Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Egg Yolkeo
Posts: 36
Joined: Fri Sep 08, 2023 1:29 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Egg Yolkeo » Fri Sep 15, 2023 7:32 am

dataq1 wrote:
Fri Sep 15, 2023 6:05 am
Quick question:
Was your Dad’s heart valve surgery done by open heart or trans catheter?
Hi Dataq1,

He had minimally invasive mitral valve surgery, they made a small 3 inch incision in between the ribs on the right hand side of the chest. I think there was a second very small entry point as well,but the primary area with the incision on the right had side of his ribs.

I've attached a pic.
Attachments
heartjnl-2018-May-104-10-861-F4.large.jpg
heartjnl-2018-May-104-10-861-F4.large.jpg (71.44 KiB) Viewed 3979 times

Egg Yolkeo
Posts: 36
Joined: Fri Sep 08, 2023 1:29 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Egg Yolkeo » Fri Sep 15, 2023 8:15 am

Rubicon wrote:
Fri Sep 15, 2023 5:07 am
Egg Yolkeo wrote:
Fri Sep 15, 2023 4:19 am
After reading up I realised this was sleep apnea at which point I got the cpap treatment organised.
Do you have the data from the start of CPAP?

Can you load data to SleepHQ?

Specifically, the nighttime breathing is a mess, but those are only snippets (the rest of the night is probably like that but I'm from Missouri).

While that looks like soft palate interference to me, since you had an ENT consult, they would have seen palate problems (or for that matter other airway problems) and would have noted that in their report.

Most important, sleep apnea problems occur when one is asleep. Airway issues during the day are an entirely different matter and must be analyzed by a pulmonologist or ENT guy.

My point in establishing a timeline is that this mess could be a complication of surgery, especially if he was intubated.

If that breathing pattern was present before surgery, then you wonder about the ENT competence.

The 90 Pound Head is an amusing cartoon and looks like it could generate a lot of chiropractic business.

There was no support for the Sleepstyle machine on OSCAR until recently and it was this fact actually that got me investigating things as it was only until recently when I saw it was available I installed it and saw how crap his sleep is and has been. The useful data only seems to go back a few recent months and then stops and reduces to a very patchy and limited data. His compliance was also terrible to begin with, I probably have a couple of months of ok usage prior to his surgery.

Those snippets are indicative of pretty much any night I can review in OSCAR going back to July this year, before that there is no flow rate data. If I dig around I can find the occasional normal looking wave form here and there but generally its all the same with a few variations in appearances.

The only observable airway events he has in the day is when he falls asleep in his chair and will sometimes wake up with a short cough and a brief gasp of air which I believe is him having an apnea. He might do that once during a half hour nap in his chair. If he falls asleep in his chair, there is no difference between his daytime awake or daytime sleeping breathing pattern when looking at his lungs. His chest and lungs behaves the same way.

One difference I noted if comparing now to the past, previously he would have what I believe was an apnea, the period of him stopping breathing would be noticeable and then he would awaken and cough/gasp. Now its more like a case of just doing his regular breathing and then at some point instantly cough/wake up more like you had a fly in your throat for lack of a better description.

In terms of date when this issue started I would say the stuttered action to his breathing was post surgery, but the shallow limited ability to inhale a big breath has been present for a long time.

I have loaded the data into SleepHQ and it seems there is a couple of issues as mentioned:

SleepHQ - shows the data from when he started using it but its very limited until August the 5th 2023 where full data is shown, perhaps due to compatibility issues.
OSCAR - likewise data is limited prior to 26th June 2023 when full data is shown.

User avatar
Rubicon
Posts: 1745
Joined: Sun Feb 20, 2022 6:59 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Rubicon » Fri Sep 15, 2023 8:28 am

Egg Yolkeo wrote:
Fri Sep 15, 2023 8:15 am
The only observable airway events he has in the day is when he falls asleep in his chair and will sometimes wake up with a short cough and a brief gasp of air which I believe is him having an apnea.
OK but previously
when breating in the daytime normally, during the inhalation phase its almost like he inhales in small steps.
This is an extremely important point-- if he has awake airway obstruction that needs a whole different avenue of approach.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

Egg Yolkeo
Posts: 36
Joined: Fri Sep 08, 2023 1:29 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Egg Yolkeo » Fri Sep 15, 2023 8:39 am

Rubicon wrote:
Fri Sep 15, 2023 8:28 am
Egg Yolkeo wrote:
Fri Sep 15, 2023 8:15 am
The only observable airway events he has in the day is when he falls asleep in his chair and will sometimes wake up with a short cough and a brief gasp of air which I believe is him having an apnea.
OK but previously
when breating in the daytime normally, during the inhalation phase its almost like he inhales in small steps.
This is an extremely important point-- if he has awake airway obstruction that needs a whole different avenue of approach.
Prior to surgery and prior to identifying he had sleep apnea, the only breathing issue he had was snoring which was most evident after drinking. He had no other breathing issues of any kind. Never complained of breathing problems and we never observed any breathing problems. If you asked him to inhale a baloon, his inhalation breath would be somewhat short. Other than that nothing.

As of today, if he is awake and sitting in a chair or walking around he himself is completely unaware of any issue, he does not experience any obstructions when he is awake. His lungs have the shallow movement I described but his oxygen levels are normal, he does not in anyway feel short of breath, his heart rate and blood pressure is normal. When he falls asleep then he can experience airway obstructions.

Im going to post some examples off SleepHQ now.

