Why doesn't APAP respond to apneas?

Snoredog wrote:

dsm wrote:Now here is an example of very hefty PS activity - possibly the worst night for unstable data even though I slept like a log through it all (a typical good night).

My wife's comment to me was 'dearest, your mask leaked a lot last night"
my reply
"oh , did it, I must check the data 1st thing"

Now, for anyone wondering about how some machines handle bad leaks - check this

DSM

Looks like that leak didn't help that Periodic Breathing seen. Was that mouth breathing that caused that leak?

With that amount of leak, you have to wonder WHY you felt so good after that session. Was it because the leak exhausted out more CO2? Periodic breathing period would suggest that.

That Large Leak would almost indicate a broken barb inside the machine on the main outlet port, it comes from twisting on the hose directly to the machine in warm weather. On that side of the machine there is only 1 screw in the center, this allows the lid of the machine to actually separate from the bottom case (you have to pay attention to the side of the machine to see it happen), but the small clear hose on the inside don't have a lot of free play, it doesn't take much tension by twisting that port to "crack" the barb, the result can be an internal leak which of course would present a Large Leak. If your LL continues, that is what I'd look for.

Snoredog,

I have several charts from the past 8 months that show that. See my details at bottom of my posts - I use a quattro F/F mask). On rare occasions (and since growing a beard) I get some bad leak nights (like this one). But the tidal flow data and AI & HI tends to remain consistent between bad leak nights & good leak nights.

RE hose, I have a std H/H & a 6ft hose + a 12" hose with a swivel to the mask. My turning in the night doesn't get back to the machine.

MY point here is that PS (which specifically targets "target peak flow" ) does a remarkable job of dealing with difficulties & does it in a way that allows a decent nights sleep. PS *ONLY* gets activated in 2 circumstances that I know of ...
1) is responding to a central when BPM=AUTO
2) when target peak flow (4-min window) is not going to be hit

There are no mysterious nor mystical reasons why PS will activate. Just a very basic response to centrals & average peak flow. I like it

Cheers

DSM

#2 got to thinking that really was a massive leak so checked prior nights data & very similar - then checked the airline out & sure enough some fine holes at the end that connects to the mask 12" hose. Have installed a new hose - wiil know tomorrow if this has made a distinct difference.

hanks for that heads up re the size of the leak.

D

So SWS, does the SV protocol consider those HI's seen on Bev's report as "obstructive" events? ...meaning do they want EPAP to also completely eliminate those? and IPAP then only targets peak flows and tidal volume? I could believe that, but I don't think its the case.

Right. The SV machines don't differentiate obstructive from central in any way. By design they are all about targeting an averaged flow peak or minute volume. A detected hypopnea is always undifferentiated, as is any detected apnea.

So both "Big R" manufacturers want the obstructive component manually addressed with the machine's fixed pressure component.

Sorry, I missed all your posts from last night. I was too tired to look at the computer. I found a styrofoam cooler tht I made cutouts in for the air intake and plugs and put it upside down over the SV. That cut down the noise significantly and I actually slept pretty well. I also lowered the max because those pressure jumps were part of what woke me up the night before. My report looks MUCH diferent form yesterday. What does is all mean?



Snoredog, I'm 5'7".

Bev

That leak rate looks beautiful, Bev...especially considering the high pressures being used most of the night!

Good lab ratting fix -- the styrofoam box you used to muffle the machine's sound. Glad to hear you slept better!

Bev, I'll post with some very detailed comments later today.

How did aerophagia work out last night? What's you followup assessment of overall quality of sleep? Do you notice any changes for the better or worse regarding daytime symptoms today?

RG, It is a beautiful leak line when you compare it to the train wrecks I was having a year ago. I attribute it to three layers of tape, one going horizontally across my mouth and two more, running at a slant from cheek to chin. On top of that I wear the CPAP Cap to keep my jaw from dropping. Mouth leaks wake me up and that is the only combination that consistently works for me.

SWS, aerophagia was much better last night. I didn't have to get up once to "let the air out". Yesterday I felt as though I had been run over by a truck. Today is only halfway thru, but so far feel much better.

What's the story of the "Patient Triggered Breathing %"? Does that mean that the SV kicked in all those times when it dropped? I was vaguely aware of the machine pushing me last night and, of course, there was the noise.

Bev

OutaSync wrote:What's the story of the "Patient Triggered Breathing %"? Does that mean that the SV kicked in all those times when it dropped? I was vaguely aware of the machine pushing me last night and, of course, there was the noise.

Yes, Bev. Hope I get a chance to post in detail about that little biomed parameter before anyone tells you that really needs to be fixed...

