CPAPtalk.com

Billmanweh wrote:

Snoredog wrote: While the software is all nice and everything, your best bet is to plot the pressure and AHI information in a spread sheet, if you then graph that data in a line chart it should resemble a bell curve so when you get 2-3 plots where AI is increasing you have gone the wrong way.

Does anyone have an example of this they could post? For the life of me I can't picture/understand this.

Snoredog's suggestion is an excellent one. I might do this myself one day. It could be done this way without using a spreadsheet program:

Using one pressure per week, write down your pressure, your AI, and your AHI for each week. Once you have the AI and AHI results for a range of pressures, take a piece of paper and make a chart with (1) the range of pressures listed one at a time along the bottom of the page and (2) a range of numbers (say, 0.1 to 12.0, if that covers your range), up the left side of the page. Above each pressure, place one dot next to the number at the left matching AI and one dot at the number for AHI for that week. A pattern should emerge on the page showing at what pressure(s) your numbers are lowest.

All that could be done by entering the numbers into a spreadsheet program that generates charts, but that would just complicate the process for some.

The point is, if I understand correctly, to find the lowest pressure(s) that will do the best job with lowering your numbers. But don't sacrifice your AI number in an attempt to address AHI.

jnk

-SWS wrote:

jnk wrote:And does anyone know what language SWS was speaking back in the old days?

Я думаю, он использовал для говорят на английском языке!

I hope SWS's post didn't jar any Russian sleeper cells out of REM!

Slinky wrote:Looks like Greek to me!

Είναι πράγματι έγραψε στο ρωσικό ότι μίλησε Αγγλικά.

SWS's looks like Russian to me! (Which is all Greek to me.) (Which is what DreamDiver's is.)

jnk wrote:

"Patients with SDB are usually worse in the later hours of sleep."--Handbook of Sleep Medicine, Avidan, Zee.

I wouldn't be confident of so broad a generalization. My own pattern, from a series of 20 observations, is as follows:

Hour:_________12_____1______2______3______4______5______6______7______8
%apneas:______20.3%__31.4%__21.3%___8.8%___2.1%___4.9%___5.7%___4.5%___1.0%___100.0%
cumulative %:_________51.8%__73.0%___81.8%

(It's a bear to get spreadsheet copies lined up. Looks OK in the post window, but horrid in preview.)

As indicated, over 80% my apnea events occurred during the first part of the night, before 4am.
But then, we all know that I am quite abnormal, even within this group.
Velbor

Velbor wrote:

jnk wrote:

"Patients with SDB are usually worse in the later hours of sleep."--Handbook of Sleep Medicine, Avidan, Zee.

I wouldn't be confident of so broad a generalization. My own pattern, from a series of 20 observations, is as follows:
<---snipped--->

I think the quote jnk found is probably true. The operative word in the quote is "usually."

Makes sense to me, since REM (rapid eye movement) cycles usually become longer and longer as sleep progresses through the night. The longest period of REM usually happens in the later hours of sleep toward morning. REM is also when people with OSA usually experience an increased number of apneas.

Generalizations usually have exceptions, I suppose.

You've always been unusually exceptional, Velbor!

rested gal wrote:

Velbor wrote:

jnk wrote:

"Patients with SDB are usually worse in the later hours of sleep."--Handbook of Sleep Medicine, Avidan, Zee.

I wouldn't be confident of so broad a generalization. My own pattern, from a series of 20 observations, is as follows:
<---snipped--->

I think the quote jnk found is probably true. The operative word in the quote is "usually."

Makes sense to me, since REM (rapid eye movement) cycles usually become longer and longer as sleep progresses through the night. The longest period of REM usually happens in the later hours of sleep toward morning. REM is also when people with OSA usually experience an increased number of apneas.

Generalizations usually have exceptions, I suppose.

You've always been unusually exceptional, Velbor!

Ditto to what Rested Gal said.

I'm thinking the "usual case" more often than not probably has to do with less "neuromuscular maintenance" of the airway (i.e. diligently keeping that sagging pallet out of the way during deeper and more relaxed sleep, especially REM).

By contrast I'm thinking Velbor's atypical distribution of events just may have more to do with intermittently moving the mandible back throughout the sleep session. And those mandible movement-dynamics just may be more likely to occur during light or disturbed sleep, but less during deep relaxed sleep such as REM.

Slinky wrote:Looks like Greek to me!

Slinky,

He has tricked you - vaht wrote he vas Rooshan (Cyrillic).

Sound it it out - you can tell the difference

DSM

-SWS wrote:

rested gal wrote:

Velbor wrote:

jnk wrote:

"Patients with SDB are usually worse in the later hours of sleep."--Handbook of Sleep Medicine, Avidan, Zee.

I wouldn't be confident of so broad a generalization. My own pattern, from a series of 20 observations, is as follows:
<---snipped--->

I think the quote jnk found is probably true. The operative word in the quote is "usually."

Makes sense to me, since REM (rapid eye movement) cycles usually become longer and longer as sleep progresses through the night. The longest period of REM usually happens in the later hours of sleep toward morning. REM is also when people with OSA usually experience an increased number of apneas.

Generalizations usually have exceptions, I suppose.

You've always been unusually exceptional, Velbor!

Ditto to what Rested Gal said.

I'm thinking the "usual case" more often than not probably has to do with less "neuromuscular maintenance" of the airway (i.e. diligently keeping that sagging pallet out of the way during deeper and more relaxed sleep, especially REM).

