41m Cheyne Stokes headaches and acid reflux

rizzo wrote: ↑

Tue Aug 22, 2023 1:26 pm

SleepHQ says i cant go that far back under the free account so ill look into costs for upgrade

It's 15 bucks a month. IIWM I'd get that date and 12/24/2022 just to see what makes the centrals go through the roof. It might be EPR.

Im kinda scared by the WTF comment

Yeah, I get that a lot.

rizzo wrote: ↑

Mon Aug 21, 2023 8:40 am

Looks like high leak rate...

Your leak rate seems unusually constant. Check for a tubing or humidifier leak, or verify that it is, in fact, around the mask someplace.

Rubicon wrote: ↑

Tue Aug 22, 2023 3:06 pm

It's 15 bucks a month.

There is a cheaper way to share your files with the group. Simply load the Oscar files to a third party server. That folder is in Documents > OSCAR_Data > Profiles > Rizzo > ResMed #########.

While SleepHQ is easy, it has limitations. Waveform definition is not as sharp so when you're looking at palatal interference vs cardioballistic artifact vs forced oscillation technique (more on that later) it's tough to differentiate stuff.

Plus keep in mind that making sense of something that normally uses 16 channels of data and trying to do it with 2 can often be a little difficult.

Original Study:

https://imgur.com/a/7OVMyRt

Oscar Data

https://ln5.sync.com/dl/d70609a60/29sx9 ... s-qxucegnf

With Oscar and better definition now we can differentiate squiggles. In this central apnea the red oval contains cardioballistic artifact, while the green shows the appearance of the FOT:



In the diagnostic sleep study they didn't score arousals. Lazy scum.

The REM Latency is incorrect. In the Interpretation it says 120.50 minutes but in the Data it's 246 minutes.

The absence of events in REM is befuddling, especially since there are a ton of events in the same body position as soon as N2 begins (respiratory events are nearly always worse in REM). As an aside, central apneas don't (can't) occur in REM (with minimal exception). So, is their claim that the centrals are really obstructive incorrect, and it's the reverse?

Peeling the onion...

Rubicon wrote: ↑

Wed Aug 23, 2023 3:15 pm

In this central apnea the red oval contains cardioballistic artifact...

I suppose you're going to explain why that CBA is ~80, but his heart rate is ~40?

Rubicon wrote: ↑

Wed Aug 23, 2023 3:34 pm

I suppose you're going to explain why that CBA is ~80, but his heart rate is ~40?

Well, there is that...

Meanwhile, the 12/26 data:

OK one more



Whatever it is seems just too precise to be caused by anything human. IMO you should rule out machine failure.

A pulsating leak from the mask?

Theoretically anyway.

Rubicon wrote: ↑

Tue Aug 22, 2023 3:29 am

. . . case against APAP . . .

Perhaps the pediatric adenotonsillectomy is a factor, if it was particularly extensive?

Rubicon wrote: ↑

Tue Aug 22, 2023 3:17 am

. . . good ENT guy for evaluation and possible solutions. . . .

Hopefully one with plenty of experience and expertise treating sleep with PAP.

Rubicon wrote: ↑

Wed Aug 23, 2023 4:30 pm

. . . too precise to be caused by anything human . . .

Rhythmic, gurgling, dripping rainout puddle in the tubing?

Sorry for my amateur spitballing.

Glad you and Pugsy are on the case.

lazarus wrote: ↑

Wed Aug 23, 2023 8:40 pm

Rhythmic, gurgling, dripping rainout puddle in the tubing?

Sure, at this point leave no stone unturned.

There's some glitches in the expiratory limb that certainly suggest some palatal interference, so IMO an ENT visit is totally warranted rather than us doing WAGs here.

But those 80/min pulses are bizarre. I think seeing if they occur on an Airsense 11 would be a good way to see if it's the machine or the patient.

If you review his data they don't appear on fixed CPAP so that might be a option. See if they disappear with a fixed pressure.

Glad you and Pugsy are on the case.

Yeah well we haven't brought home much bacon yet...

I have noticed when I would wake up the machine is pulsing but I assumed it was trying to get me to breathe. I dont know if it always does it or not.

I have a new hose I bought 1 month ago and receive new masks every other month.

"See if they disappear with a fixed pressure." - What pressure should I try?

9.0 cmH2O no EPR should be fine.

This from the 17th:

Ok ill set it to 9 and give it a go. Will report my stats after a few days! Thanks for the insight

I set mode to cpap and pressure to 9. Here is first night which to me seemed ok from going to a different mode:
https://sleephq.com/public/c1184f89-065 ... 14b9184d62

The second night however did not go so well. I think the instant pressure and no ramp time was tough to get used to:
https://sleephq.com/public/4ca95a0c-00e ... a8187731bb

I switched back to APAP but set min and max pressure to 9, but this allowed me to have ramp time:
https://sleephq.com/public/fcb7528b-21b ... 83db0ad951

And finally last night seemed better but I was awake around 3:30 am and correlates with graphs.
https://sleephq.com/public/dd957aa4-70a ... 75ad2b009c

I do not understand the large leak stats. Normally I would hear or my wife would hear large leaks from the mask or machine but I nor my wife hears the leaks and seems like a good seal. Maybe I should go back to a different mask like the Amara Full or resmed quattro? Im wondering if the soft foam on the F20 is leaking and I dont know/hear it?

Let me know what you think of these stats when possible. Thanks!

Oscar data also:

https://app.box.com/s/3jf9njd73ij522p3h9eniu3yc86eqb02