Respiratory Rate of 7 on ASV - UARS x 13 years

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MRI_Doc
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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Fri Apr 29, 2022 12:00 am

Respirator99 wrote:
Sun Apr 24, 2022 12:58 am
MRI_Doc wrote:
Sat Apr 23, 2022 8:12 pm
1. Does suddenly dropping from a RR of around 12 to 7 on ASV (with metronome-like, sinusoidal flow tracings) indicate any sort of pathology. ...
I'd be interested in the answer to this. As I said, I have seen the same thing in my traces and it doesn't seem to cause any specific problems. I had a very thorough heart health work-up a couple of years ago and it was sound as a bell, so I don't think it's associated with any heart issues. Central apnea can be largely a neurological problem but again I've had no specific symptoms in that regard.
2. What ASV settings has the most effect on hyperventilation and centrals ? Is it Max PS or Max pressure or EP? I'm thinking Max PS is likely the most impactful. Again, an extensive literature search yielded nothing. But I'm sure this is respiratory therapy 101.
My understanding is that EPAP primarily controls obstructive events and pressure support helps with central apnea. I read something on the Resmed site a few years ago to the effect that if your PS is high enough (they recommend PSmax = 15) then all central apneas are eliminated and any events that do occur can be regarded as obstructive. Therefore EPAP should be set high enough to reduce the number of obstructives. In my case I have EPAPmin at 5 with PSmin = 3. This gives me the equivalent of P = 8 with EPR = 3 on a conventional CPAP, and that is a comfortable place for me. EPAPmax and PSmax are both at 15, giving a potential IPAPmax of 30 if the stars align, though I don't think it's ever got that high.
Thanks for that reply! I have UARS and never have obstructive events. Literally never. So the EPAP setting is arbitrary for me. Because of my theory that EPAP over 7 cm causes normal tension glaucoma (happy to expound), I try not to go too high on that setting.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Fri Apr 29, 2022 12:09 am

[img[/img]
Rubicon wrote:
Sun Apr 24, 2022 5:35 am
Can you load a zoom screen shot of the first episode? The expiratory times don't line up.

That's a weird sleep period.

Feel like uploading the whole SD card to dropbox for dissecting?

Conceivably could be REM-related.

Got an oximeter to simulmonitor with the ASV?
I've uploaded a zoom in from the 4-20 tracings and another from last night. The red rectangle outlines the low RR episode with perfect flow curves. I'm thinking N3, not REM.

I use Apple Watch and I have no significant PO2 drops during these bradypnea periods. I also own a WatchPAT and could wear it for continuous PO2.

But with UARS, I never have obstructive events or significant hypoxemia w/o PAP.

Will upload entire SD card if you like to a Sync account that anyone could download.

Thanks for your ideas!
Attachments
RR = 7.jpg
RR = 7.jpg (895.51 KiB) Viewed 175 times
RR = 7 #2.jpg
RR = 7 #2.jpg (958.35 KiB) Viewed 175 times

MRI_Doc
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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Fri Apr 29, 2022 12:10 am

Rubicon wrote:
Sun Apr 24, 2022 6:00 am
Rubicon wrote:
Sun Apr 24, 2022 5:35 am
Feel like uploading the whole SD card to dropbox for dissecting?
Cause your breathing pattern seems to be able to allow you to sneak by the ability of ASV to make a classic attack, and it's choosing to make a PS attack instead. One wonders if what you got shouldn't be getting ASVed.
Do you have a DropBox link I could upload to ?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri Apr 29, 2022 3:50 am

MRI_Doc wrote:
Fri Apr 29, 2022 12:10 am
Do you have a DropBox link I could upload to ?
You need to create that at your end.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri Apr 29, 2022 4:02 am

MRI_Doc wrote:
Fri Apr 29, 2022 12:09 am
Rubicon wrote:
Sun Apr 24, 2022 5:35 am
That's a weird sleep period.
I'm thinking N3, not REM.
By weird sleep period, your bedtime is 4 AM. I mean, there are night owls and there are night owls.

I'd still have to bet REM as the location is about right (first starts at ~90 minutes after sleep onset)(assuming you're sleeping) and it would be unlikely to have a big block of N3 later in the night.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri Apr 29, 2022 4:08 am

osc.jpg
osc.jpg (37.63 KiB) Viewed 161 times


Very artsy breathing pattern.

MRI_Doc
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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Fri Apr 29, 2022 11:17 pm

Rubicon wrote:
Fri Apr 29, 2022 4:02 am
MRI_Doc wrote:
Fri Apr 29, 2022 12:09 am
Rubicon wrote:
Sun Apr 24, 2022 5:35 am
That's a weird sleep period.
I'm thinking N3, not REM.
By weird sleep period, your bedtime is 4 AM. I mean, there are night owls and there are night owls.

I'd still have to bet REM as the location is about right (first starts at ~90 minutes after sleep onset)(assuming you're sleeping) and it would be unlikely to have a big block of N3 later in the night.
My bedtime is 1:30. I may have fallen asleep w/o PAP then but it on later.

