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ajack wrote:more than like the pressure is going to go up to settle the breathing,

In CPAP mode... :facepalm:

I know it was fixed cpap, read my post again.
If he want's to change to auto he can, but auto won't react to this pattern normally and swapping to auto is a big deal to some people.

in double checking my post, there is one bit wrong. I thought it was fixed 10cm in my head when I wrote the post, not fixed 9, so move 8 the 7 to rule stuff out and then 10 and then 11 to see if it sorts out the issue.

ajack wrote:I know it was fixed cpap, read my post again..

Still makes no sense... all the words look right, it's just the order you spilled them onto the screen is suspect.

lets see if this is clearer, the machine is fixed at 9, I think an increase will help, before you do the increase, you should check that that a lower pressure makes the ahi worse and doesn't fix the RR. When this is confirmed. then I would increase the pressure to 10 and then 11, to see if that's on the path that fixes RR. I have seen more pressure fix this type of hiccup.

ajack wrote:lets see if this is clearer, the machine is fixed at 9, I think an increase will help, before you do the increase, you should check that that a lower pressure makes the ahi worse and doesn't fix the RR. When this is confirmed. then I would increase the pressure to 10 and then 11, to see if that's on the path that fixes RR. I have seen more pressure fix this type of hiccup.

OR just switch the machine to *Auto* for a few nights and find a more optimal pressure from that data... PR understood you the first time I think, I know I did. But it makes no sense to me to tinker with a fixed rate when you already have an APAP.

Steve's charts from earlier posts.

In the top one, as Rick says, it looks like the actual respiration rate by counting the obvious cycles is around 17. The rate reported is 40-50.
In the bottom, the RR is around 17 by count and the report is likewise around 17.

Steve's charts indicate he is a mouth breather by the rapid return to zero flow on exhale. Steve's cardiogenic artifacts (the humps or bumps on inhale) are quite pronounced. These bumps are the heart beat, typically around 60 bpm or one per second. The frequency of Steve's appear to be about that. It is my opinion (guess) that these artifacts are more apparent in mouth breathers. I believe, again agreeing with Rick, that the cardiogenic artifacts are confusing the RR in the top chart.

Also in the top chart, we can see the leak line varying with each breath increasing on exhale, this is typically seen with mouth breathers using a nasal mask. What type of mask is Steve using? I thought it was a full face, if so, then there appears to be some mask leakage on exhale.

In the bottom chart, at around 23:01:30, there are two exhales bracketing a Zero inhale, again usually seen as mouth breathers inhale through the mouth while wearing a nasal mask. I'm not sure what that implies if Steve is wearing a FFM.

I have most often seen artificially high respiration rates due to cardiogenic artifacts using respironics equipment. Not so much with ResMed. In the past, I have suspected that SleepyHead is incorrectly computing the RR. But I don't know. I am curious to know how ResScan would present these data. (Ah, but there's the rub, ResScan would not report these data. It only reports Minute Ventilation for non ventilators such Steve's AirSense 10 Autoset.)

I believe the high Respiratory Rates are in error, confounded by the cardiogenic artifacts being amplified by mouth breathing. I also suspect there is some mask leakage (Again, I am curious as to the type of mask).

As a disclaimer, it should be noted that I am no expert and my opinions are based solely on previous observances and self study.

Teds, been here for 7 years, he knows enough to help his friend move to auto by now, if that was his wish.There hasn't been any indication that he wan't to move to auto, some people are scared of going against doctor etc. So moving the fixed pressure will do the same thing, it just takes longer.

Thanks for the responses.
Steve is using a FFM. He has very bad nasal passages so I was wondering if transitioning between airways could be causing the strange looking waves. I'll ask him to describe how he feels. Previously he said the machine makes him pant and he feels like he is not getting enough air. The suggestion of trying some HIGH pressure may be worth a try. Or maybe trying to pinch off the nose so breathing is always oral.
He has tried a few different machine settings (see the first two pictures). I'll explore the SH data tonight to see if the other settings effected the wave form.

