420E Run Question ???

Sorry for not getting back sooner. I'd definitely like to continue putting our thoughts together to further explore the 420e and a few of the physiology comments as well. I have some ideas about what might be going on in ozij's graphs. As a relevant side note, we know there are some Silver Lining reporting bugs.

Before heading off to work with a client, I'd like to offer just a quick comment about Bill's tentative take regarding his own excessive FL runs. Spring time allergy season is truly here and so is allergic rhinitis! And spring time allergy season seems to concur with the timing of Bill's excessive FL runs. So I suspect Bill's favored analysis is correct. And I agree that it might not be such a bad idea to see an ENT and/or allergist, Bill.

Bill, you were able to run your 420e without those excessive FL runs until just recently. Right? If so, allergies sound pretty likely to me as well.

A busy weekend kept me from seeing this thread until this morning. Very interesting reading. Bill, have you tried the 8.5-9.5? I was thinking along the same lines, but would have suggested 8.5 - 10.

Cathy

Bill, I somehow missed your last chart posting yesterday (too busy with my first ever posting of charts, I guess...). If you use the crossbar tool (and the magnifying glass to stretch the picture across the whole screen) you'll see that the initial pressure raise for the min=initial= 8.0 was
triggered by a snore. And not that lone hypopnes ignored at the end of the session - a hypopnea occuring when there are no flow limitation runs.

For the second graph, in session 160 it bypasses 10 because of a snore, in 163 you had a blip in response to one hypopnea, shoot up to 8.5 in response to an apnea later on. And in session 165 it blithely disregards a hypopnea an goes on merrily dropping the pressure - maybe because it sees no flow limitation runs at that point.

Just curious: what is the percentage of your flow limited cycles and intermediate cycles (pie chart on the pressure screen)?

O.

In another thread, -SWS wrote:I voted that I leave IFL1 on. I leave it on with absolutely no problems of pressure runaway under any circumstances.

Along that same topic of FL detection and settings on the 420e: When I do happen to have terrible nasal congestion I don't even score a significant increase in FL runs. Go figure...

OK, perhaps congestion, per se, isn't quite the answer ...

-SWS wrote:Sorry for not getting back sooner. I'd definitely like to continue putting our thoughts together to further explore the 420e and a few of the physiology comments as well. I have some ideas about what might be going on in ozij's graphs. As a relevant side note, we know there are some Silver Lining reporting bugs.

Before heading off to work with a client, I'd like to offer just a quick comment about Bill's tentative take regarding his own excessive FL runs. Spring time allergy season is truly here and so is allergic rhinitis! And spring time allergy season seems to concur with the timing of Bill's excessive FL runs. So I suspect Bill's favored analysis is correct. And I agree that it might not be such a bad idea to see an ENT and/or allergist, Bill.

Bill, you were able to run your 420e without those excessive FL runs until just recently. Right? If so, allergies sound pretty likely to me as well.

Umm ..., No. I'd like to be quite clear on this though. I don't have a great deal of data from the 420E. I've really only been using the 420E full-time for the past month or two. Prior to that I used it primarily as a travel machine. (Now, it does double duty, and is currently packed for a Denver trip this afternoon.) Nevertheless, springtime came late this year and the trees are just now opening their leaves. So, while it's pollen season right now, it wasn't when I first started using the 420E full time. We still had snow on the ground a little over a month ago.

I've been seeing the flow-limitation "runs" the whole time I've been using the 420E. The difference I observe now is that the runs became more or less constant when I increased the minimum pressure. Prior to that the "runs" only occurred when the machine determined that it was necessary to increase pressure. It seemed to make sense that some breathing disturbance was occurring whenever the machine found it necessary to increase pressure, so I didn't really think too much about it until after I raised the minimum pressure.

It was when I raised the minimum pressure that the "runs" began to occur on a more-or-less continuous basis (as presented visually on the graph). That's what prompted this topic. The difference between earlier and now isn't big by statistical measures. Silverlining reports the "runs" occuring just over 30% of the time now, versus just over 20% earlier (although that does represent a 50% increase, but I digress ... ).

