Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Andréa
Posts: 64
Joined: Tue Dec 08, 2020 7:59 am
Location: Sweden

Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by Andréa » Tue Feb 07, 2023 4:25 pm

Hi!

I'm far from feeling refreshed when I wake up, I always feel much worse than when going to bed. It feels like half of my day goes to "sobering up" from my pap. Usually somewhere around dinner my brain starts working a lot better and it feel like I've recovered, only to repeat the following day.

1.
I've had my apap for 2,5 years and tried about every setting there is in trying to optimize my treatment. What I've found out is that a i-min above 7 make me feel truly shit; eyes and sinuses burning, head pounding and a general feeling of being exhausted and half dead. I've also notised that my AHI is the lowest, the TV and MV most stable and even when at i-min is close to 6, but... I've also noticed that I, with that setting, have a median TV and MV that's below what's considered normal. Is that something to worry about - like if I'm not getting ventilated enough - or can I ignore that if I feel as good as I possibly can with these settings? (I've got other dx too: ME/Cfs and hEDS.) TV and MV is a bit higher (within normal range) if I set i-min higher, but I feel som much shittier; and that must mean something, right?

2.
I also have periods when my RR is around 7-8, also not in the normal 12-20 range. Is that alarming if I don't have any symptoms other than that?

Posted three pics for guidance :) It shows that I have some limited breaths (if I understand it right) although no FL is registered, they look a bit more rounded when on higher i-min, but I rather feel better than having a perfect curve.

My usual Q: Your thoughts?

Good to know: my heart rate and oxygen looks perfect, I measure with a Wellue-ring.

https://imgur.com/a/wWjyep3

//A
PS!
I don't know what I would have done without you and this forum. <3

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ N30i Nasal CPAP Mask with Headgear Starter Pack
Additional Comments: Using the old N30i without Quiet Air.

User avatar
Andréa
Posts: 64
Joined: Tue Dec 08, 2020 7:59 am
Location: Sweden

Re: Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by Andréa » Tue Feb 07, 2023 4:41 pm

Andréa wrote:
Tue Feb 07, 2023 4:25 pm
Hi!

I'm far from feeling refreshed when I wake up, I always feel much worse than when going to bed. It feels like half of my day goes to "sobering up" from my pap. Usually somewhere around dinner my brain starts working a lot better and it feel like I've recovered, only to repeat the following day.

1.
I've had my apap for 2,5 years and tried about every setting there is in trying to optimize my treatment. What I've found out is that a i-min above 7 make me feel truly shit; eyes and sinuses burning, head pounding and a general feeling of being exhausted and half dead. I've also notised that my AHI is the lowest, the TV and MV most stable and even when at i-min is close to 6, but... I've also noticed that I, with that setting, have a median TV and MV that's below what's considered normal (ca. 500 and 6-8 for adults in rest). Is that something to worry about - like if I'm not getting ventilated enough - or can I ignore that if I feel as good as I possibly can with these settings? (I've got other dx too: ME/Cfs and hEDS.) TV and MV is a bit higher (within normal range) if I set i-min higher, but I feel som much shittier; and that must mean something, right?

2.
I also have periods when my RR is around 7-8, also not in the normal 12-20 range. Is that alarming if I don't have any symptoms other than that?

Posted three pics for guidance :) It shows that I have some limited breaths (if I understand it right) although no FL is registered, they look a bit more rounded when on higher i-min, but I rather feel better than having a perfect curve.

My usual Q: Your thoughts?

Good to know: my heart rate and oxygen looks perfect, I measure with a Wellue-ring.

https://imgur.com/a/wWjyep3

//A
PS!
I don't know what I would have done without you and this forum. <3

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ N30i Nasal CPAP Mask with Headgear Starter Pack
Additional Comments: Using the old N30i without Quiet Air.

rick blaine
Posts: 614
Joined: Tue Dec 15, 2015 7:30 am

Re: Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by rick blaine » Tue Feb 07, 2023 6:15 pm

[deleted]
Last edited by rick blaine on Wed Feb 08, 2023 7:22 am, edited 1 time in total.

User avatar
Rubicon
Posts: 1678
Joined: Sun Feb 20, 2022 6:59 am

Re: Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by Rubicon » Tue Feb 07, 2023 7:23 pm

rick blaine wrote:
Tue Feb 07, 2023 6:15 pm
Anyway, below is a chart based on Force Expiratory Volume which should help you determine the tv and mv numbers which are 'normal' for you. It's in cubic centimetres.
Negative. That chart has nothing to do with what she's looking for.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

User avatar
robysue1
Posts: 897
Joined: Sun Sep 18, 2022 3:39 pm
Location: Buffalo, NY

Re: Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by robysue1 » Tue Feb 07, 2023 9:23 pm

Rubicon wrote:
Tue Feb 07, 2023 7:23 pm
rick blaine wrote:
Tue Feb 07, 2023 6:15 pm
Anyway, below is a chart based on Force Expiratory Volume which should help you determine the tv and mv numbers which are 'normal' for you. It's in cubic centimetres.
Negative. That chart has nothing to do with what she's looking for.
Agreed.

