I see it as insignificant, other that it represents a period of somewhat disturbed breathing that we would call SWJ. BTW, this looks like it is occurring around 7 AM, a time when we would expect to see a lot of SWJ appear.

I do follow most of the sleep hygiene rules. One naughty pleasure is surfing the iPad in bed. Gotta work on that.

If the time is correct and you are not a shift worker, you are not practicing Good Sleep Hygiene, IMO. Typically, our body clocks want us up with the sun. You should be going to bed and getting up earlier, again IMO. Many people give Sleep Hygiene lip service, but not so many actually practice it. As I said in the post above, until you are, you are just spinning your wheels. I'm just sayin'.
j

[Jay Aitchsee]

Ron, since you are quite interested in the shape of the Flow Rate waveforms, I'd like you to conduct an exercise and post the results here. It will take about 5 minutes. The purpose of the exercise is to capture, record, and identify the characteristics of your Flow Rate Waveforms under different conditions while wearing a nasal mask. This will help to identify future waveforms by having a reference to which to compare them.

To start, during the day, put on your nasal mask and start your machine. Be sure your card is installed so the session can be recorded. Get comfortable and breathe normally. When ready, note the time and begin breathing following the pattern below. It is important to follow a pattern so the wave shapes can be identified after recording. Each set of 12 breaths will be about a minute long. After completing the last set, note the time, breathe normally for a bit and turn off the machine. When finished, download the results to SleepyHead to record and label and then upload them here for us to see. Your results might also help others to identify characteristics of their waveforms.

Breathing Pattern of Exercise, 12 breaths each.

• 1. Nose in, Nose Out
  2. Nose in. Mouth Out
  3. Mouth In, Mouth Out
  4. Mouth In, Nose Out
  5. Nose In, Nose Out

P.S. In the interest of science and the forum, If you'd like to repeat the exercise with a Full Face Mask for comparison, that would be great. Thanks
Also check the "Ignore Short Settings", SleepyHead/Preferences/Import, isn't in conflict.