I'll also add that my congestion is more or less a constant. (Perhaps it's not really congestion at all, but rather UARS.) I always considered myself a mouth-breather until after starting PAP therapy. I also take supplements with anti-histamine properties, and have whole-house electronic air filtering which minimizes congestion for not only me, but other members of the household as well.

Hopefully, the rambling above reveals a little more of the thought process behind my saying that I ought to see an ENT. It's been on the back-burner for a while anyway. .

Regards,
Bill

ozij wrote:Bill, I somehow missed your last chart posting yesterday

I know what you mean. It wasn't until late last night that I finally worked through all the posts you, -SWS, and Snoredog put into this topic the prior night. .

ozij wrote:(too busy with my first ever posting of charts, I guess...).

Wow, I'm officially impressed. I thought your charts, with the circles around areas of interest were very nicely done, ozij, and serve as an example of well charts can be done.

ozij wrote:(If you use the crossbar tool (and the magnifying glass to stretch the picture across the whole screen) you'll see that the initial pressure raise for the min=initial= 8.0 was
triggered by a snore. And not that lone hypopnes ignored at the end of the session - a hypopnea occuring when there are no flow limitation runs.

For the second graph, in session 160 it bypasses 10 because of a snore, in 163 you had a blip in response to one hypopnea, shoot up to 8.5 in response to an apnea later on. And in session 165 it blithely disregards a hypopnea an goes on merrily dropping the pressure - maybe because it sees no flow limitation runs at that point.

Interesting connection, ozij. Your point is (I think) that the machine is respondind to what it views as obstructive events, but ignoring possible/probable "central" events.

ozij wrote:(Just curious: what is the percentage of your flow limited cycles and intermediate cycles (pie chart on the pressure screen)?

While I didn't pull numbers from the pie chart in my prior post, the numbers are about 20% when the APAP range was from 6 - 12 cm and about 30% with the range from 8 - 10.5 cm.

This is working from memory though, but that's the best I can do until later in the week after I return from travel.

Regards,
Bill

Silverlining reports the "runs" occuring just over 30% of the time now, versus just over 20% earlier (although that does represent a 50% increase, but I digress ... ).

Flow limitation runs, or flow limited cycles?


O.

It wasn't my first creation of charts, just my first ever attempt at using a file sharing service. Thaks for the compliment anyway....

Yes, that was my point about the machine's resonse.

Have a nice trip, Bill!

O.

ozij wrote:

Silverlining reports the "runs" occuring just over 30% of the time now, versus just over 20% earlier (although that does represent a 50% increase, but I digress ... ).

Flow limitation runs, or flow limited cycles?


O.

"Runs". (I think I'm pretty sure of that, maybe) The number came from the bottom of the same listing which includes all the indices such as AI, HI, etc.

Dang! I almost took a printscreen of that data, but then decided against posting it ...

Regards,
Bill

Then it's a Runs index: the number of flow limitation runs per hour.

The pie chart refers to cycle percentages, the runs are numbered, and indexed - you don't get a percentage for them. The number differ slightly - you get them separately on the *.se export table as well

O.

HEY!!!

That means we can use the exported data to calculate breaths per minute!!!!

We've got:
Normal Cycles
Flow Limited Cycles
Intermediate Cycles
Invalid Cycles

We've also got utilization time. Add the four kinds of cycles, divide by utilization, and you've got breaths per minute!!!

O.

I've been seeing the flow-limitation "runs" the whole time I've been using the 420E. The difference I observe now is that the runs became more or less constant when I increased the minimum pressure. Prior to that the "runs" only occurred when the machine determined that it was necessary to increase pressure. It seemed to make sense that some breathing disturbance was occurring whenever the machine found it necessary to increase pressure, so I didn't really think too much about it until after I raised the minimum pressure.

It was when I raised the minimum pressure that the "runs" began to occur on a more-or-less continuous basis (as presented visually on the graph).