MRI_Doc
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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Fri Apr 29, 2022 11:18 pm

Rubicon wrote:
Fri Apr 29, 2022 4:08 am
osc.jpg



Very artsy breathing pattern.
At least I accomplished something that session!

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Fri Apr 29, 2022 11:20 pm

Rubicon wrote:
Fri Apr 29, 2022 4:02 am
MRI_Doc wrote:
Fri Apr 29, 2022 12:09 am
Rubicon wrote:
Sun Apr 24, 2022 5:35 am
That's a weird sleep period.
I'm thinking N3, not REM.
By weird sleep period, your bedtime is 4 AM. I mean, there are night owls and there are night owls.

I'd still have to bet REM as the location is about right (first starts at ~90 minutes after sleep onset)(assuming you're sleeping) and it would be unlikely to have a big block of N3 later in the night.
If that’s REM I would be pleasantly surprised, as I have high rates of arousals in REM at PSG. So this would be good therapy.

MRI_Doc
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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Sun May 01, 2022 10:57 pm

Rubicon wrote:
Sun Apr 24, 2022 6:01 am
MRI_Doc wrote:
Sat Apr 23, 2022 8:12 pm
HRV peaks
What means that?
Heart Rate Variability

The higher the better. Strongly associated with lower cardiovascular events and deaths.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Sun May 01, 2022 10:59 pm

klv329 wrote:
Sun Apr 24, 2022 4:39 pm
For my asv charts, 12 bpm or a little higher would mean asleep, and 7 bpm would mean not asleep. Rough troughs at 7bpm in the respiratory rate chart come with recollections of awakening, smooth troughs at 7bpm come with no recollections of awakenings. It took awhile to figure out the awakenings were due to loud noises like the fire engine going by or the cell phone left on and a call received. I'm sure acid reflux causes awakenings, too, as well as other physical discomforts.
Definitely not awake. I live in a very quiet area, have black-out curtains on my windows and sleep with earplugs. I've always been a VERY light sleeper with my UARS.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Sun May 01, 2022 11:02 pm

Rubicon wrote:
Fri Apr 29, 2022 3:50 am
MRI_Doc wrote:
Fri Apr 29, 2022 12:10 am
Do you have a DropBox link I could upload to ?
You need to create that at your end.
Here's a link if anyone wants to download my Resmed ASV sleep data. 118 MB.

For anyone that takes the time to download and have a look: THANK YOU!

https://ln5.sync.com/dl/2bdf1e0f0/p56xa ... h-7h4ps54a

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Mon May 02, 2022 11:06 am

MRI_Doc wrote:
Sun May 01, 2022 10:57 pm

Heart Rate Variability

The higher the better. Strongly associated with lower cardiovascular events and deaths.
Depends on which one. Low Frequency HRV not so good.

viewtopic.php?t=57907

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Mon May 02, 2022 11:30 am

MRI_Doc wrote:
Sat Apr 23, 2022 8:12 pm


1. Does suddenly dropping from a RR of around 12 to 7 on ASV (with metronome-like, sinusoidal flow tracings) indicate any sort of pathology. I know the left ventricle has an "escape" heart rate of about 40 BPM, which kicks in if there's a total block of electrical activity to the LV. I'm wondering if this RR of 7 is a similar phenomenon. Otherwise, as my minute ventilation is maintained (via gigantic tidal volumes), this seems like some really deep, zen-like sleep (likely N3). An extensive literature search yielded nothing, other than HRV peaks at a RR of about 6-7 (which seems like a good thing). Any thoughts?

2. What ASV settings has the most effect on hyperventilation and centrals ? Is it Max PS or Max pressure or EP? I'm thinking Max PS is likely the most impactful.
In no particular order:

Since you shared that you were already sleeping for 3 hours prior to the screenshot I must retract my guess of REM (although since they are still of ~90 minute cycles they could be).

And if it's phasic REM it's definitely probably not.

Since it's now very late in the night N3 is most definitely absolutely probably out.

Yes Max PS is most impactful.

Yes those are massive VTs.

So HF (aka sinus arrhythmia) HRV is good (at least up to the point of it becoming LF HRV).

Image
Image
Image

To be continued...

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Mon May 02, 2022 11:54 am

I think these Z episodes are a result of an aggressive algorithm, overly aggressive settings and some Resmed calculations.

Resmed uses signal averaging for tidal volume, rate and minute ventilation so those parameters are not as smooth as they appear. If you look at I and E:time it looks like normal breath variation.

The Z-episode in the above example (and most of the others reviewed so far) is actually triggered by an arousal. It should have been left alone, but the ASV PS went crazy and started sending in huge breaths. With respiratory drive now happy your respiratory rate drops to 8 cause that's all you need. This continues until another arousal bails you out (note the MV is gradually falling to try to get back to "normal", but (insert slow metaphor here)).