Variable Breathing always 60%+ - Concerned

[dsm]

Weight 250 (was 235 at PSG)

72 inches tall

Neck - 17ish

40ish

General build - Have been called "Big Guy" not because of weight.... Medium build, very skinny my entire life - too skinny - problem started as I gained weight and got worse with more weight. I think the last 15 pounds really made it bad because if I don't use the machine the thing that hangs in the back of my throat swells up and turns red due to the snoring.

I think I need another and a better PSG because it has gotten much worse since last PSG. The last PSG was only for 1.8 hours on CPAP,not enough time for changes in sleep stages if you ask me.

Browser, that info helps enormously. Expect even better quality feedback on what to try & already the suggestions to try 16 fixed are good value. There is one other very obvious contribution & I am in the same boat. I really need to lose 5 kilos I gained over winter. Your therapy will improve markedly for the loss of a few lbs. Weight gain is a real killer for us on CPAP therapy.

Cheers

DSM

[StillAnotherGuest]

Am confident the comedy act will now fall away to all parties focusing on your data & what help we can provide

Not a chance.

PM ? - only sent the one ? (another mystical meaning)

Well put the %&*#% Foster's down and maybe you'll remember:

who is the three stooges and who is Harpo. You said Harpo has a high VB% so I would like to search for their posts.

The Stooges are in the AVAPS thread, alternatively Dial Wingin', Machine Flingin' and Patent Tossin', hoping to... hoping to... actually I don't know what they're hoping to do.

Harpo is AKA "The Beaver".

The other poster with the high VB% is dllfo.

He comments here on VB.

Get all the sleep architectures from the prior studies. I believe that data can be used to plot that 55% VB in the download.

Since there is only 1 NRAH flag thrown the whole night and your pressure is up there no reason to suspect anything else then current machine is inadequate to treat your disorder.

I would not rely on the Respironics Non Responsive Apnea Hypopnea identification, since :

Above 8 cmH2O pressure, the pressure increase for sustained apneas/hypopneas is limited to 3 cmH2O above the pressure setting at the onset of the apnea/hypopnea sequence. The pressure setting at the onset of the sequence is called the Onset Pressure. The pressure 3 cmH2O above the Onset Pressure is called the NRAH Threshold. NRAH is an acronym for Non-Responsive Apnea/Hypopnea.
An apnea/hypopnea x2 event detected after reaching the NRAH Threshold is considered to be non-responsive.

Which means once you've reached an apnea onset pressure of 17, your machine wont even realize your apneas are not responding to the added pressure.

The NRAH window is finite (it turns off after a set period) so there absolutely could be additional phenomena underfoot, including exactly what is suggested that the NR algorithm is preventing.

Not all SSRIs cause sleep disruption, but that one can be a real problem.

What software package did they use (a scan of the documents should reveal that)? SAG can read anything in an .edf format and do a modified CAP analysis. More on that later.

I told you that Ginko stuff don't work for Alzheimer's

Nothing like slapping everyone else in the face who has ever contributed to this board with your arrogance.

Snoredog's mad cause RG knows "The Secret Handshake":



SAG

[MrSandman]

Last nights info. .

Thanks in advance - I have my PSG but it is unreadable no matter how I scan it in. I had to argue to get it and then they gave me such a bad copy I can barely read it. I will put a new one up here when I get it. I am going back to the original Dr. that read my very first PSG and get another study while I have great insurance(Which I paid $175 every two weeks for and barely used).

Auto set to = 12 - 16

Humidifier set to = 3

Cflex set to = 1

[StillAnotherGuest]

What's the VB on that?

SAG

[MrSandman]

Sorry - I said always 60%+ because that is what was the norm in the past but as you can see on the posted chart it varies some and the only thing different on the nights in the 20's is I took a quarter milligram of Klonopin before bed...

Thanks

I also don't know why 12-16 gave me my best results in a long time compared to 9-20 ie why was 9-20 at 20 a lot but 12-16 wasn't pinned at 16 all night. I feel a big difference today!I have used 12-16 before with worse results. I will be leaving it at 12-16 for now and see how it goes. Need to let things calm down from all the changes. Now that I think about it I started that 9-20 night on my back(Not sure how long I stayed on my back) versus on my side for last night.

[MrSandman]

What's the VB on that?

SAG

The last bar on the right of the above posted chart: 39.2%

[dsm]

Browser,

I went for a short slow jog this morning - have to start sometime. I barely was able to make it around the small block we live on - so am making it a matter of pride that I get fit enough to do it without walking half way.

Are you able to get into some exercise - walking, gym ?

The VS data in your chart says you need to get started too

DSM

[MrSandman]

Browser,

I went for a short slow jog this morning - have to start sometime. I barely was able to make it around the small block we live on - so am making it a matter of pride that I get fit enough to do it without walking half way.

Are you able to get into some exercise - walking, gym ?

The VS data in your chart says you need to get started too

DSM

I am not too sure about that logic since skinny fit people snore but based on the height and weight I posted it is not hard to figure out I am overweight. It deposited in my belly and neck/chin. My family has double chins. When I weighed 155 I had a double chin but not as pronounced. When this apnea started a had gone from a 14.5 to 15 inch neck shirt size to 15.5 to 16 to 16.5 to 17 and probably 17.5 now.

I started walking then it got cold out and I hate the cold excuses,excuses...

[Snoredog]

I told you that Ginko stuff don't work for Alzheimer's

Nothing like slapping everyone else in the face who has ever contributed to this board with your arrogance.

Snoredog's mad cause RG knows "The Secret Handshake":



SAG

you mean the Secret Handshake you could NOT fix? Where's them butt ugly argile socks you were wearing?