By contrast I'm thinking Velbor's atypical distribution of events just may have more to do with intermittently moving the mandible back throughout the sleep session. And those mandible movement-dynamics just may be more likely to occur during light or disturbed sleep, but less during deep relaxed sleep such as REM.

and all this time I thought REM was a rock band from the 70 and 80's.

-SWS wrote:By contrast I'm thinking Velbor's atypical distribution of events just may have more to do with intermittently moving the mandible back throughout the sleep session. And those mandible movement-dynamics just may be more likely to occur during light or disturbed sleep, but less during deep relaxed sleep such as REM.

So what you're saying is that possibly the pattern of more events the first part of the night and the lesser number of events the latter part of the night may be due to something such as jaw clenching, teeth grinding, etc. the first part of the night during lighter sleep and we are less likely to do this as the night passes and we progress to deeper more relaxed sleep?

Slinky wrote:

-SWS wrote:By contrast I'm thinking Velbor's atypical distribution of events just may have more to do with intermittently moving the mandible back throughout the sleep session. And those mandible movement-dynamics just may be more likely to occur during light or disturbed sleep, but less during deep relaxed sleep such as REM.

So what you're saying is that possibly the pattern of more events the first part of the night and the lesser number of events the latter part of the night may be due to something such as jaw clenching, teeth grinding, etc. the first part of the night during lighter sleep and we are less likely to do this as the night passes and we progress to deeper more relaxed sleep?

That's pretty much what I'm thinking about Velbor's obstructions, Slinky. We've had some really interesting discussions in the past about Velbor's apnea. Velbor says that he receives better results with a dental appliance than he does using xPAP. A classic sagging pallet tends to resolve nicely with airway inflation via xPAP (short of a CompSA/CSDB type response or some other less-common complication/contraindication).

Velbor also stated that his airway entails unusually narrow clearance to begin with. He just doesn't sound like the classic pallet-sagging apneic patient from what he described. Classic "pallet saggers" or even passive "tongue sliders" are going to get in more and more trouble as neuromuscular airway maintenance or control diminishes throughout sleep. If Velbor's apneas are more pronounced when neuromuscular control is most active throughout the night, then I'm thinking his airway occlusions are probably the result of muscular activity rather than muscular inactivity.

I believe there are a few ways in physiology to achieve more obstructions during NREM versus REM. However, Velbor's issues sound rooted in narrow airway clearance and receding mandible (and/or occluding tongue). By contrast "classic" obstructive apnea etiology tends to entail a narrow airway coupled with a passively sagging pallet and/or passively receding tongue.

snoredog wrote:and all this time I thought REM was a rock band from the 70 and 80's.

LOL! I can remember when I thought REM was an esoteric acronym. Now that I'm middle-aged and saddled with apnea, REM just doesn't sound anywhere near as esoteric as it used to! Still like the rock band, though!

So far as I know I have no "structural" problems w/the airway. I do have COPD, I do have mild OSA. AND my data thru out the night appears similar to Velbor's - more events the first 1/2 to 2/3 of the night and less or no events the second half to last one third of the night - consistently.

I'm thinking in my case this is the result of Spiriva, an inhaler, taking a while to work and doesn't reach full effect until 4-5 hours after taking it. Its supposed to be "effective" ? for 24 hours. On the other hand I know I tend to clench my teeth and I have no "padding" or cartilege left in the TMJ. Thankfully, I have only occasional symptoms such as the jaw locking and almost never pain or discomfort.

rested gal wrote: You've always been unusually exceptional, Velbor!

Thank you Slinky and -SWS also.

I am impressed and moved by your thoughtful and caring reflections on my anomalous data, physiology and experiences.

Reminds me of my mother describing my breech birth, and commenting that I entered life ass-first, and have continued going that way ever since!

Velbor wrote:

rested gal wrote: You've always been unusually exceptional, Velbor!

Thank you Slinky and -SWS also.

I am impressed and moved by your thoughtful and caring reflections on my anomalous data, physiology and experiences.

Reminds me of my mother describing my breech birth, and commenting that I entered life ass-first, and have continued going that way ever since!

Now that you mention it, Velbor, I recall my own mother using the descriptive term "bass ackwards" more than once or twice.

Slinky wrote:So far as I know I have no "structural" problems w/the airway. I do have COPD, I do have mild OSA. AND my data thru out the night appears similar to Velbor's - more events the first 1/2 to 2/3 of the night and less or no events the second half to last one third of the night - consistently.

Slinky, I think COPD-related bronchiospasms or COPD-related alveolar hypoventilation can account for some of those trends. Bruxism entailing mandible grinding (not clenching) in a receding direction sounds like another possibility as well.

If your COPD ever reaches the point of being hypercapnic COPD, then "volume assured" BiPAP just might be an even more suitable xPAP treatment option for you: http://avaps.respironics.com/Features.asp

Whoa, SWS!!! That last went over my head! I'm off to read the link. Thanks. I don't know that my current pulmo would explain or tell me if I was hypercapnic COPD if I even asked. He's the one who told me to stay away from PubMed 'cause I wouldn't understand those abstracts and articlels. SNORT!

Would a recent spirometry result tell you anything? I haven't had a full PFT in a couple of years but I've had 3 spirometries the last 9 months and have those printouts.

My current therapy settiings are: VPAP Auto
Max IPAP 13.0
Min EPAP 8.0
Pressure Support 4.0
Ti Maximum 4.0s
Ti Minimum 0.5s
Exhalation Medium
Trigger Sensitivity Medium
Cycle Sensitivity Medium