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GeneMpls wrote: ↑

Wed Nov 09, 2022 6:56 pm

I started to post an Oscar chart this morning but hit a posting limit and moved on as I was having rare good day and need to get a much done while I can as possible. I'll try again tomorrow, it was a chart with 'no' CSR events, which I do not recall seeing before. Gene

Glad you're back, Gene, and very happy at your reason for that!

zonker wrote: ↑

Wed Nov 09, 2022 6:58 pm

you may want to post that chart on an image hosting site and post a link here. imgur.com is a good and free site.

@zonker
Does imgur demand registration to make an image "unhidden"? I tried yesterday, and I could see the image when pasting the link in the browser, but found no way of making it visible on the message - despite using the correct code.
Couldn't really get google to give me good answers when I asked...

ozij wrote: ↑

Wed Nov 09, 2022 8:54 pm

zonker wrote: ↑

Wed Nov 09, 2022 6:58 pm

you may want to post that chart on an image hosting site and post a link here. imgur.com is a good and free site.

@zonker
Does imgur demand registration to make an image "unhidden"? I tried yesterday, and I could see the image when pasting the link in the browser, but found no way of making it visible on the message - despite using the correct code.
Couldn't really get google to give me good answers when I asked...

it's been so long, i'm not sure of giving you the proper answer. i DO have an account there and just remained signed in. so try that and see how it goes.

are you choosing from the menu on the right hand side? i click on the image i want, then i choose from the menu on the right. i choose the one that says "BBCode" and click copy. then in the message here, i'd find a place for it then left click and "paste as plain text".

if this isn't working, let me know via pm and we'll discuss it further. been enough nonsense in gene's thread already!

I actually had a Imgur account- we will see if this works

https://imgur.com/U9o9xUB
https://i.imgur.com/U9o9xUB.png


It appears that the BBcode link is the good one. Nothing to see here except that the CSR column is blank. I have been fighting a F&P Evora nasal for a week, I like it but cannot get past the leaks... back to the Evora full face with mouth tape I guess. I remembered to wear my O2ring last night- I still remember how to link to that image so- a bonus pict. Gene

GeneMpls wrote: ↑

Thu Nov 10, 2022 9:17 am

.. back to the Evora full face with mouth tape I guess.

Full face and mouthtape? Whatever for?
If you need an FFM - its great advantage is equalizing the pressure between your mouth and nose.

OSCAR can import some oximeter info, so you can look at how oxygen events correspond to breathing events.
Go to OSCAR's "Data" tab to see supported oximeters.

The Lanky Lefty on his youtube channel has a video about importing from a Wellue ring (through its data files).

I have a jacked-up jaw and if I don't tape, the lower edge of the mask ends up in my mouth. That's why I bought the Evora nasal, since I have to tape anyway- and the harness on the nasal is much more comfy . Lefty can afford an Apple puter and doesn't know how real puters work . I have a second nosepiece coming for the Evora and plan to try mods on it to seal to my furry face. And yes I tried a chin strap. Gene

I have no O2 ring - do have a PC (no Mac) and here are some links to the upload.

http://www.apneaboard.com/forums/Thread ... se-O2-Ring

http://www.apneaboard.com/wiki/index.ph ... ile_Import

I hope it works for you.

Thank you Oz- I had gone thru those tutorials before and went thru them again. I kept fussin' with it and got it to load finally [not sure I can do it again but now I have a chance].
Here is last night with pulse and SpO2 added- time seems to be synced as well. My mind seems to be firing on most of my cylinders today, which makes things easier. I notice the CSR shaded sections are back. I am thinking I will try the Bleep system with my mouth taped, I have always been a believer [in business] in spend the money, see if it works, and move on if it does not. I have found some awesome products that way. Gene

OSCAR lets you drag graphs to wherever you want them. If you put the cursor on the graph's title, you can click and drag to reorder the graphs.
I would drag my SPO2 data so that it's just beneath the flow, the pulse data beneath it.
And I'd put the leak graph next.
And I'd zoom into the CSR periods to see how they correspond to my SPO2 and pulse rate, and leak.

