WaveForm analysis Please explain how this works

pudellvr wrote:Snoredog,
Around 0230 I had ripped my mask of to deal with some major nose itches! I think the 2 centrals there can be ignored due to my disturbing the piece. What do you think?

I seen that, just ignore those, if you stop breathing longer than 10 seconds it will record those.

pudellvr wrote: What came first? The runs seem to preceed the obs then ca. I am unclear as to what runs mean. I thought at first they were runs of ah but they proceed the marks on the upper line. I am also curious about the cycle states.

depends on what period you are looking at, you have to reference the timeline at the bottom, but they all started with Flow Limitation except for the cluster seen at 3:30AM, it started with a central. That can be from transitioning from non-REM to REM, since the cluster of events follows the central, that is my guess what happened. Machine didn't respond to it which is what you want to see.

If you are feeling better that is a positive sign. You are doing pretty good, don't see a lot that needs changing, just make sure you give the machine the room it needs to respond. I would still move that Command on Apnea back down to 10, I would even try 9 for a few days. If the CA's drop off on line 2 that is what you want.

Here is the data:
http://picasaweb.google.com/lh/photo/BT ... mpSx6tfQKQ

http://picasaweb.google.com/lh/photo/Wa ... 3i6cCX8b1A

DH reports that I was snoring pretty hard. He says that he doesn't remember me snoring since I have been on the machine. I am not sure if I feel tired due to the clonazepam or my sleep pattern.

Thanks for your patience

Trish

Hi Trish
When you look at the last data compared to the data for the previous nights you can see many more indications of obstruction in last night's data.
Things were much better on Nov. 1 - and that's where you should go. There's not much of a difference your central apnea index, but the difference in the obstructives is very big. On Nov. 1 you had hardly any flow limitation runs (think of them as traffic moving very heavily, but not brought to a stop) no snores, and hardly any apnea - a combined AH of 0.4. Look at the cycle states (another indication of how good your breathing was) they are always at the top that nigt, ever when you have central apneas. Whereas yesterday, you had a combined AH of 4.9, and snoring, and lots of flow limitations. Those can all be caused by the minimum pressure being too low.

And don't get worked up about the central apneas:

Professor Ian Wilcox wrote:It’s not unusual for normal individuals who don’t have obstructive apnea to have a few central apneas, particularly changing between sleep stages, and so you may also see a few central events or a central element to what is otherwise predominantly OSA in patients without heart failure. You can also get occasional central apneas in untreated OSA and during PAP treatment possibly due to stimulation of upper airway afferents as there’s a protective reflex that stops you from continuing to inhale when there is something in your upper airway. In general, therefore, we don’t usually worry about the occasional apnea, central or obstructive, during PAP treatment. In the absence of heart failure you would not normally expect a change in the central component of OSA over time.

Professor Wilcox is in practice as a Cardiologist, including appointments as Consultant in Cardiology at Royal Prince Alfred Hospital and Clinical Associate Professor at the Department of Medicine (Central Clinical School), Sydney University where he supervises a Research Program on Sleep and Cardiovascular Disease. He is also Head of the Department of Medicine at Strathfield Private
Hospital, Sydney.

Source: Resmedica. http://www.resmed.com/en-au/assets/docu ... 0933r1.pdf[/quote]

You central apneas may be a response to the newness of the therapy and may drop eventually - if you stick to a pressure that keeps you from obstucting.

If it were me, I would stay at least a week at a mimimum of 9 or so. When the machine doesn't run into snores for flow limitation, it doesn't even take you above 11.

O.

Your minimum pressure is 6 - and that's probably too low as Ozij points. Maybe you're confusing that setting with the initial ramp pressure. Why did you change it to 6?

Comfort pressure, I'm still guessing, is the "Initial pressure" from the 420E - set that to 9, which is just above your average pressure from last night.

But then don't change anything else and leave that for a week.

Actually, according to the manual, comfort pressure is "the level of pressure produced by the device when the ramp feature starts up".
It's the minimum pressure that has to be set higher.
Trying going about the settings changes more slowly, Trish - something in either the LCD interface or the Software is giving you results you're not expecting.

Minimum pressure is as low as you should let the machine go when it is giving you therapy.
Maximum pressure is as high as the machine will go in response to snores and flow limitations.
Maximum pressure for command on apnea is a limit set for how high the machine will go in response to apneas. This is frequetly lower than the maximum, because of the fact that even on the Sandman you can't be sure all apneas it identifies are obstructive, and you don't want to raise the pressure if an apnea is not obstructive. So if apneas appear without any other indications of obstruction (that is, withou flow limitations or snores) you instruct the Sandman to play it safe and not respond to them above the pressure set on this parameter.

Ramp is a personal comfort setting you can set to start at low pressure, and to keep the machine from responding till you're asleep.

When you've finished setting up your machine, use the software to read the setup, just to make sure that it is what you meant it to be. Don't wait for the next morning to discover that its was not what you wanted.

O.

11/04 Waveform report looks much BETTER, lowering the Command on Apnea back to 10 cm greatly reduced the number of Centrals seen from prior night.

I would use current settings for a few days. If you want to experiment you might change Pressure Decrease from fast to slow and compare. Setting it to slow may eliminate a few more of those Flow Limitation runs. At the same time it could get worse but you don't know how the change would impact your sleep until you try.

But your report looks good, you will probably never be able to obtain a very low AHI do to the Central dysregulation seen on the earlier reports.

Hopefully you feel better.

11/04 is better than what?
Snoredog is recommending you maintain the settings that gave you a total AHI of 7.8.

I suggest you return to those that gave you a total AHI of 2.8.

