"Odd" Waveform?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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lazarus
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Re: "Odd" Waveform?

Post by lazarus » Sun Apr 23, 2023 2:15 pm

Rubicon wrote:
Sun Apr 23, 2023 2:11 pm
lazarus wrote:
Sun Apr 23, 2023 2:07 pm
Miss Emerita wrote:
Sat Apr 22, 2023 5:34 pm
. . . when someone closes their mouth when they inhale but lets it open when they exhale. . . .
Close enough, then?
Only in atomic bombs and hand grenades.
So partial prize?

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robysue1
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Re: "Odd" Waveform?

Post by robysue1 » Sun Apr 23, 2023 2:19 pm

Rubicon wrote:
Sun Apr 23, 2023 2:10 pm
robysue1 wrote:
Sun Apr 23, 2023 1:36 pm
How significant are the occasional snores scored during the "odd wave flow" breathing?
If you sleep through them, I'd say they're academic. If they create tons of arousals, get the stent or the scalpel.
And I'll hazard a wild guess: Is it possible this "odd wave flow" might be tied to some very, very soft expiratory snoring (almost like a cat's purring) with my mouth closed?
I'd say that's exactly what it is.
And so what's my prize?

Other than being pretty sure I don't need to worry too much about this kind of thing these days since I'm pretty sure I'm no longer having "tons of arousals" like I did back in the bad old days.
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lazarus
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Re: "Odd" Waveform?

Post by lazarus » Sun Apr 23, 2023 2:31 pm

May I humbly suggest a split of the prize for this thread, with one getting the SUV and the other getting the Mediterranean cruise?

And since my two answers were the most wrong, I suppose I'm the one who should have to foot the bill.

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Rubicon
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Re: "Odd" Waveform?

Post by Rubicon » Sun Apr 23, 2023 3:58 pm

Your prizes are in the mail.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

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chunkyfrog
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Re: "Odd" Waveform?

Post by chunkyfrog » Sun Apr 23, 2023 4:07 pm

Rubicon wrote:
Sun Apr 23, 2023 3:58 pm
Your prizes are in the mail.
Postage due?

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Rubicon
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Re: "Odd" Waveform?

Post by Rubicon » Sun Apr 23, 2023 4:10 pm

chunkyfrog wrote:
Sun Apr 23, 2023 4:07 pm
Rubicon wrote:
Sun Apr 23, 2023 3:58 pm
Your prizes are in the mail.
Postage due?
Yeah, and for that matter, the prize, too.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

tyrinryan
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Re: "Odd" Waveform?

Post by tyrinryan » Sun Apr 23, 2023 9:01 pm

Is this wave form perhaps indicative of palatal prolapse?

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Rubicon
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Re: "Odd" Waveform?

Post by Rubicon » Mon Apr 24, 2023 2:52 am

tyrinryan wrote:
Sun Apr 23, 2023 9:01 pm
Is this wave form perhaps indicative of palatal prolapse?
Most definitely maybe probably.

Interestingly, there is another image posted on TOF by someone who is also a member of TF:

Image

Whadya think?
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Rubicon
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Re: "Odd" Waveform?

Post by Rubicon » Mon Apr 24, 2023 12:10 pm

Time for another clue!

Would your answer be influenced if I said that the poster claims to be a
Uvulectomy victim.
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palerider
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Re: "Odd" Waveform?

Post by palerider » Mon Apr 24, 2023 1:29 pm

Rubicon wrote:
Mon Apr 24, 2023 2:52 am
tyrinryan wrote:
Sun Apr 23, 2023 9:01 pm
Is this wave form perhaps indicative of palatal prolapse?
Most definitely maybe probably.

Interestingly, there is another image posted on TOF by someone who is also a member of TF:

Image

Whadya think?
I think I really wish the zero line was turned on by default, or at least, turned on by anybody that's looking for help.

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Re: "Odd" Waveform?

Post by robysue1 » Mon Apr 24, 2023 1:51 pm

palerider wrote:
Mon Apr 24, 2023 1:29 pm

I think I really wish the zero line was turned on by default, or at least, turned on by anybody that's looking for help.
A big +1 on that comment.
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Rubicon
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Re: "Odd" Waveform?

Post by Rubicon » Mon Apr 24, 2023 2:45 pm

Similarly, including the Leak Graph is helpful when looking for...

...leaks.

But I digress...

Hey listen-- I've been using lipsicles long before the subject was broached here...
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Re: "Odd" Waveform?