That chart is for peak expiratory flow rate (PEFR) which is the maximum rate of expiration while awake. It's can be a useful statistic when dealing with dealing with asthma or COPD, but it's not a relevant measure of anything in particular that is related to sleep breathing.

And it's worth mentioning that when rick blaine states, "It's in cubic centimeters", he's wrong: PEFR is measured in Liters/min, not cubic centimeters.
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.

Correct number of posts is 7250 as robysue + what I have as robysue1

Profile pic: Frozen Niagara Falls

User avatar
robysue1
Posts: 897
Joined: Sun Sep 18, 2022 3:39 pm
Location: Buffalo, NY

Re: Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by robysue1 » Wed Feb 08, 2023 1:03 am

Andréa wrote:
Tue Feb 07, 2023 4:25 pm
I'm far from feeling refreshed when I wake up, I always feel much worse than when going to bed. It feels like half of my day goes to "sobering up" from my pap. Usually somewhere around dinner my brain starts working a lot better and it feel like I've recovered, only to repeat the following day.
I am sorry that you are still not feeling rested when you wake up and that that you take a long time to become fully functional.

I would like to know what you mean when you say that it feels like you have to "sober up" from the PAP. Are you talking about something other than brain fog?

1.
I've had my apap for 2,5 years and tried about every setting there is in trying to optimize my treatment. What I've found out is that a i-min above 7 make me feel truly shit; eyes and sinuses burning, head pounding and a general feeling of being exhausted and half dead.
Not sure exactly what you are talking about here when you refer to i-min, and we do need some clarification.

The data you post shows your machine's settings are:
  • Min Pressure = 6
  • Max Pressure = 11
  • EPR = 2
  • Ramp = Off
  • Response = Soft
It seems that when you are talking about your "i-min" pressure, you mean your minimum pressure setting. And it seems you are saying that when you increase the min pressure from 6 to 7, you start feeling worse---as in the eyes & sinuses start to burn, your head stars pounding, and you feel exhausted and half dead. But when you have min pressure = 6, you feel better. Is that an accurate summary of what you mean?

And what about the max pressure setting? Does that affect how you feel? If so, how?

Notably, in data that you've posted, your median pressure for the night was 7.18, meaning that for at least 50% of the night, your pressure was at or below 7.18. When you reset the min pressure to 7, I bet the median pressure goes up to something around 8.10.

I've also notised that my AHI is the lowest, the TV and MV most stable and even when at i-min is close to 6, but... I've also noticed that I, with that setting, have a median TV and MV that's below what's considered normal. Is that something to worry about - like if I'm not getting ventilated enough - or can I ignore that if I feel as good as I possibly can with these settings? (I've got other dx too: ME/Cfs and hEDS.) TV and MV is a bit higher (within normal range) if I set i-min higher, but I feel som much shittier; and that must mean something, right?
Several comments:

1) I think you are overthinking things quite a bit in terms of worrying about your TV and MV numbers: Ventilation naturally decreases quite a bit when we are asleep, so so your TV and MV numbers when your min pressure is set to 6 and your median pressure is low are most likely perfectly normal for you. I think that since you are still not feeling well and your AHI is under 5 and you've tried multiple settings without anything working, you are starting to grasp at straws hoping to find some kind of a magic bullet that will fix everything. But there probably isn't a magic bullet that will fix all your problems.

2) You have two other significant diagnoses that may explain your daytime brain fog and fatigue:
  • ME/Cfs = Myalgic encephalomyelitis/chronic fatigue syndrome. The major symptoms of ME/CFS are extreme fatigue, daytime sleepiness, daytime brain fog, and night-time sleep problems. In particular, waking up feeling less rested than when you went to bed is specifically listed as one of the symptoms of ME/CFS on CDC site for ME/CFS. Unfortunately ME/CFS doesn't have a cure and treatments are aimed at helping patients live and cope with the disease. What kinds of treatments/therapy are you using to try to manage your ME/CFS?
  • HEDS = Hypermobile Ehlers-Danlos Syndrome. This is a rare disease of the connective tissues. Symptoms include joint pain, and pain of any type can make getting quality sleep harder. What treatments are you using to manage this disease? Do any of them have potential side effects that disrupt sleep?

3) Does your AHI go up when you increase your minimum pressure? If so, can you tell us what kind of events become more numerous?

