Respiration Rate above normal value

ittiandro · Post by **ittiandro** » Sun Oct 11, 2020 7:08 pm

Hi,
I am 79 and I have been diagnosed with severe Sleep Apnea last May ( 40 AHI/min.)
Now I am down to about 2 AHI/min , after wearing a CPAP mask for three months..The doctor says I;m OK now.
I’d have liked to discuss a few more details with him , but he was busy and we had no time...Sometimes doctors are rather dismissive as they think we are too dummy to understand and to ask the right questions..…

Here are my questions,
1.What is the max acceptable leak rate? My avg has been 4.37 l/min over one week.
2.What is the Large Leak threshold? Out of 8 readings, 5 were between 0.00-0.17%,
one at 0.88%, one at 6.79% and one at 33.88%..
3,Respiration rate : in my case, it averages at about 21-22 l/min (95%) with occasional peaks of 30-32 l/min. I have read it should be 12-20 l/min . What does it mean?

Can you comment on this, please?

Thanks
Franco

Pugsy · Post by **Pugsy** » Sun Oct 11, 2020 7:23 pm

Exactly which brand and model machine are you using?
Where are you getting these numbers you are reporting?....off the machine or using the software?

Since you are reporting a respiration rate I assume probably OSCAR software since respiration rate isn't normally shown on machine LCD screens.

Can you post a typical detailed daily report in the format shown here
viewtopic/t158560/How-to-post-images-for-review.html
We don't need all those graphs.

95% numbers are NOT where you were at all night....the actual definition is "at or below" for 95% of the night.

Once we know which brand and model machine we can better advise you about leak numbers and ranges of acceptable but I can tell you right now that 4 L/min average excess leak is well within any machine's ability to compensate for it.
Large leak threshold....that depends on the brand of machine. Different brands have different thresholds.

Your respiration rate...probably just within a normal variance since it is a 95% number but there is a situation where the machine actually double counts the respiration rate due to a little artifact on the flow rate that means nothing other than scaring the heck out of people. That might explain the higher respiration rate numbers but once we know more about your machine I can show you a little trick to look for so we can see if that artifact explains away your higher respiration rate at times.

ittiandro · Post by **ittiandro** » Mon Oct 12, 2020 6:46 pm

Hi
I am using the Res Med Air Sense 10 Autoset machine,
I am getting the numbers from the machine SD card with the Oscar app.
I am attaching the reports with the Snip Tool, but I don't see how I can leave out the graphs.
I hope once you get the reports you can answer my questions

Thanks

Pugsy · Post by **Pugsy** » Mon Oct 12, 2020 6:57 pm

Normal average respiration rate is between 12 and 20....your median average falls within that range. This median average is the most important number.
95% numbers just mean at OR BELOW for 95% of the time. The "or below" part of the definition is very important.

I would have to see a zoomed in section/segment of the time frame where the max is much higher to see if it is an artifact caused by cardiac echo or just a software scoring blip.
Probably a 3 minute segment so each breath is clearly seen and can be manually counted.

How to zoom in on various segments...explained in the videos here
http://freecpapadvice.com/sleepyhead-free-software

Now...you are hitting your maximum quite often and your flow limitation graph is a bit ugly at times and you are having some clustering of OA events when hitting the max. All these clues point to the machine wanting to go higher but not being able to.
It wouldn't be impossible for the apnea events to be putting stress on the body and causing an increase in respiration rate in an effort to get more air.
You need to increase the maximum...probably to 20 and see what happens.

multicast · Post by **multicast** » Tue Oct 13, 2020 4:58 am

A high *indicated* respiration rate may occur when there are massive flow limitations which are not detected as such by the machine. See for example these screenshots:

: Bildschirmfoto 2020-10-03 um 10.57.34.png (667.03 KiB) Viewed 1810 times

: Bildschirmfoto 2020-10-03 um 10.52.14.png (622.65 KiB) Viewed 1810 times

Clearly massive flow limitations are present, but not detected as such. Rather the machine counts the respiration approximately double: the machine counts way above 20 whereas the real rate is about 12. So you may take a look at the time intervals where the respiration rate is above roughly 20 or 25 to examine whether not detected flow limitations are present.

Mike

palerider · Post by **palerider** » Tue Oct 13, 2020 8:35 am

Those are *not* "massive flow limitations", they are ballisticardigraphic effects showing up in the respiratory flow.