Post by robysue1 » Mon Apr 24, 2023 3:58 pm

Rubicon poses this teaser of a question:
Rubicon wrote:
Mon Apr 24, 2023 2:52 am
tyrinryan wrote:
Sun Apr 23, 2023 9:01 pm
Is this wave form perhaps indicative of palatal prolapse?
Most definitely maybe probably.

Interestingly, there is another image posted on TOF by someone who is also a member of TF:

Image

Whadya think?
Once again, we have no leak data, which is a shame since leak data would significantly reduce the need to microanalyze the flow rate graph.

And we have no 0 line showing in that flow rate data, which would significantly help us microanalyze that flow rate graph since there is no leak data.

And we have the mask pressure graph. Which is supposed to tell us what exactly?

Adding the 0 L/min line to the wave flow graph as well as lines to better judge EPAP and IPAP in the mask pressure graph, we get this image of the same data:

Image

The mask pressure graphs tells us that this data likely comes from a Resmed bilevel since it appears (to me) that the difference between IPAP and EPAP is on the high side of 3cm. And since those are not the usual waves from the EasyBreathe algorithm, that may indicate the OP has turned EasyBreathe off and is using S, ST, or T mode with a RiseTime setting. (As far as I know there's no way to turn EasyBreathe off, and Rise Time on, while using VAuto mode on an AirCurve 10 VAuto.)

But how that might be responsible for the wave form looking the way it does, I really don't have any ideas.

Getting back to those inhalations and exhalations: To my eye, those inhalations and exhalations do seem to be pretty much the same size in area. I don't have a tool to verify that with, however. And a few of the exhalations look like they may be larger than the preceding (or following) inhalation.

So the there's probably little or no leaking going on, based on what Rubicon said several posts back concerning the first "odd wave form" he posted:
Rubicon wrote:
Sun Apr 23, 2023 1:45 pm
If the areas +/- of the -0- line are =, then the volumes are the same and there are no leaks present:

Image

They certainly look close by eyeball (I suppose exhalation actually appears larger), but I went the additional step of using a "Figure The Area Of An Irregular Shape" app and measured a few and they are spot-on.

So whatz happening...
And since there are no leaks present, we can answer the OP in TOF's question: This is NOT expiratory mouth breathing if you are using a nasal interface instead of a full face mask.

But then the question becomes, "If it's not expiratory mouth breathing, then what is it?"

My informal first answer would be some kind of very soft expiratory snoring with the mouth closed---what my husband refers to as my purr-snoring---and/or palatal prolapse. But then why would Rubicon post the question? (Unless he's being devious like some teachers I've had in the past.) And to beat a dead horse: What exactly is palatal prolapse, and how much should we worry about it if we're feeling pretty well rested and refreshed when we wake up and our AHI is nice and low?

And then there's this comment/hint from Rubicon:
Rubicon wrote:
Mon Apr 24, 2023 12:10 pm
Time for another clue!

Would your answer be influenced if I said that the poster claims to be a
Uvulectomy victim.
An uvulectomy removes all or part of the uvula, which (correct me if I'm wrong) is NOT part of the palate. But since the OP on TOF says he/she is a "uvulectomy victim" we can assume that the surgery did not improve the snoring and OSA AND/OR the OP suffered one or more significant side effects, which include damage to the muscles in the throat and soft palate.

All of that makes me want to stick with my original guess: This is likely some kind of soft snoring on exhalation, possibly (probably?) caused by a palate prolapse.

So how far off base am I Rubicon?
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Rubicon
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Re: "Odd" Waveform?

Post by Rubicon » Mon Apr 24, 2023 4:24 pm

Oooh, good eye on the rise time!

I have no information on the uvulectomy, but my thought was since it's a procedure you really shouldn't try at home, she (oops! 'nother clue!) saw an ENT guy, and the ENT evaluated the palate and either addressed it or it wasn't an issue. So IMO PP goes to the back of the line, at least temporarily.

There is an interesting relationship between the expiratory unspike (downward spike) in flow and the pressure waveform:

Image

The drop to EPAP overshoots the baseline of 10 cmH2O, causes a pressure bounce and results in a positive fluctuation of about 0.5 cmH2O. IMO the expiratory unspike, heretofore a telltale "PP" sign, is caused by a relative IPAP burst of 0.5 cmH2O, and abruptly shifts the expiratory upwards.
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palerider
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Re: "Odd" Waveform?

Post by palerider » Mon Apr 24, 2023 6:33 pm

robysue1 wrote:
Mon Apr 24, 2023 3:58 pm
(As far as I know there's no way to turn EasyBreathe off, and Rise Time on, while using VAuto mode on an AirCurve 10 VAuto.)
This is correct

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