Hmmm... Is it possible that your pressure band isn't high enough? What if you experience apneas & hyopneas at 8 cm and below, and pressures between 8 and 10 are enough to partially open your airway, but not totally? To me, it explains the trade-off between your earlier charts showing a high AHI / low runs, and your later charts showing low AHI / high runs. I don't know your history with air swallowing, but I haven't seen anything in this thread so far that discounts my theory that the answer might lie in a higher pressure range, like 10-12. In my experience, chasing a flow limitation is much harder than preventing one.

Just my 2 cents.

Take Care,
Cathy

tangents wrote:Hmmm... Is it possible that your pressure band isn't high enough? What if you experience apneas & hyopneas at 8 cm and below, and pressures between 8 and 10 are enough to partially open your airway, but not totally? To me, it explains the trade-off between your earlier charts showing a high AHI / low runs, and your later charts showing low AHI / high runs. I don't know your history with air swallowing, but I haven't seen anything in this thread so far that discounts my theory that the answer might lie in a higher pressure range, like 10-12. In my experience, chasing a flow limitation is much harder than preventing one.

I'd need to attempt that after a low-aerophagia night (exceptionally low). That's painful even to contemplate at the moment. My first post in this thread shows that pressure up to 12 cm made the "runs" worse, but it might be worth knowing what effect sustained higher pressure has on the overall apnea events. I suspect I already know what the effect on aerophagia will be though. .

ozij wrote:That means we can use the exported data to calculate breaths per minute!!!!

OK. I guess I'm dense at the moment, but can that be broken down into breaths-per-minute per state? If not, then how is that useful?

Regards,
Bill

NightHawkeye wrote: OK. I guess I'm dense at the moment, but can that be broken down into breaths-per-minute per state? If not, then how is that useful?

If this is what you mean, then the answer is yes.
*.se file
Excel Pivot chart
Functions to calculate AHI
Thats AHI on the left and BMP on the righ. And I drop all session shorter than 60 minutes.




Disregard the meaning of the data - it doesn't acount for no. of nights at setting. And I'm not sure its a meaningful relationship in any case, but I found the mere idea of being able to calculate breaths per minute fun.

O.

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

ozij wrote: OK, here's both IFLs off:, Min and Intial = 4.0, Max=7.5 Max for command on Apnea =7.5
Note the non-response to the hyponea+FL that seems to have snuck in:

Ozij: In the nicely circled graph on the prior page where you indicate both IFL1 & IFL2 are disabled or unchecked, you conclude that it doesn't respond to stand alone hypopnea, yet you have Max pressure limited to 7.5cm and you have Maximum command on apnea lowered to 7.5 from its default of 10.

How can you conclude from those settings that disabling of IFL2 prevents any response to hypopnea when you have the machine so limited in its ability to respond?

If I seen the command on apnea setting left at its default and Maximum pressure at 10 cm, then IFLx's disabled I'd be more inclined to follow along, but the machine couldn't respond to any event with those settings.

just asking is all, doesn't seem like a valid test in my opinion. IF it didn't respond to a hypopnea as you suggest, i would think those would turn into apnea and show up as such.

I received my PB420 the same day as my Headrest mask. Before that, I did not have any data. So for the first three nights, I ran in the CPAP mode like I had for the previous 2 months, so that I would know what my therapy was like before APAP. Here's a graph of CPAP pressure = 10 cm with the Aura Twilight Aeiomed Headrest:



Here's a couple of nights later with the Hybrid mask that I picked up from a forum member. How do I know that's what I was wearing? Look at the leak rate...



The runs seem to trigger the pressure rise, which just blows out the mask.

Once I settled into a setting of APAP 9.5-12, with IFL1 ON and IFL2 ON, my graphs look more like this:



I still get some Runs, especially when I have a leaky mask night. To me, it makes sense that when my mask is leaking, not enough pressure is going down my throat and I start having flow limitations. But I'm just guessing.

Take Care All,
Cathy