Now I'm Confused

[6PtStar]

I thought I had it all figured out but I got Pro Analyzer and I am confused again. Can someone explain what Variable Breahing is and what effect it has on your condition. Breathing in and out seems to be variable but why do I care as long as I get enough air?

Also found out while I don't have many apneas they seem to be fairly long in duration. This morning I had only 1 (.01 OA) but the duration was 12 or 13 seconds. This seems like a long time, I tried to hold my breath for 12 seconds and could not do it. What can I do to shorten the duration. I am running my APAP in standard CPAP mode. Would I be etter off running in APAP to allow it to raise the pressure and shorten the duration. Or am I asking to much?

[Wulfman]

I thought I had it all figured out but I got Pro Analyzer and I am confused again. Can someone explain what Variable Breahing is and what effect it has on your condition. Breathing in and out seems to be variable but why do I care as long as I get enough air?

Also found out while I don't have many apneas they seem to be fairly long in duration. This morning I had only 1 (.01 OA) but the duration was 12 or 13 seconds. This seems like a long time, I tried to hold my breath for 12 seconds and could not do it. What can I do to shorten the duration. I am running my APAP in standard CPAP mode. Would I be etter off running in APAP to allow it to raise the pressure and shorten the duration. Or am I asking to much?

Sometimes I wish Derek would have left out the Variable Breathing charts. It keeps coming up in these posts.....(apparently) the only people who have a clue as to what that data refers to work at Respironics. Derek found it in the data being captured and put the graphs in his MyEncore program. FYI, my overall average runs in the high 20's.

Don't fret about the length of 12 second apneas, either. That's about what mine average......when I have one. My longest (in the beginning of my therapy) was 72 seconds and I had another one for about 60 seconds. Occasionally, I've had a few for around 24 seconds, and as low as 9 seconds, but these are "averages" based on the amount of total time and number of events, as James explained in a post the other day.

You won't gain anything by going to APAP mode. In fact, you may have MORE apnea events if you do.

Den

[6PtStar]

Thanks Den

My Varible Breathing runs a bit higher than yours, mine seems to Avg about 30. I was afraid it had something important to do with hypopneas. If Respronics is the only people that know what it is I guess I will just not worry about it since everyone knows Respronics won't tell!

Thanks also for the information on apnea duration. It just seemed that 12 seconds seemed a long time. I had some longer ones to but that was before I went to the NA II. Most now seem to be around 6 or 12. I guess that is Ok so I will leave everything alone and keep sleeping and breathing even if it is variable.

[Niteair]

There is a definition of sorts for variable breathing at this location.

myencore.php#VarBreath[/url]

[Slinky]

Ha! Another Michigander! Ya think its somethin' in the water??

[6PtStar]

Thanks Niteair, You could almost overlay the example on mine. I hope that is good!!

[Sleepdeprived]

[quote="6PtStar"]I thought I had it all figured out but I got Pro Analyzer and I am confused again. Can someone explain what Variable Breahing is and what effect it has on your condition. Breathing in and out seems to be variable but why do I care as long as I get enough air?

Also found out while I don't have many apneas they seem to be fairly long in duration. This morning I had only 1 (.01 OA) but the duration was 12 or 13 seconds. This seems like a long time, I tried to hold my breath for 12 seconds and could not do it. What can I do to shorten the duration. I am running my APAP in standard CPAP mode. Would I be etter off running in APAP to allow it to raise the pressure and shorten the duration. Or am I asking to much?

[RosemaryB]

I've always been able to hold my breath for a pretty long time. I used to think this was because I learned to do it taking yoga many years ago. Then once I got dx'd with OSA, I figured it was because I "practiced" all night, every night. But again, I find that's not true.

However, if you have very few apneas and they are this duration, it doesn't seem too bad, since in yoga you learn to hold your breath for longer than this. (But not over and over all night every night).

FWIW.

[StillAnotherGuest]

I thought I had it all figured out but I got Pro Analyzer and I am confused again. Can someone explain what Variable Breahing is and what effect it has on your condition. Breathing in and out seems to be variable but why do I care as long as I get enough air?

It may make more sense to view Variable Breathing (VB) as not necessarily related to variable breathing per se, but rather the machine has entered a different mode, and the algorithm has been taken over by the Variable Breathing Control Layer. But let's call it Variable Breathing Mode (VBM). It has seen some erratic breathing and has suspended titration mode.

Right, there's not a lot of clinical data about it, but I imagine you could have either some normal variation (REM sleep, normal wake periods) and/or abnormal variation (insomnia, repeated wake/1 transitions, arousals from non-respiratory events).

There are times, however, when seemingly "variable breathing" per se will not cause the machine to enter VBM (the algorithm hierarchy seems to say that if there are leaks, snores, or apnea/hypopnea, you can't enter VBM). Without this hierarchy, anyone with untreated SBD would undoubtedly be in VBM all night long.

