OSCAR chart to grade please? Newguy

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And here is the little guy that is creating all the ruckus:

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OK I guess you could add "Increased Chemoresponsiveness", maybe "Circulatory Delay" (although with a normal EF maybe not) and of course, "Controller Gain" --(xPAP), the Root of All Evil.

But see in image #1? It all starts with a "Ventilatory Disturbance".

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OK so trick question--

Gene's got about 400 events per night, AHI 60 (don't believe what you read).

How many of them do you have to treat?

[ozij]

OK so trick question--

Gene's got about 400 events per night, AHI 60 (don't believe what you read).

How many of them do you have to treat?

One. The first one.
But it has to be the correct treatment....

Still trying to understand all those technical terms in images.
And in this paper - which is helpful: The Pathogenesis of Central and Complex Sleep Apnea , but not enough...

[robysue1]

OK so trick question--

Gene's got about 400 events per night, AHI 60 (don't believe what you read).

How many of them do you have to treat?

I take it the little guy in the red oval is the initial Ventilatory Disturbance and that it can be considered event #1.

In that case, I agree with Ozij that the correct treatment for event #1 should be enough. I assume that an ASV machine can properly treat event #1 and thus prevent most/all of the remaining 400 events per night.

But I have to ask: What's the significance of the stuff in the green box vs. the stuff in the orange box? And what is the significance (if any) of the stuff that lies between the orange boxes?

[Rubicon]

OK so trick question--

Gene's got about 400 events per night, AHI 60 (don't believe what you read).

How many of them do you have to treat?

One. The first one.
But it has to be the correct treatment....

Yup. Theoretically anyway. The goal is to break the chain, stop the harmonic resonance, not superimpose pretty waveforms on apneas all night.

Y'know, respirations are calmer at lower pressures seen early in the course of treatment. As well they should be.

Problem is those nasty desats.

WAY too risky for arbitrary DWing.

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But I have to ask: What's the significance of the stuff in the green box vs. the stuff in the orange box? And what is the significance (if any) of the stuff that lies between the orange boxes?

Within the boxes are the increasing (or decreasing, depending on how you look at it) pseudo-hypopneas that through harmonic resonance are on their way to becoming hypopneas, apneas and periodic breathing.

[robysue1]

But I have to ask: What's the significance of the stuff in the green box vs. the stuff in the orange box? And what is the significance (if any) of the stuff that lies between the orange boxes?

Within the boxes are the increasing (or decreasing, depending on how you look at it) pseudo-hypopneas that through harmonic resonance are on their way to becoming hypopneas, apneas and periodic breathing.

And the stuff between the orange boxes? What part of the feedback loop are they?

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That is, or will be, hyperventilation phase. The havoc can be more clearly seen looking at tidal volume and minute ventilation:



Check out your own Vt and MV. Should be darn near a straight line.

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As an aside, most CompSAS will resolve on it's own after about a month, but here we're still wicked bad at 3.

BTW Gene, exactly when did you start levothyroxine and what time of day are you taking it?

[lynninnj]

No prob:

You just HAD to ask Ozij!

(jk)

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Some labels will help:

(D) is ventilatory disturbance
(R) is ventilatory response
The horizontal line in Plant Gain is the apnea threshold.
CR is chemoresponsiveness
PAV is BiPAP (pretty much)
VE is minute ventilation.

If you look at Gene's MV graph there are are huge swings, so the point on each graph is in a significant and constant state of motion.

Every time PACO2 drops below apnea threshold, hypopnea/apnea ensues.

Increased chemoresponsiveness (hallmark of CompSAS) increases VE and then shoves PACO2 under the apnea threshold again.

Rinse and repeat.

Ad infinitum.

Until with ASV you gently ventilate only through the apnea to avoid the increased PACO2 > increased PCRCO2 > increased VE > ensuing apnea > following hyperventilation phase.

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November 10 even on low-level CPAP breathing instability almost immediately appears:

[GeneMpls]

BTW Gene, exactly when did you start levothyroxine and what time of day are you taking it?
[/quote]

I take it when I get up, 4 or 5:00. Started 10.17- almost a month. I am feeling a lot better- the sleep issue did not bother me the first 75 years? Thanks for all the effort, Gene

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the sleep issue did not bother me the first 75 years?

Did you ever boil a frog?