You seem to have lots of oxygen drops tonight - if this turns out to be true of other nights, I would discuss it with my doctor and ask for a professional oxygen tracking for night or two. The sampling rate for the "real" (medical grade) oximeters is higher.

The desats below 90 call for some thought. They seem to correspond to some of the time you were having lots of hypopneas. An increase in your EPR might help a little with the hypopneas (and the flow limitations, which may or may not be causing you trouble). This may also increase the prevalence of CAs, so it may turn out to be a balancing act. I'm curious whether others would recommend an increase in EPR as an experiment.

Like ozij, I think it'd be well worth providing your doctor with information about your night-time O2 levels.

I haven't scrolled back through the thread; have you posted zoomed-in views of your flow rate from the green areas? A 10 or 12 minute stretch that includes a bunch of CAs in a green area would be helpful.

Miss Emerita wrote: ↑

Sat Nov 12, 2022 11:58 am

The desats below 90 call for some thought. They seem to correspond to some of the time you were having lots of hypopneas. An increase in your EPR might help a little with the hypopneas (and the flow limitations, which may or may not be causing you trouble). This may also increase the prevalence of CAs, so it may turn out to be a balancing act. I'm curious whether others would recommend an increase in EPR as an experiment.

Way back on page 1, GeneMpls posted data that showed his CAI was elevated as well as a lot of Hs and CSR-flagged breathing. At that time GeneMpls was using EPR = 2, and Pugsy made the suggestion to turn the EPR down or off to see if it would help with the CAs. I'm not sure if GeneMpls ever did that or not, because the thread quickly started focusing on the amount of CSR-flagged breathing, including discussions about just what Resmed means when one of their machines flags something as CSR.

We know that GeneMpls is working with a cardiologist as well as trying to work with a sleep doc.

The question that I've been unable to tease out is whether all those Hs in GeneMpls's data are obstructive (which points to the need for more pressure) or potentially central in nature (which together with the number of CAs would point to the possible need for less pressure if all these events are pressure induced.) Because of GeneMpls's history of heart disease, I've been super reluctant to offer anything in terms of advice other than ways to try to light a fire under his non-responsive sleep doc's rear end.

Like ozij, I think it'd be well worth providing your doctor with information about your night-time O2 levels.

I agree. I think both the cardiologist and the sleep doc need to be provided with this information.

I haven't scrolled back through the thread; have you posted zoomed-in views of your flow rate from the green areas? A 10 or 12 minute stretch that includes a bunch of CAs in a green area would be helpful.

That might very well help to settle the question about whether what's being flagged as CSR is or is not CSR breathing.

True CSR has a distinctive pattern that shows up when you are zoomed in close enough to see the individual breaths. But there are other breathing patterns that get flagged as "CSR" that are really more correctly called Periodic Breathing which do not have the characteristics of genuine CSR and should not be called CSR.

Likewise I think it could be useful if GeneMpls found a 10 minute period that is full of Hs and posted that (together with the corresponding O2 data) as well as a zoomed in snippet of the stuff that's being flagged as CSR + CAs.

robysue1 wrote: ↑

Sat Nov 12, 2022 12:27 pm

True CSR has a distinctive pattern that shows up when you are zoomed in close enough to see the individual breaths. But there are other breathing patterns that get flagged as "CSR" that are really more correctly called Periodic Breathing which do not have the characteristics of genuine CSR and should not be called CSR.

Likewise I think it could be useful if GeneMpls found a 10 minute period that is full of Hs and posted that (together with the corresponding O2 data) as well as a zoomed in snippet of the stuff that's being flagged as CSR + CAs.

While awaiting GeneMpls to post your suggested segments….
Can you expand on the elements of the flow curve that are necessary for a “true or real” CSR evaluation?