The basic goal of VBM seems to move the patients back to the setting that was in effect before the onset of erratic breathing. In both APAP and AutoBiPAP, this is accomplished slowly, at a rate of 0.5 cmH2O/minute, up to 2.0 cmH2O (using IPAP in AutoBiPAP, affecting EPAP only if an IPAP change would necessitate an EPAP change because of PS restrictions). Also, pressure changes are tempered based on the presence or absence of snoring prior to the initiation of VBM.

Being able to analyze a patient's VB Mode more closely, like when it actually occurs, would be extremely helpful (but right now, you can't).

REM sleep in adults is generally pretty stable, at least stable enough that if you see 25% VB you shouldn't think it's all REM. I mean, there may be a little variation, but I think the point of considering VB in REM is that you don't want to poke at it at all with unnecessary pressure changes.

I would look for poor sleep architecture as the most likely culprit of abnormally high percentages of VBM.

In an edit of the VB algorithm:

Variable Breathing Pressure Control

Once the variable breathing controller has been granted control of the pressure support system, it takes some initial action based on the action the auto-CPAP controller is taking. After this initial action, it performs an independent pressure control operation.

A prior pressure that is flat will cause the pressure delivered to the patient to remain at that level.

A prior pressure that is increasing will cause the variable breathing controller to initially decrease the pressure delivered to the patient at a rate of 0.5 cmH2O per minute. The magnitude of the decrease is dependent on the magnitude of the increase in prior pressure. The pressure decrease is intended to erase the prior pressure increase that possibly caused the variable breathing. However, the total decrease in pressure drop is limited to 2 cmH2O. After pressure decrease, the variable breathing controller holds the pressure steady.

A prior pressure that is decreasing will cause the variable breathing controller to initially increase the pressure delivered to the patient at a rate of 0.5 cmH2O per minute. The magnitude of the increase is dependent on the magnitude of the decrease in prior pressure. The pressure increase is intended to erase the prior pressure decrease that may have caused the variable breathing. However, the total increase in pressure is limited to 2 cmH2O. After pressure increase, variable breathing controller holds the pressure steady.

The pressure curve is provided for 5 minutes or until the variable breathing condition clears. Thereafter, the pressure is controlled according to the following:

The pressure is either maintained at a constant value, or it follows a decrease and hold pattern. The decision to hold the pressure or to decrease the pressure is made by comparing the current pressure with the snore treatment pressure. It is to be understood, however, that this duration can be varied over a range of durations.

If there is no snore treatment pressure stored in the system, which will be the case if the snore controller has not been activated, the pressure is held constant. If there is a snore treatment pressure, and if the current pressure is more than a predetermined amount above this snore treatment pressure, such as more than 2 cmH2O above the snore treatment pressure, the variable breathing controller decreases the pressure to a level that is a predetermined amount higher than the snore treatment pressure and holds the pressure at the lower level. The pressure decreases to the snore treatment pressure +1 cmH2O.

The duration during which pressure is provided according to the paradigms discussed above for region is set to 15 minutes or until the variable breathing condition clears. It is to be understood, however, that this 15 minute duration can be varied over a range of durations.

SAG

[Wulfman]

SAG/Dave,

While most of the examples you're describing refer to "Auto" operations and changing pressures, bear in mind that VBF is also tracked in CPAP mode on the Autos and on the Pro 2/Pro CPAP models.

The "unknown" part that people seem to want to know is "What's a good or bad number?". In my mind, I think it's one of those "Your Mileage May Vary" situations. I've had good AHI "numbers" at various numbers of VBF, and my extreme numbers range from the "teens" to the low 40's, but is typically and averages in the mid to upper 20's to slightly over 30.
I think that if a person actually watches those numbers, they might be able to relate it to how soundly they slept. It seems in my case, that the lower the number, the more "comatose" I seem to have been during the night. And, conversely, the more restless I am, the higher my VBF will be.

Den

[everson]

how do you all know when you are having events? I have a memory card that only my doc can read. Is that what you all do is talk to the doc?
Thanks crabby2005

[JeffH]

how do you all know when you are having events? I have a memory card that only my doc can read. Is that what you all do is talk to the doc?
Thanks crabby2005

Oh no, we are evil people on this board...we have the software and have learned to read our own info off the card!

DME's and Sleep professionals for the most part think we are awful.

[Guest]

how do you all know when you are having events? I have a memory card that only my doc can read. Is that what you all do is talk to the doc?
Thanks crabby2005

You don't have your equiptment profile filled in so we don't know what you are using, you must have a full data XPAP, the correct software and reader for the card. If you have all that, you can see what happened and when, and why (maybe).

And yes, I reformatted MoneyPit 1, and it now log-in challanged, and MoneyPit 2 is too busy to use. Jim