Periodic Breathing - What's Acceptable

Just got my Remstar 60 series and it looks at a lot more things than the S9 did.

One of those is Periodic Breathing. Last night this was 3.9%. Is this an acceptable figure? I've just been discharged by my cardiologist as having a great working heart - especially for my age. Most of the PB episodes were around the two and half minute mark though the last one was over four minutes.

Holden4th wrote:Just got my Remstar 60 series and it looks at a lot more things than the S9 did.

One of those is Periodic Breathing. Last night this was 3.9%. Is this an acceptable figure? I've just been discharged by my cardiologist as having a great working heart - especially for my age. Most of the PB episodes were around the two and half minute mark though the last one was over four minutes.

eh, actually, the s9 collects more data than the respironics, but, *shrug*

I wouldn't worry about that, the prs1 is flaky on flagging 'periodic breathing'.

Periodic Breathing by definition is just a waxing and waning of the flow rate that lasts for at least 2 minutes. It is NOT automatically Cheyne Stokes Respiration. CSR is a type of PB but not necessarily the only type out there.

I suspect your PB looks like this if you zoom in real close.


That's what a call boring PB...no centrals with it and know where near looking CSRish which looks like this


The boring PB was mine....the one that looks CSRish and really is someone with CSR for sure is someone else.

Even if yours looks similar to the CSR one...the % of time in PB would need to be a lot higher before we worry about it in your case.

Actually the S9 and the PR S1 collects just about the same amount of data but they just present the data differently. I rather prefer the PR S1 software reports over the S9 myself with the exception of the S9 doesn't flag CSR/PB at all. The newer AirSense models do flag CSR/PB though.
Same thing with RERAs...PR S1 has that flagging and the ResMed only has it in their AirSense line.
The PR S1 shows Flow limitations as individual flagged events which I prefer over the FL graph that the S9 offers. I find it's easier to measure something when I can count it quickly and spot it easily....but that's just my preference and doesn't mean a whole lot.

As with a lot of things related to CPAP... there are pros and cons to everything and that includes the data available and how it is presented.

So yes...there are a few things on that event graph on your new machine that wasn't available on the event graph on the S9 but with the exception of the RERAs and PB the S9 pretty much gathered the same data just presented it in graph format.
I never found the snore graph or the FL graph all that easy to evaluate on the S9. Give me actual flagged events from the PR S1 and I found it much easier.

Pugsy wrote:Actually the S9 and the PR S1 collects just about the same amount of data but they just present the data differently.

for me, the higher resolution pressure data on the s9 shows you more of what's happening, and sometimes the mask pressure shows even more, when you zoom in. the prs1 only shows the pressure in halfcm steps, and SH tries to smooth out the transitions, so it's a bit harder to see what pressure is actually doing... the beta shows the 'flex' pressure, which is higher resolution.

the snore flags for the prs1, never really having been defined as to what they are lend some confusion, encore shows one kind of snore on one chart, and the other snores on a different chart, to me, looking at the snore chart, higher is worse, is easier to read.

then there's the resmed FL chart, where you can see the amount of FL rising and falling, vs hitting some undefined threshold to get a tick mark on the respironics.

now, I'll admit there are more flags on the respirs, multiple snores, fl, rera, no breathing, PB (sometimes called CSR, even when it's not)... but, to me, that's just a mess.

as you say, both opinions are valid, because different folks like to see data differently

Holden4th wrote:Just got my Remstar 60 series and it looks at a lot more things than the S9 did.

One of those is Periodic Breathing. Last night this was 3.9%. Is this an acceptable figure? I've just been discharged by my cardiologist as having a great working heart - especially for my age. Most of the PB episodes were around the two and half minute mark though the last one was over four minutes.

Pugsy has it nailed. I have PB almost every night from .5% to 8% and there seems to be no real pattern that I can discern. They've lasted up to 10 minutes for me and normally last at least 4-5 minutes. I had a stress test about a year ago and it came up great so I think it's more an added item of possible interest.

palerider wrote:different folks like to see data differently

Maybe part of my preference for Respironics way of presenting the data is because that was my first machine and I didn't use a ResMed until a few years later....so it was my first learning curve.

I find the mask pressure chart useless...

I hate the ResMed FL graph...just hate it...

Pros and cons to everything and the data presentation is no different.

Pugsy wrote:

palerider wrote:different folks like to see data differently

Maybe part of my preference for Respironics way of presenting the data is because that was my first machine and I didn't use a ResMed until a few years later....so it was my first learning curve.

I find the mask pressure chart useless...

I hate the ResMed FL graph...just hate it...