And how to distinguish the difference between periodic breathing and CSR? (Not an academic question, wife had a string of a couple of weeks that Resmed classified as CSR, interestingly during that period she switched to her Respironics machine using the same therapy settings, they evaluated her pattern as “periodic breathing”)

dataq1 wrote: ↑

Sat Nov 12, 2022 6:38 pm

While awaiting GeneMpls to post your suggested segments….
Can you expand on the elements of the flow curve that are necessary for a “true or real” CSR evaluation?

Look at page 8 of the Resmed AirSense 11 Clinical manual That page of the Resmed manual includes these figures:



The top figure gives an indication of what real CSR looks like. Note the rounded shape of the increasing/decreasing parts fo the cycle that are separated by the CAs. The bottom figure includes a breathing pattern that can be called periodic breathing and this kind of breathing can be flagged as "CSR" by xPAP machines, particularly if the central apnea detection algorithm says those apneas are CAs that separate the breathing parts of the pattern.

That's why looking at a zoomed in part of GeneMpls's breathing pattern that's been labeled as "CSR" would be useful. If the breath by breath pattern looks like the top figure, then there's a much higher probability that the breathing is real CSR. But if the breath by breath pattern looks closer to the second figure, it may be periodic breathing, but it's much less likely to be real CSR breathing.

While the AirSense 11 Auto clinical manual implies that the machine will distinguish between these two patterns, the fact is that if you zoom in on stuff that gets flagged as CSR on Resmed machines and PB (Periodic Breathing) on PR machines, a heck of a lot of the time the breath by breath breathing pattern looks much closer to the second figure than the first one, particularly if the lowest spots in the respiration pattern are scored as Hs and/or CAs instead of OAs.

And how to distinguish the difference between periodic breathing and CSR? (Not an academic question, wife had a string of a couple of weeks that Resmed classified as CSR, interestingly during that period she switched to her Respironics machine using the same therapy settings, they evaluated her pattern as “periodic breathing”)

It's important to understand that all CSR is a particular form of periodic breathing (PB). But not all periodic breathing meets the formal criteria of CSR.

And PR (Resprionics) doesn't claim that their machines can distinguish between "periodic breathing" and "CSR". Rather, PR machines label anything (including CSR) that looks like periodic waxing/waning breathing patterns as "Periodic Breathing" or PB. Philips Resprionics expects that if a patient's detailed data is showing significant amounts of PB, the doctor treating the patient should follow up by looking at the actual flow rate data on a breath by breath basis to evaluate whether the breathing pattern is typical of real CSR or is more typical of periodic breathing that is not actually real CSR.

This is a case where PR is being more honest than Resmed is. The fact that Resmed chooses to label things as CSR when it can flag things that are periodic breathing, but not CSR, is misleading at best. And it can lead to patients panicking unnecessarily if there's just a wee bit of breathing flagged as CSR somewhere in their data.

robysue1 wrote: ↑

Sat Nov 12, 2022 7:55 pm

@robysue1
Thank you that was very informative and I now know that the wax/wane pattern needs to be sinusoidal rather than cosineal. I'll now go back and look at my wife's pattern.

(incidentally, the reported CSR nights persisted for a couple of weeks and then disappeared. Her cardio/electrophysiologist said the CSR (as reported by Resmed) should be examined by her sleep doc; the sleep doc said it should examined by her cardio/electrophysiologist ... eventually it went away on it's own)

@robysue1
here is an example of what Resmed classified as CSR, and the waxing/waning looks like a sine wave, however there is no consistent apnea between wax/wane cycles.
https://imgur.com/a/nddARfW

(Not intending to derail Gene's discussion - just waiting for his return)

I am gratified that some of you understand these things, my memory has gotten so short I have trouble concentrating. For the record I feel sleepy today but my body is responding and I am semi-functional . That is 2 good days and one pretty good day in the last four- I am cautiously optimistic.
Here is what I think you asked of me from the chart- I hope. I have O2 data from last night but it does not correspond with the CPAP time so I will post the 11.10 chart details. I get the new mask [forgot the name already] on Monday. Thanks Gene