2.
I also have periods when my RR is around 7-8, also not in the normal 12-20 range. Is that alarming if I don't have any symptoms other than that?
My guess is that your RR drops down to the 7-8 range only occasionally, and it may happen when there are small clusters of events.

Posted three pics for guidance :) It shows that I have some limited breaths (if I understand it right) although no FL is registered, they look a bit more rounded when on higher i-min, but I rather feel better than having a perfect curve.

My usual Q: Your thoughts?
Picture 1:
Image

This is the overall night. You've got a cluster of CAs that may represent some sleep-wake-junk restlessness scored between 8:30 and 9:30 as well as a second cluster of CAs between 10:30 and 11:20 that also look like sleep-wake-junk restlessness. If you were restless, then many of those events probably are not "real" in the sense that they didn't happen when you were sound asleep. But the flip side is that if you were really restless during these two 50 minute periods, that might also be contribute to your not feeling very good when you finally got out of bed. It's worth asking the question: Would you have felt better and functioned better during the day if you had just gotten out of bed when you first appear to have woken up around 8:30 and found yourself unable to get back to a sound sleep?

Overall, the look of the flow rate when you don't zoom in seems to show what should be pretty decent sleep breathing between 2:30 and 7:20. But the rest of the night? The breathing is ragged enough to beg the questions:
  • Did you get any real sleep between 1:30 and 2:30 during the first CPAP session?
  • Did you get any real sleep after you turned the machine off and back on around 7:20?
  • How much sleep did you actually get on this night?

Picture 3:
Image

This snippet actually shows pretty reasonable sleep breathing. Yes, the first breath has some flow limitations, but it's not really that badly deformed. The small bumps on the flat part of the exhalation are likely cardioballistic artifacts that you don't need to worry about.


Picture 2:
Image

Yes, these breaths appear to be really small/squashed. But it's worth considering whether the vertical scale you are using is making these breaths appear smaller than they really are. The inhalations in Picture 3 are topping out at about 30 L/min, while the inhalations in Picture 2 are topping out at about 20-25 L/min. It also looks like you may have changed the vertical scale a bit for Picture 3: The 30 L/min line in Picture 2 is the second tick mark above the dotted red line at 0, but the 30 L/min line in Picture 3 is the third tick mark above the dotted line at 0. That means in Picture 3 there is more vertical room for showing the shapes of the inhalations that have peaks in the 20-30 L/min range than there is in Picture 2. So inhalations of the exact same size in Picture 2 and Picture 3 would look smaller in Picture 2 than they would in Picture 3.

Having said all that, it is possible that this whole snippet is part of a period of breathing where the respiratory drive was slowly, but surely decreasing. In order to tell, however, we'd need to see the breathing for 2-5 minutes before the start of this snippet. The decrease was slow enough that it's not going to be flagged as a hypopnea. Answering the question of whether a bit more pressure would have helped or not is beyond my pay grade. However if this were my data, I wouldn't really be giving it much thought. In other words, there's nothing so severely distorted with these breaths that I would be tempted to use them as an explanation of why I felt rotten the next morning.


Final observations
I strongly suspect that the reason you are still feeling really lousy when you get up and continue to feel pretty lousy for a significant chunk of the day is your ME/CFS. Your data shows that the CPAP is doing a pretty decent job of controlling your obstructive sleep apnea events. The overall AHI is a bit higher than what a lot of people around here think is desirable, but notably your CAI = 2.22, and when you subtract that from overall AHI = 3.02, you are left with an obstructive AHI = 0.8, which is actually quite good.

Give the clustering of the CAs, I would not immediately jump to the conclusion that they indicate something wrong with your sleep breathing. In other words, if this were my data, I'd be zooming in on those clusters of CAs looking for evidence of micro arousals and sleep-wake-junk and wake breathing. Because if you were really restless during those periods, then chances are the events are not real, but the long periods of restlessness are very likely a major contributor to your not feeling well in the morning.

So overall, I would suggest talking to the doctor(s) treating the ME/CFS about strategies for getting good quality sleep while living with ME/CFS. Because CPAP is not going to magically make the restlessness that comes from things not related to sleep disrupted breathing go away. You have to treat the causes of that restlessness and address how to spend less time tossing and turning and not sleeping during the night before your non-restful sleep can be fixed.
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.

Correct number of posts is 7250 as robysue + what I have as robysue1

Profile pic: Frozen Niagara Falls

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Tidal volume, respiratory rate, minute vent - should I care, how correct do the show?

Post by palerider » Wed Feb 08, 2023 1:23 pm

To answer the question in the title, "should I care",
No.

If it wasn't for the data in the machine, you wouldn't know any of this, and you wouldn't be obsessing about squiggles on your computer screen.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.