Pros and cons to everything and the data presentation is no different.

the mask pressure chart is really the only way to tell what your s9 vpap adapt or air10 asv is doing, looking at the ipap peaks on there. you can also, zooming in, see FOT, and how it's behaving. I can't remember if I got my hint to raise the trigger sensitivity on my machine from the flow, or mask pressure traces... I think it was a combination, I'd see a little bump in flow, but no corresponding switch to ipap pressure, that would happen a couple times, then flatline, and apnea. I increased trigger to most sensitive, and now it switches to IPAP when I start those little inhales, and my AHI went down.

as to the FL graph, all I look at it is more is worser *lols*

This is last night and it's bizarre. I was asleep for 8 hours last night but not according to this.

Can anyone explain the gaps in the flow limitation graph? I didn't wake up and I didn't take the mask off. Have I done something wrong in the settings for my new Remstar, do I have a problem that this machine has picked up or do I have a faulty machine?

http://i1108.photobucket.com/albums/h41 ... bwummr.png

Holden4th wrote:This is last night and it's bizarre. I was asleep for 8 hours last night but not according to this.

Can anyone explain the gaps in the flow limitation graph? I didn't wake up and I didn't take the mask off. Have I done something wrong in the settings for my new Remstar, do I have a problem that this machine has picked up or do I have a faulty machine?

http://i1108.photobucket.com/albums/h41 ... bwummr.png

I think it's a bug in sleepyhead.

palerider wrote:

Holden4th wrote:This is last night and it's bizarre. I was asleep for 8 hours last night but not according to this.

Can anyone explain the gaps in the flow limitation graph? I didn't wake up and I didn't take the mask off. Have I done something wrong in the settings for my new Remstar, do I have a problem that this machine has picked up or do I have a faulty machine?

http://i1108.photobucket.com/albums/h41 ... bwummr.png

I think it's a bug in sleepyhead.

It could be a bug in SleepyHead, or it could be the machine failed to sense any flow. This could happen with oral inhalations or with somehow blocking the flow (as in crushing the pillows). This has happened to me when the mask has become dislodged.

See this experiment where blocking the flow has been tested for results. It's in a thread where another user was experiencing similar blanks in recording.

Note that this experiment was done with a ResMed machine. Holden, perhaps you could try it with your Remstar? BTW, the results of the experiment were the same viewed with either ResScan or SleepyHead.

I can't see the image...link won't work for me.

We may need to get you Encore for bug verification.

Another thought occurred to me while I was showering this morning. I have had issues getting autostart to work immediately, it takes some quite strong breaths to turn it on. I have the ramp feature turned off and wondered if this would fix that problem.

The other issue, and maybe the cause, is difficulty in getting auto off to function at all. I am wondering if when I stop nose breathing and mouth breathe, the machine eventually detects no backflow from my breathing and turns off my machine. (That said this never happened with the S9). Eventually, when I nose breathe again, it turns back on. This would also mean that I am not being treated during these times.

So, If I disable the auto off feature, will this solve the problem? I don't really need it as it's not hard to reach over and turn off the machine.

Also, Pugsy mentioned Encore software for bug fixes. As this is a new machine there might be some firmware that needs updating. More information on Encore would be appreciated.

Finally, I am going to exchange the SD Card. I don't think its the issue as the readouts on the machine also show very limited hours of use.

Holden4th wrote:Another thought occurred to me while I was showering this morning. I have had issues getting autostart to work immediately, it takes some quite strong breaths to turn it on. I have the ramp feature turned off and wondered if this would fix that problem.

The other issue, and maybe the cause, is difficulty in getting auto off to function at all. I am wondering if when I stop nose breathing and mouth breathe, the machine eventually detects no backflow from my breathing and turns off my machine. (That said this never happened with the S9). Eventually, when I nose breathe again, it turns back on. This would also mean that I am not being treated during these times.

So, If I disable the auto off feature, will this solve the problem? I don't really need it as it's not hard to reach over and turn off the machine.

Also, Pugsy mentioned Encore software for bug fixes. As this is a new machine there might be some firmware that needs updating. More information on Encore would be appreciated.

auto on/auto off on the respironics doesn't work nearly as well as it does on the resmeds. gentle breath on resmed, on, take off mask, shuts off in a couple seconds. with respironics, it felt like I was trying to suck start a lawn mower... and that's with multiple respironics machines, they're just MUCH less sensitive, and they keep blowing or about a minute after mask off. the machine determines that your mask is off from the lack of any backpressure, not from breathing, because there's a "no breathing detected" flag that it'll put up when it senses pressure, but no breathing.

encore has nothing to do with bug fixes, encore is the 'official' software from respironics to read the data. sign up over on apneaboard, there's posts that lead to a post in the members only section that gives instructions on sending an email to get download link.

firmware can only be updated at a service depot.

I've done these things to see if they make a difference.

1 turned on Ramp to kick in at 9.0 for 5 minutes

2 Disabled Auto off

3 Replaced the power supply cord. The machine came with the US plug and I bought an adaptor to cater for this set up. Looking at the power brick I've gotten rid of the adaptor (which came with a circuit breaker) and attached an Australian verison of the cord that leads from the power brick to the mains.

Tonight will let me know if this has solved the problem.