djam's therapy thread

[djams]

Maybe do an awake experiment and simply pinch off one side of the DreamWear frame and look at the subsequent respiration pattern???

Did the pinch test. No way this pattern was from blocking one side of the frame.

In fact, the main conclusion from the test is that the air flow isn't blocked in any noticeable way when I lay on my side. It's a non-issue.

[Pugsy]

Maybe do an awake experiment and simply pinch off one side of the DreamWear frame and look at the subsequent respiration pattern???

Did the pinch test. No way this pattern was from blocking one side of the frame.

In fact, the main conclusion from the test is that the air flow isn't blocked in any noticeable way when I lay on my side. It's a non-issue.

Confirms what Respironics says...laying on one side doesn't impact anything. Any reduction in air flow coming in just switches to the side that is up.

It's very possible that the variation in flow rate you saw was indeed a little mouth exhaling going on. Jay has much more experience looking at the minute differences with mouth exhaling or breathing than I do. It's just not something I was ever interested enough in to spend much time digging into it. You know me...if I can't do anything about something or really need to do something ...then I don't expend the energy to learn much about it.
I simply can't try to learn everything about every little potential minor thing. I try to stick to the big stuff that I can do something about.
Besides Jay has already done all that work and a great job....why do I need to do it when he has done it for me.
I defer to him and move on to an area that I am better at.

[Jay Aitchsee]

The I:E ratio isn't something I'm concerned about. I do look at the averages, but that's it. Somewhere along the line I got the idea that it was normal for exhalation time to be greater than inhalation while sleeping. Is this a correct perception?

Yes, typically exhalation time is greater than inhalation time. Averages can be misleading. One needs to compare I:E on a breath by breath basis, as the period of both can vary overnight. Further, if the SleepHead calculation of RR is in error than so to will be I:E.

[djams]

The I:E ratio isn't something I'm concerned about. I do look at the averages, but that's it. Somewhere along the line I got the idea that it was normal for exhalation time to be greater than inhalation while sleeping. Is this a correct perception?

Yes, typically exhalation time is greater than inhalation time. Averages can be misleading. One needs to compare I:E on a breath by breath basis, as the period of both can vary overnight. Further, if the SleepHead calculation of RR is in error than so to will be I:E.

Thanks again Jay.

Understand about the averages. And I'm learning about SH's respiratory chart related problems. I've been spooked by them myself.

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

SH_pref_waveforms.PNG (33.85 KiB) Viewed 5512 times

[Pugsy]

Can anyone tell me how to make this I:E chart show up?

I think you need a bilevel machine.
I just looked through ResScan and while it shows as an option for the graphs that I should see...I don't see it anywhere.
Back when I was using a bilevel...I remember seeing it.
Some of the stuff you see in the list as being available is only available on some of the other models...remember SH covers many models that report different stuff.

[Jay Aitchsee]

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

I'm thinking this chart may not be available unless you have at least a Bi-Level machine. Remember, I:E is really only applicable to ventilators. I know it is available with the S9 Vpap Auto, but, as far as I know, not with a lesser machine.

Oops, didn't see your post, Pugsy but we agree.

[Pugsy]

Oops, didn't see your post, Pugsy but we agree.

I did go fire up ResScan on the off chance there was a graph or something in it that SH wasn't showing but while it shows as an option to see that graph and I have the appropriate check mark in the box....there is no graph for IE...no IE stuff anywhere.

[Jay Aitchsee]

Dave, quit worrying about I:E

Let's revisit an earlier item in this thread, your "abnormal" waveform.

file[1].png

which we decided was mouth breathing through your appliance.

To confirm, here's an example of breathing through pursed lips. Notice the similarities. There are two major differences. One is the dip at the start of my exhalations, which I believe is a little "pop" as the lips open.
The second difference is that your example lacks an associated leak which would be expected with mouth breathing using a nasal interface. Note that my example shows about a 5 L/min leak rate. This bothered me for a bit until I remembered that the Dreamwear has a 5-7L/min lower static vent rate than Resmed masks, viewtopic/t115230/Leak-Rate-comparison- ... l#p1116938. I think this lower vent rate hides low level leaks because ResMed sees them as part of the vent rate it is expecting and wouldn't treat them as a leak until it was greater than the vent rate expected for the mask setting. I believe this would also account for the small volumetric difference between inhale and exhale as noted by PR.

It appears that breathing this way, through a restricted opening, tends to draw out the period of exhale resulting in a smaller I:E (just to tie this all together )

[palerider]

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

WHY??? it's *meaningless*!

[djams]

Dave, quit worrying about I:E

I'm starting to get the idea here.

Let's revisit an earlier item in this thread, your "abnormal" waveform. file[1].png
which we decided was mouth breathing through your appliance.

To confirm, here's an example of breathing through pursed lips. Notice the similarities. There are two major differences. One is the dip at the start of my exhalations, which I believe is a little "pop" as the lips open.
The second difference is that your example lacks an associated leak which would be expected with mouth breathing using a nasal interface. Note that my example shows about a 5 L/min leak rate. This bothered me for a bit until I remembered that the Dreamwear has a 5-7L/min lower static vent rate than Resmed masks, viewtopic/t115230/Leak-Rate-comparison- ... l#p1116938. I think this lower vent rate hides low level leaks because ResMed sees them as part of the vent rate it is expecting and wouldn't treat them as a leak until it was greater than the vent rate expected for the mask setting. I believe this would also account for the small volumetric difference between inhale and exhale as noted by PR.

It appears that breathing this way, through a restricted opening, tends to draw out the period of exhale resulting in a smaller I:E (just to tie this all together )

Thanks for all of this. I really appreciate the detailed explanations. Very good thought about the different vent rate on the masks. I noticed this while reading the literature that came in my mask packages, but never would have considered it's application in this example.

Sure glad you started posting in this thread. I appreciate the details.

[djams]

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

WHY??? it's *meaningless*!

Well, so that I can look at it every day, and then when it looks different one day, post a screenshot and waste a bunch of your time explaining it to me! Why else?

(I get it...)

[palerider]

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

WHY??? it's *meaningless*!

Well, so that I can look at it every day, and then when it looks different one day, post a screenshot and waste a bunch of your time explaining it to me! Why else?

(I get it...)

Where's my nerf bat? *digs in the closet*.

[babydinosnoreless]

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

WHY??? it's *meaningless*!

Well, so that I can look at it every day, and then when it looks different one day, post a screenshot and waste a bunch of your time explaining it to me! Why else?

(I get it...)

I have a bilevel machine. Its got all the cool graphs and toys. Unfortunately I don't know enough to recognize when its different so I can post it to make palerider crazy. instead I pester pugsy with mask questions.

[palerider]

Can anyone tell me how to make this I:E chart show up? Based on Jay's comment about the avareages, this would be interesting to look at.

WHY??? it's *meaningless*!

Well, so that I can look at it every day, and then when it looks different one day, post a screenshot and waste a bunch of your time explaining it to me! Why else?

(I get it...)

I have a bilevel machine. Its got all the cool graphs and toys. Unfortunately I don't know enough to recognize when its different so I can post it to make palerider crazy. instead I pester pugsy with mask questions.

Everybody's gotta have a hobby!

Besides, I was crazy long before djams came along, just ask Pugsy.

[djams]

The apnea-free streak has been ended at 20 days by this hypopnea last night.

I'm feeling great. Pugsy, thanks (again) for getting me going on the pillow mask.

20190117_hypo.PNG (30.39 KiB) Viewed 5391 times