Egg Yolkeo
Posts: 36
Joined: Fri Sep 08, 2023 1:29 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Egg Yolkeo » Fri Sep 15, 2023 8:57 am

I have imported data into SleepHQ.

Any date prior to August 6th is very limited, following days after that have much more data.

3rd - limited data example all pages prior to this the same
https://sleephq.com/public/413155c1-dea ... 982fd46fb0
5th - Good data onwards
https://sleephq.com/public/32eb2274-da8 ... befa760b72
6th
https://sleephq.com/public/a3400741-93d ... a619f6f3d5
7th
https://sleephq.com/public/1621c893-228 ... 1e6a93a07b
8th - He drank a small glass of wine at lunch time as it was a special occasions. AHI much higher
https://sleephq.com/public/34ee1ddc-5d0 ... b3dded84bf
9th
https://sleephq.com/public/87e49d1d-1df ... ebf2e4d8d0
10th
https://sleephq.com/public/1cb207ea-ecd ... 77596a702d


User avatar
Rubicon
Posts: 1745
Joined: Sun Feb 20, 2022 6:59 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Rubicon » Fri Sep 15, 2023 9:12 am

So what are those small steps you were talking about?
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

User avatar
Rubicon
Posts: 1745
Joined: Sun Feb 20, 2022 6:59 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Rubicon » Fri Sep 15, 2023 9:22 am

I mean, this sounds like wake obstruction to me:
Egg Yolkeo wrote:
Sun Sep 10, 2023 2:54 am
To clarify my description is based on physically looking at my Dad sitting in a chair during the day time. When he is breathing the best way I cant describe is as follows:

Daytime breathing, unassisted:
Inhalation starts
Chest starts to expand
Pauses extremely briefly (fraction of a second)
Expands a little more
Pauses extremely briefly (as above) chest almost looks like it goes back in
expands a little more
Exhalation starts
process repeats.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

Egg Yolkeo
Posts: 36
Joined: Fri Sep 08, 2023 1:29 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Egg Yolkeo » Fri Sep 15, 2023 9:29 am

Rubicon wrote:
Fri Sep 15, 2023 9:12 am
So what are those small steps you were talking about?
Sorry I probably didnt write that clearly, when I was referring to airway obstructions I meant as in some kind of event where he struggles to breathe, ie when he sits in his chair falls asleep and then wakes up and gasps for air.

The small steps relate to the odd way he breathes, however just to be clear he is oblivious to this, he doest complain of any issue breathing, he is not experiencing any difficulty when this is going on, but obviously it doesnt look right to me.

User avatar
Rubicon
Posts: 1745
Joined: Sun Feb 20, 2022 6:59 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Rubicon » Fri Sep 15, 2023 9:43 am

Egg Yolkeo wrote:
Fri Sep 15, 2023 9:29 am
...but obviously it doesnt look right to me.
I think you're absolutely correct and that's where you need to start. See if anything is noted on the old ENT report, and if not, get a new endoscopic exam.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

Egg Yolkeo
Posts: 36
Joined: Fri Sep 08, 2023 1:29 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Egg Yolkeo » Fri Sep 15, 2023 10:01 am

Rubicon wrote:
Fri Sep 15, 2023 9:43 am
Egg Yolkeo wrote:
Fri Sep 15, 2023 9:29 am
...but obviously it doesnt look right to me.
I think you're absolutely correct and that's where you need to start. See if anything is noted on the old ENT report, and if not, get a new endoscopic exam.

Thanks when I am around next I will see what I can find.

Putting aside the respiratory wave form, from a perspective of managing his AHI's, does his figures look ok, or is there anything that could be done to improve things? I saw that some people have had success with a static pressure rather than APAP mode.

Max46
Posts: 33
Joined: Sat Dec 10, 2022 9:55 pm

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Max46 » Fri Sep 15, 2023 11:00 am

ChicagoGranny wrote:
Thu Sep 14, 2023 12:22 pm
Max46 wrote:
Wed Sep 13, 2023 6:30 pm
[
My FIL died three years ago.
Sorry, but you spoke of your FIL in the present tense.
If Egg's Dad's kyphosis is anything like my father in law's
Sympathy appreciated, excuse not so much. You assumed my FIL's status.The present tense verb "is" is associated to the subject of the sentence, the OP's father.

User avatar
Rubicon
Posts: 1745
Joined: Sun Feb 20, 2022 6:59 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Rubicon » Fri Sep 15, 2023 11:04 am

There is no AHI problem, it's all about trying to improve the inspiratory waveform.

It appears whatever that is is not particularly pressure-responsive as there is some marginally good stuff at any pressure. And bad stuff at any pressure. Perhaps body position, neck position and/or sleep stage has influence on waveform.

BiPAP, with some fiddlement of Advanced Settings like I:Time, is definitely worth a shot to improve that inspiratory waveform rather than jacking that pressure any higher.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

User avatar
Rubicon
Posts: 1745
Joined: Sun Feb 20, 2022 6:59 am

Re: Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

Post by Rubicon » Fri Sep 15, 2023 11:07 am

Max46 wrote:
Fri Sep 15, 2023 11:00 am
ChicagoGranny wrote:
Thu Sep 14, 2023 12:22 pm
Max46 wrote:
Wed Sep 13, 2023 6:30 pm
[
My FIL died three years ago.
Sorry, but you spoke of your FIL in the present tense.
If Egg's Dad's kyphosis is anything like my father in law's
Sympathy appreciated, excuse not so much. You assumed my FIL's status.The present tense verb "is" is associated to the subject of the sentence, the OP's father.
Would you please do me a favor and FO?

TIA.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.