I didn't see you clearing up those FL runs any from the post reports, certainly not going to do it with CPAP. Good
thing she didn't have to pay for it, that would have been money down the drain. Yeah she gets a little senile
every once in awhile what's your excuse?

[MrSandman]

Ok Eddie,

quit pickin' on



Mr. and Mrs. Cleaver or I will have to have Wally hold you down while Beaver gives you a pink belly...

Back on subject please

[StillAnotherGuest]

I didn't see you clearing up those FL runs any from the post reports, certainly not going to do it with CPAP.

But they were, as clearly shown in this hypnogram:



Ooops! Sorry! That would entail revealing part of "The Big Secret"!

SAG

PS - RG check your PMs. Secret Handshake Upgrade 1.10 sent.

[Snoredog]

Sorry - I said always 60%+ because that is what was the norm in the past but as you can see on the posted chart it varies some and the only thing different on the nights in the 20's is I took a quarter milligram of Klonopin before bed...

Thanks

I also don't know why 12-16 gave me my best results in a long time compared to 9-20 ie why was 9-20 at 20 a lot but 12-16 wasn't pinned at 16 all night. I feel a big difference today!I have used 12-16 before with worse results. I will be leaving it at 12-16 for now and see how it goes. Need to let things calm down from all the changes. Now that I think about it I started that 9-20 night on my back(Not sure how long I stayed on my back) versus on my side for last night.

Why are you showing us a 11/23 report and a VB report only going to 11/18 or 11/19?

If your are going to go by what Pro Analyzer reports say, then use the one that counts, the AHI vs. Pressure report, put the machine in CPAP mode so it isn't going from the Min to the Max and plot your AHI along the way. It should present a flow curve showing best AHI for the pressure, find that pressure and use it in CPAP mode. Your other option is get a different machine because that one isn't designed for controlling VB. Sure it gives you what is happening with VB but it is very limited on what it can do about them.

Snoring is going to make any auto chase events. Snoring generally appears right before an apnea, reason they chase it. Snoring says you are breathing, NRAH flag that came up on one of your other reports is a Non-Responsive Apnea.

VB coming from that machine don't mean crap, if it did the Manufacturer would have put it in Encore reports, they didn't, because there is not a damn thing the machine can do about it. NRAH circuit once tripped will lock itself out for 15 minutes. IF the NRAH appeared at 20 cm pressure then you could argue it could NOT clear the apena because machine was at its Maximum pressure, but the pressure at the time your other NR appeared the machine was NOT at the maximum pressure it was below it and the NRAH still tripped. Since there was only 1 NR appearing in the nightly session and pressure has been high all night that NR flag was there due to a stubborn apnea, that only means the machine applied pressure to it 3 times and the apnea did not respond. Was it from a Central Apnea? I say NO, if it was you would have NR's showing up throughout your report. This addresses the reasoning behind SAG's questioning of the NRAH seen on your report.

For the NRAH flag to trip, the event has to be double apnea/hypopnea that remain after 3 pressure increases. Once that is seen, machine will drop pressure by 2 cm and lock it self out for 15. Since that only happened 1 time and lots of snoring the chance that the NRAH was caused by a central is slim to NONE.

Without seeing your PSG, the chances of you having Centrals is extremely low, you need to use your report to find the lowest AHI, if the machine you are currently using is screwing up and seeing any centrals they will too show up under that same AHI, get a lower AHI on that machine you are also having fewer centrals.

Like I said, I don't see you having centrals at all, SAG is trying to throw a monkey wrench in this with the bogus VB issue. If it is NOT on your Encore report don't worry about it. IF that VB was worth while to have they would have put it on the Encore report.

The Encore software has a template database which includes all the machines it supports, some machines support VB the one you are using doesn't. While it may be in the Remstar Auto algorithm and addressed as much as possible this machine is not designed to resolve that modality.

You almost have to ignore the snore and go after the OA, the rest is meaningless. You are having FL's at 16cm pressure, you want to chase that stuff get a Bipap Auto.

Hey, you are 6 ft and 250lbs, you could be a big boned guy, chubby maybe, obese I doubt it, you like to snore, suck your tongue deep into the throat and it will take strong pressure to dislodge it, you are using a boing boing boing Activa, which allows a lot of dead space and "give", it will soften any delivery pressure over other mask, air pressure on CPAP resembles that of hydraulic action. Soften that hydraulic pressure and it will be more difficult to dislodge your tongue. Losing some weight would help.

Now SAG is trying to make the point that you have VB leading to Periodic Breathing and that NR flag was a Central appearing after a period of VB, that would at best be only a guess. If that was happening, you would have NR's in other reports and more than 1 per night.

Try a different mask, sleep on your side and manually titrate for lowest AHI, if you go to another machine type you will need that anyway.

[Snoredog]

I didn't see you clearing up those FL runs any from the post reports, certainly not going to do it with CPAP.

But they were, as clearly shown in this hypnogram:



Ooops! Sorry! That would entail revealing part of "The Big Secret"!

SAG

PS - RG check your PMs. Secret Handshake Upgrade 1.10 sent.

You and Dr. K need to go write another book, I have $5 bucks in my pocket, that should cover it.
So that hypnogram is going to show RG having nice round normal round flow curves eh? SAG you are still
dehydrated from last run.

<------------see avatar

[StillAnotherGuest]

You and Dr. K need to go write another book, I have $5 bucks in my pocket, that should cover it.

Actually, I'm happy to give everything I have out for nothing (reread the part about being frugal).

SAG

PS - -SWS, check your PMs, CAP Software Analysis Package sent.

[-SWS]

PS - -SWS, check your PMs, CAP Software Analysis Package sent.

Thank you, SAG! I'm still on lesson one of the CAP tutorial.