Sometimes it needs to be fixed regarding imperfect settings, and other times it represents an imperfect biologic respiratory controller being very efficiently fixed.

SWS wrote:other times it represents an imperfect biologic respiratory controller being very efficiently fixed.

The "biologic" being you, Bev! And the biologic respiratory controller being the thing(s) within you that handles your breathing.

The "imperfect" part (of your biologic respiratory controller) being whatever it is about your physiology that causes dysregulated breathing during sleep for you sometimes, and not other times. The "sometimes/not other times" being the bifurcation -SWS has speculated about earlier in this thread.

Bifurcated dysregulated breathing - a continually moving target! Gonna mean some good nights, some bad nights, even if settings stay the same. Plus, there can always be other factors besides "cpap" treatment that can effect how well you sleep -- pain, stess, meds, congestion, room temp, mattress, squirrel dropping acorns on the roof...you get the picture. Glad that was a good one for you, and hope you have MANY more good ones than bad ones.

Yeah, I have to take drastic steps (BIGGG patch of tape AND a chin strap) to prevent my mouthbreathing during sleep, too. Don't we look cute going to bed at night?

Bev,

Good going and getting better.
The data that stands out is the BPM and the Patient triggered breaths info. That combined with the small
number of events scored shows the machine did a lot to bring you in-line. Am sure SWS will give us a good
analysis of the extent that your breathing fluctuates. What I see is a machine that appears to be dealing
with this complication in your breathing. Naturally the bottom line is how you feel.

Cheers

DSM

#2 One other observation which may relate to the deeper sleeping last night, is that your av peak flow was similar \
but your av tidal volume was noticeably higher. Again I am sure SWS will give us an explanation of why that
occured and while I am assuming it shows a big improvement (the peak tidal volume that is) am sure Steve
will explain.

RG, thanks for the interpretation. I guess I've been called worse things than a bifurcated dysregulated breather! I don't know if this means anything, but I woke up with a headache that has gotten worse as the day progresses. This is not unusual for me, either.

SWS, I'm looking forward to you thoughts. I hope that I have the right machine for the job.

DMS, did you get to the source of your large leak?

Bev

OutaSync wrote:I guess I've been called worse things than a bifurcated dysregulated breather!
---
Bev

Me too. A funny one that comes to mind is my having been called "a shill", but thankfully not by -SWS.

Your designation as a BDB sounds much more sophisticated!

OutaSync wrote: Snoredog, I'm 5'7".

Bev

My opinion:

yes that means your breathing caused the machine to switch to backup mode more often then the first night. The PB (Periodic Breathing) seen is not good but it tells what caused it to switch. Your tidal volume came up from 375 to 420, at 69" tall you should be at 530ml avg range for your height, a ways to go yet. There are no Apnea Periods being seen which is good.

According to the Titration guide I sent, you are in the center with residual Hypopnea or Periodic Breathing being seen, you will probably need to increase IPAP Max by 2 cm, if that doesn't eliminate the events, IT would have to come down to a minimum of 1.2 sec. The guide is calling for fixed settings.

First Night (2nd & 3rd sessions):

EPAP=9.0
IPAP Min=11.0
IPAP Max=21
BPM=Auto, avg. seen 14.6

2nd Night:
EPAP=9.0
IPAP Min=12.0
IPAP Max=18.0, IPAP consistently bumping into Max, you will need to maintain at least 10 cm between EPAP and IPAP Max.
BPM=Auto, avg. seen 11.6

Big change seen on report by increasing IPAP Min by 1 cm, target Volume came up from 375 to 420 (for height should be at 530ml avg), Periodic Breathing now noted.

OutaSync wrote: I guess I've been called worse things than a bifurcated dysregulated breather!
Bev

Do you have Asthma?

OutaSync wrote:RG, thanks for the interpretation. I guess I've been called worse things than a bifurcated dysregulated breather! I don't know if this means anything, but I woke up with a headache that has gotten worse as the day progresses. This is not unusual for me, either.

SWS, I'm looking forward to you thoughts. I hope that I have the right machine for the job.

DMS, did you get to the source of your large leak?

Bev

Bev,

I fitted a new hose & it seemed fine - wife concurred. I downloaded the night's data but forgot to go back & check it before leaving for work.
I did also tighten the face straps on the Quattro as am again losing weight (put on 5 kilos over winter plus due to lazy lifestyle while recently
visiting NZ).

I am sure you just need a couple of nights of consistency while getting used to the machine. The stress of all this will take its toll. That headache
could be stress related but it may also be connected to your significantly increased av tidal volume - anyone else got any thoughts as to cause ?

DSM

As far as I know, I don't have asthma. But I didn't know I had GERD, either, until I discovered this forum and went to an ENT and GI Dr. to have it checked out.