They should be ignored, as should the artificially inflated RR caused by the multiple crossings of the zero line per breath.

ittiandro · Post by **ittiandro** » Tue Oct 13, 2020 6:23 pm

Pugsy wrote: ↑
Mon Oct 12, 2020 6:57 pm

Now...you are hitting your maximum quite often and your flow limitation graph is a bit ugly at times and you are having some clustering of OA events when hitting the max. All these clues point to the machine wanting to go higher but not being able to.
It wouldn't be impossible for the apnea events to be putting stress on the body and causing an increase in respiration rate in an effort to get more air.
You need to increase the maximum...probably to 20 and see what happens.

Thanks for your feed-back

I don't know if you are a doctor specialized in pulmonology and sleep disorders or a qualified health provider, but you certainly sound very knowledgeable.

I should mention, though, that on my first follow-up visit, 10 days ago, the doctor didn't pick up on this or any other issues of concern from the reports. He only looked at the vast improvement ( AHI's down to about 2/hr average from the initial 40-50 /hr before the treatment) and said I'm Ok., stressing that I am not young and I shouldn't expect perfect sleep scores.

I mentioned to him, though, that I still wake up occasionally with slight head aches and I tend to feel sluggish/sleepy until early afternoon,( which, by the way, never happened before starting the treatment! Actually I have always been symptoms free..Lots of energies, no concentration or memory problems, even at age 79. I saw him only because of my heavy snoring causing some..social problems)

I therefore suggested that perhaps the mask pressure should be increased, to allow a better flow of air for hypoapnea and O.S.A.
He agreed and gave me a prescription to raise it . Only on the low end,though, i.e. from 8-15 cm H2o to 10-15. and see how it goes.
I'll start with the new setting tonight, but I still don't understand why adjusting the pressure only the minimum pressure and maximum limit. It would sound more logical.. Anyway, I am not a doctor...

Thanks

Pugsy · Post by **Pugsy** » Tue Oct 13, 2020 6:47 pm

Some docs are afraid to raise the maximum for some old fashioned ideas. Instead they raise the minimum and make you use more pressure all night instead of part of the night. (Picture me shaking my head)...

Anyway...it might be that with a higher minimum pressure the machine won't need to go as high. Worth trying...increasing the minimum would have been my second recommendation if increasing the max didn't clean things up enough.
I just tend to try to keep people at lower pressures for most of the night if at all possible and let the machine go higher only when needed.

BTW....Palerider is correct with his comment above and the artifact I mentioned above relates to what he talks about with the ballisticardigraphic echos. Essentially the machine picks up the heart beat echo and it gets counted as a breath and it's not a breath.
People get a high respiration rate with it but it's not really a respiration. I have seen people show 50 as a respiration rate from the machine's software but if we go in an manually count the breaths...only 25. The echo doubles the respiration rate. Looks scary I know but means nothing.

ittiandro · Post by **ittiandro** » Mon Nov 02, 2020 9:21 am

Just wanted to report that my doctor increased the minimum pressure threshold from 8 to 10 and my average AHI count has further come down from about 2 to about 1 over a 15 days period..

Ittiandro

multicast · Post by **multicast** » Tue Nov 03, 2020 4:49 am

palerider wrote: ↑
Tue Oct 13, 2020 8:35 am
Those are *not* "massive flow limitations", they are ballisticardigraphic effects showing up in the respiratory flow.

I dare to differ: according to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688581/ I'm inclined to detect some class 2 and 3 limitations in the second screenshot posted. Where am I wrong?

Mike

palerider · Post by **palerider** » Tue Nov 03, 2020 8:15 am

multicast wrote: ↑
Tue Nov 03, 2020 4:49 am

palerider wrote: ↑
Tue Oct 13, 2020 8:35 am
Those are *not* "massive flow limitations", they are ballisticardigraphic effects showing up in the respiratory flow.
I dare to differ:

Anyone can be wrong, you got to that point right away.

multicast wrote: ↑
Tue Nov 03, 2020 4:49 am

according to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688581/ I'm inclined to detect some class 2 and 3 limitations in the second screenshot posted.

For one thing, "some flow limitations" are not "massive flow limitations"

multicast wrote: ↑
Tue Nov 03, 2020 4:49 am
Where am I wrong?

You're wrong when you say that these imagined "massive flow limitations" are causing an inflated RR, Flow limitations do not affect the RR.

You allege that there are "massive flow limitations" that are

multicast wrote: ↑
Tue Oct 13, 2020 4:58 am
not detected as such by the machine

by trotting out some unrelated pics *and then misinterpreting them*.

the RR is counted not by flow limitations during inhalation (which is what all the examples you posted above are, but by the times when the flow crosses the zero line, which is *NOT during inhalation, it is after, during the pause *between* breaths, and that gets miscounted as breaths, artificially inflating the RR.

Now, please, stop arguing about things you don't understand, and thus derailing the OP's thread.

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