As for seeing "central dysregulation" on unspecified "previous reports" nothing indicates that on 11/01. The AH cnt for 11/01 is 2.8.
The AH cnt on 11/04 is 2.9.


O.

http://picasaweb.google.com/lh/photo/UL ... 7By4dnjahg

http://picasaweb.google.com/lh/photo/-O ... 6FtdeLwwiQ

Much better last night. I didn't post 11-05-08 because I slept horribly and was trying to just be patient with staying with the same settings. I made one change last night. I increased the min pressure to 8. I slept better than a baby. (Didn't wake up every 3 hours and cry!)

Thanks for all of your help!
Trish


Link to all reports http://picasaweb.google.com/randtyork/CPAP#

Trish, that looks much better! Guess you can tell the difference the next day eh

I won't make any more suggestions on pressure (listen to either Ozij or Snoredog ) but I will say whatever setting you settle on, stay with it for a week - your body will adjust and maybe those central's will settle down. You'll also get a better overview of what your real AHI is (never trust just one night's results). Happy sleeping

ozij wrote:11/04 is better than what?
Snoredog is recommending you maintain the settings that gave you a total AHI of 7.8.

I suggest you return to those that gave you a total AHI of 2.8.

As for seeing "central dysregulation" on unspecified "previous reports" nothing indicates that on 11/01. The AH cnt for 11/01 is 2.8.
The AH cnt on 11/04 is 2.9.


O.

Read the post after yours, pretty hard to argue with success. Sometimes wingin dials ain't the thing to do.

pudellvr wrote:http://picasaweb.google.com/lh/photo/UL ... 7By4dnjahg

http://picasaweb.google.com/lh/photo/-O ... 6FtdeLwwiQ

Much better last night. I didn't post 11-05-08 because I slept horribly and was trying to just be patient with staying with the same settings. I made one change last night. I increased the min pressure to 8. I slept better than a baby. (Didn't wake up every 3 hours and cry!)

Thanks for all of your help!
Trish


Link to all reports http://picasaweb.google.com/randtyork/CPAP#

Stick with those settings your numbers look great, you are getting fewer CA's showing up and that is what you want. This is all about finding your sweet spot, it can take several nights to find it. You will probably still have some bad nights that is to be expected, but last night's report looks good. The number of events seen on the report is decreasing that is a positive sign.

Snoredog wrote:11/04 Waveform report looks much BETTER, lowering the Command on Apnea back to 10 cm greatly reduced the number of Centrals seen from prior night.

11/04 was dreadful.
And you did not answer my question, Snoredog. You consider 11/04 BETTER than what?

As for diag winging:
viewtopic/t35957/viewtopic.php?p=310113#p310113

on Mon Nov 03, 2008 16:52 Snoredog wrote: You need to go back to your 11/01 settings (first 2 days) those results look a lot better.

Just my point: - no need to argue with success.


O.

ozij wrote: 11/04 was dreadful.
And you did not answer my question, Snoredog. You consider 11/04 BETTER than what?

O.

Now that I look at it again, NO I don't think it is better.

The best therapy was seen on the reports with settings used on 10/31 and 11/01.

10/31 report shows settings at:
http://picasaweb.google.com/randtyork/C ... 3600668002

11/01 report using the same settings.
11/02 report was going from UMFF to Swift, obviously the Swift had some leak issues and you have to discard that data as invalid.
11/03 report was better than 11/02 but still not great.
11/04 report was "11-04-08 waveform data clonazepam taken naproxin taken umffm", obviously the medication didn't help things.
11/05 report looks like 3 "sessions" have no idea what was up with that one.
11/06 report looks better than last 4 reports but still NOT better than 10/31 and 11/01.

Obviously she needs to go back to the settings used on 10/31 shown above.

Those settings show:

Min Pressure:10 cm
Max Pressure:20 cm
Ramp Latency:15 min
Pressure Decrease: fast
Command on Flow Limitation Run: enabled
Maximum pressure for Command on Apnea: 14 cm
Comfort Pressure: 10 cm

AH obs: 0.1 (can't get much better than that)
AH cnt: 2.7 (nothing wrong with that)
90% pressure: 10 cm

What is a bit confusing is the manual says it will use Min to Max pressure range after Ramp latency expires. Well if you have to have Minimum pressure at or below any Ramp pressure what good does that do? Why not call Ramp pressure Ramp pressure instead of Comfort pressure. Let's reclassify a setting that has been used in the industry for years to something that confuses everyone.

Her BEST settings where those that were used on 10/31, she needs to go back to them. But how one feels should override any settings used.

viewtopic.php?p=310767#p310767

by ozij on Wed Nov 05, 2008 20:11
Things were much better on Nov. 1 - and that's where you should go

viewtopic.php?p=311588#p311588

by Snoredog on Sat Nov 08, 2008 11:23

10/31 report shows settings at:
http://picasaweb.google.com/randtyork/C ... 3600668002

11/01 report using the same settings.
<snip>
Her BEST settings where those that were used on 10/31, she needs to go back to them. But how one feels should override any settings used.

I'm glad that's clarified.

O.

These are the changes I am considering making over the next few weeks.

Decreasing Ramp time- I really could care less about it, and I always fall asleep fast and hard. No counting sheep here. If you look at last nights data (skip the nap session) I am snoring almost immediately.

Pressure Decrease- change from fast to slow. Just to see how much difference it would make. It doesn't seem to bother me.

Minimum pressure- adjust up by .5 at a time to get a little better control of snoring. Not looking to permanently abolish it but it seems to be part of the cart before the horse[[errr I mean horse before the cart ]].

I will keep my waveform data updated on picasa for a while. The new one is there at the link in my siggy. I appreciate everyones input.

Thanks
Trish