Breath Pattern - inspiration and expiration curves

Applecheeks · Post by **Applecheeks** » Mon May 30, 2022 9:07 am

This is a new topic - actually a transition from a older somewhat unrelated topic.
This thread seemingly begins with a post:

Topic.jpg

At Pugsy''s request I"ve opened this new topic to further discussion on the (apparent) abnormality of this breath pattern.

For those who want to refer to the previous conversation, it begins at viewtopic/t184231/Respiratory-Rate-of-7 ... #p1412555

So, if you want to add anything to this conversation, Pugsy requests that you do it here (and that makes good sense to me!)

ozij · Post by **ozij** » Mon May 30, 2022 9:41 am

Applecheeks wrote: ↑
Mon May 30, 2022 8:39 am

ozij wrote: ↑
Mon May 30, 2022 7:32 am
Could it be you were not sleeping?
If I define sleeping as "in my partner has to shake me to get me to respond" - yes I was clearly sleeping.
Do you ever see the more typical patterns?
Yes, I do, but only at higher pressures. Those higher pressures having been initiated by "flow limitations" (distorted flow curves).
Do you actually use the APAP to treat sleep apnea i.e. sleep induced breathing stops?
Longish story, I was sent for a home sleep study at the insistence of my electrophysiologist (EP is treating me for AFIB). Pulmonologist who interpreted the home study initially recommended NO treatment in spite of knowing that I had occasional AFIB - therefore no PAP was ordered. The EP guy told the Pul guy that Apnea causes AFIB and insisted that the Pul guy order APAP. That's how I've been on APAP for the last six months or so.

By the way, the frequency of AFIB events (1 to 2 a month) has not changed in the past six months. For whatever it's worth, my OSCAR average for the past six months is : AHI 2.4, OA 0.37, CA 0.22, and HI is 1.75 (so my bias seems to be toward shallow breathing). I also don't see any abnormal sleep days just prior to an AFIB episode, and almost all of my AFIB events are occurring mid-day so it appears to my way of thinking that any apneas do not (for me) trigger an AFIB event.

So the short answer is: I'm not sure why I'm "actually" using APAP.

ozij · Post by **ozij** » Mon May 30, 2022 10:04 am

Pugsy on the other thread wrote: ↑
Mon May 30, 2022 8:48 am

Do you ever see the more typical patterns?
Yes, I do, but only at higher pressures. Those higher pressures having been initiated by "flow limitations" (distorted flow curves).
This makes me wonder if the weird exhale on the snippet you shared was indeed related to just the way the machine is limited to the 4 cm exhale. If you have a more normal looking exhale at higher pressures.....then maybe what we are seeing on the snippet isn't necessarily anything more than being related to a restriction on the machine itself in terms of what it can do and record.

How about a snippet at a higher pressure where the FLs drove the pressure up and you were above the 4 cm limit?

And yes...do this new snippet in the new thread...just link back to this page in this thread so people can see what we have already talked about.

I think Pugsy's right. What were seeing in the snippet is an atifact that comes from the lower 4 cm limit of those machines.
We're not seeing the dip on exhalation because Applecheeks may have quite normal exhalation, but the machine can't record the full exhalation and therefore Oscar can't report it.

And apnea can cause arrythmias at night, without necessarily triggering AFIB at that very moment. Your EP seems knowledgeable and responsible.

Pugsy · Post by **Pugsy** » Mon May 30, 2022 10:09 am

How about a little snippet of the flow rate when the pressure has gone higher in response to FLs where you say it looks different?
If it is more normal and you were in fact asleep for both snippets then maybe we are just seeing a weird artifact thing because of the 4 cm limitation upon exhale. These machines are good but they aren't perfect especially when we push them in some manner at their restrictions.

Applecheeks · Post by **Applecheeks** » Mon May 30, 2022 9:02 pm

Pugsy wrote: ↑
Mon May 30, 2022 10:09 am
How about a little snippet of the flow rate when the pressure has gone higher in response to FLs where you say it looks different?

Ok, company has gone home, and the Memorial day get together is done for another year. Hope you all had a good day.
So here's another snip, a little different, but at a higher pressure:

May 28.jpg

Details on this one: Pressure is at 9.7, EPR is off, Flow limit = 0.0, Snore = 0.0, leak 3.6, no "events" within 10 minutes prior, fully asleep, F30 mask

Looks a little better than previous (at low pressure) , but still doesn't look like the OSCAR logo - particularly the exhalation phase.

Pugsy · Post by **Pugsy** » Mon May 30, 2022 9:22 pm

That last snippet has some irregular breaths. Too small of a snippet to really see what is going on but they look sort of like arousal breathing to my eye. Not quite asleep and/or maybe not quite awake. We often have arousals that we don't remember. The first breath looks normal enough for sleep but the others don't.
BUT your exhale looks at least more normal in the sense of how it goes down as we would expect no matter if asleep or not.

Here is an example of asleep breathing (circled in red) followed by arousal breathing and while yours don't look like mine that doesn't mean much because arousal breathing if often all over the place and varies widely.

I tend to think that the weird look to your flow rate in that other thread where your pressure was 5 with EPR of 1....with sort of flat exhale....I tend to think it was a product of the 4 cm limitation of the machine and the fact that it can't go lower.

Breath Pattern - inspiration and expiration curves

Breath Pattern - inspiration and expiration curves

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