Flow Limits mid Clear Airway Events?

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Pugsy
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Re: Flow Limits mid Clear Airway Events?

Post by Pugsy » Thu Aug 09, 2018 6:48 pm

Stom wrote:
Thu Aug 09, 2018 6:05 pm
That's what comes to mind when you write "Flow limitations aren't something we can fake". They might not be *easy to fake well*, but humans can do amazing things if they practice.
Why bother trying to fake them anyway?
I can't change the shape of my breaths no matter how hard I might try and believe me...I have tried. I can make them bigger or spaced out and alter frequency but I can't change the shape of them to create the appearance of what constitutes a flow limited breath pattern on that breath. It's the shape that earns the FL distinction. The flattened part at the top of the inhale. It's a very subtle change and takes a practiced eye to notice the subtle differences.

All of this from a machine that was never really designed to provide this level of under the microscope scrutiny and can't even tell if we are awake or asleep. It's not perfect by any means.

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djams
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Re: Flow Limits mid Clear Airway Events?

Post by djams » Thu Aug 09, 2018 7:56 pm

Pugsy wrote:
Thu Aug 09, 2018 5:43 pm
Flow limitations aren't something we can fake I don't think and a small blip on the flow rate graph isn't a flow limitation either...at least by anything I was ever taught. I was taught flow limitations are something we see on the breath itself and the shape of the breath.
Thanks for that chart! Downloaded for future reference. Immediately recognized the 4th shape - it's what I always see leading up to my RERA's. And I know I've seen some of the 3rd. Again, Thanks!

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Hartemed
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Re: Flow Limits mid Clear Airway Events?

Post by Hartemed » Thu Aug 09, 2018 8:31 pm

Pugsy wrote:
Thu Aug 09, 2018 6:48 pm
It's the shape that earns the FL distinction. The flattened part at the top of the inhale. It's a very subtle change and takes a practiced eye to notice the subtle differences.

Forgive me, because I easily get all of this turned around in my head. Just when I think I understand something, I learn something new - which is a good thing, but it shakes my confidence a bit. I wasn't necessarily concerned about a flow limited breath in the middle of a clear airway... I was concerned about the flow limitation "blip" thing on the the flow limit chart (not the waveform). My flow limited breaths and what the machine reports as flow limitations do not always travel together, it seems. They are two different things, right?

Perhaps the title of my post is technically not correct and confusing? Or maybe we are all actually talking about the same thing; I I don't know.
Pugsy wrote:
Thu Aug 09, 2018 6:48 pm
All of this from a machine that was never really designed to provide this level of under the microscope scrutiny and can't even tell if we are awake or asleep. It's not perfect by any means.
A lot of my interest in this is academic. I'm comfortable moving on understanding that it comes down to degrees, math, and a bit of semantics, as fellow posters and the patent have said, and I accept that my machine knows what it is doing, at least with this issue. It's all good.

With respect to my other question, I will post a picture to show what I mean, in a bit. It appears to be happening in the picture Stom just posted, around the 6:55 mark, where the exhale is hanging around in the negative flow space, appearing to fluctuate. I'm wondering if these count as breaths and what impact (if any) they have on how the machine behaves.
palerider wrote:
Thu Aug 09, 2018 5:04 pm
Hartemed wrote:
Thu Aug 09, 2018 4:29 pm
Does the machine convert a negative + negative flow rate to a positive and count those breaths? Some are so small in comparison to the preceding flow, I wonder what the machine makes of them, if anything.
If you mean the respiration rate, the machine doesn't count breaths, other than for it's moving averages.. sleepyhead is coming up with the RR.
No, not RR. More like does the machine change the baseline zero flow rate if there are increases and decreases during a period of negative flow, or below zero. (ie moving from -20 to -15 to -22 to - 20, for example) I've been trying to work out how inhalation is positive flow, above zero and exhalation is negative flow, below zero. But if the volume of your breaths aren't returning to whatever has been established as baseline, how does the machine handle that and does this pattern of breathing
have a negative impact on my sleep. I see this happen quite a bit, and I wonder if it is one of the reasons why I still feel terrible all day.

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palerider
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Re: Flow Limits mid Clear Airway Events?

Post by palerider » Thu Aug 09, 2018 8:54 pm

Hartemed wrote:
Thu Aug 09, 2018 8:31 pm
Pugsy wrote:
Thu Aug 09, 2018 6:48 pm
It's the shape that earns the FL distinction. The flattened part at the top of the inhale. It's a very subtle change and takes a practiced eye to notice the subtle differences.

Forgive me, because I easily get all of this turned around in my head. Just when I think I understand something, I learn something new - which is a good thing, but it shakes my confidence a bit. I wasn't necessarily concerned about a flow limited breath in the middle of a clear airway... I was concerned about the flow limitation "blip" thing on the the flow limit chart (not the waveform). My flow limited breaths and what the machine reports as flow limitations do not always travel together, it seems. They are two different things, right?
They're not different things.. it's just that the blips and the breaths don't showup at the exact same time, you'll see the rise of the FL chart *after* the fl breaths. Whether that's just how the machine reports it, or that's how SH is (mis)interpreting the data, is another question. I've been involved in the development of sleepyhead, and while it's a really great piece of software, there's a lot of guessing that went into it as to "what's THIS bit of data mean?" for instance, between the current public version, and the previous, there was a ... but? issue? interpretation failure that caused "large leak" flags on respironics machines to be half the length they should have been... as well as making various of the flags show up in stranger places than they should.
Hartemed wrote:
Thu Aug 09, 2018 8:31 pm
palerider wrote:
Thu Aug 09, 2018 5:04 pm
Hartemed wrote:
Thu Aug 09, 2018 4:29 pm
Does the machine convert a negative + negative flow rate to a positive and count those breaths? Some are so small in comparison to the preceding flow, I wonder what the machine makes of them, if anything.
If you mean the respiration rate, the machine doesn't count breaths, other than for it's moving averages.. sleepyhead is coming up with the RR.
No, not RR. More like does the machine change the baseline zero flow rate if there are increases and decreases during a period of negative flow, or below zero. (ie moving from -20 to -15 to -22 to - 20, for example) I've been trying to work out how inhalation is positive flow, above zero and exhalation is negative flow, below zero. But if the volume of your breaths aren't returning to whatever has been established as baseline, how does the machine handle that and does this pattern of breathing
have a negative impact on my sleep. I see this happen quite a bit, and I wonder if it is one of the reasons why I still feel terrible all day.
The machine averages your breathing. it calculates baseline vent rate over a number of breaths. On my VPAP Auto, you can see it start figuring out the baseline over the first few breaths.

All the machine gets is flow rate, and pressure. everything else is calculated from those two measurements.

Your breathing *has* to return to baseline, volumewise, your lungs are a closed system.

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