Here is another zoom which shows jagged breathing transition to more standard.

Ted, it's not clear to me what you're trying to fix. Again, it is my opinion, Steve's Respiration Rate, the subject of this thread, is normal. It would appear to be, from the examples you posted, around 17bpm. The unusual Flow Rate wave forms result from mouth breathing with cardioballistic artifacts superimposed. These artifacts are also normal. See https://www.thoracic.org/professionals/ ... hannel.php .

Raising the pressure has not helped the AHI in the past. To the contrary, it would seem from the statistics of his sleep you posted, he has done better with lower pressure. In the nightly sleep example you posted, he only had 3 hypopneas for an AHI of 1.9. Unfortunately, that sleep sample is only 1 hr and 34 minutes long. Which seems to point to the real problem; Steve's average use for the past year has been less than 3 hours per night.

I think the thing to do is forget Respiration Rates, AHI, etc,. and try to get Steve to wear a mask through the night. Maybe an increase in preasure will make him more comfortable, but I doubt it. Maybe a decrease in pressue would be better? A different mask? Maybe a hybrid? It looks like Steve has been using cpap for almost 2 years without being able to tolerate the mask overnight. I think that's the first thing that needs work.

Here is data from the one time he tried auto. Unfortunately the EPR was set to 3. It did max out at 14 but breathing was jagged everywhere.

"The one time he tried auto ... " With the EPR switched on? And set to 3?

Am I the only one who sees the problem? EPR and its Respironics counterpart, A-Flex, are algorithms, which - as I understand it - take their cues from the beginning of the slight change in breathing which heralds expiration.

So what will the algorithms do when they 'see' the saw-tooth pattern?

I can't tell you - because I didn't write the algorithms, and because I don't know enough. But it seems to me that some kind of mix-up or chaos will ensue. If said algorithms try to 'take the edge off' what they think are out-breaths - but aren't ....

Seems to me that once the median number for anybody's resps gets up to 20-to-25, then both EPR and A-Flex should be turned right off. AFAIK, the auto-adjusting response can continue unaffected - and the machine may even 'see' an easier task in front of it because there's less ground clutter, to use the radar metaphor.

Jay Aitchsee wrote:Ted, it's not clear to me what you're trying to fix. Again, it is my opinion, Steve's Respiration Rate, the subject of this thread, is normal. It would appear to be, from the examples you posted, around 17bpm. The unusual Flow Rate wave forms result from mouth breathing with cardioballistic artifacts superimposed. These artifacts are also normal. See https://www.thoracic.org/professionals/ ... hannel.php .

Raising the pressure has not helped the AHI in the past. To the contrary, it would seem from the statistics of his sleep you posted, he has done better with lower pressure. In the nightly sleep example you posted, he only had 3 hypopneas for an AHI of 1.9. Unfortunately, that sleep sample is only 1 hr and 34 minutes long. Which seems to point to the real problem; Steve's average use for the past year has been less than 3 hours per night.

I think the thing to do is forget Respiration Rates, AHI, etc,. and try to get Steve to wear a mask through the night. Maybe an increase in preasure will make him more comfortable, but I doubt it. Maybe a decrease in pressue would be better? A different mask? Maybe a hybrid? It looks like Steve has been using cpap for almost 2 years without being able to tolerate the mask overnight. I think that's the first thing that needs work.

The bottom line is that he has given up. I will get back to you after I have had a chance to ask him some questions; it has been a while since we spoke about his struggle and I didn't have access to his data at that time. Thanks

As far as Respiratory Rate, Doctors seem to be for it, but Morticians are against it. Jim

rick blaine wrote:"The one time he tried auto ... " With EPR?

EPR=3 except for 10/12&13/2017. The second picture shows the setting changes he made, the first picture shows the results.