CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

unadog wrote:2) dillion...

Hi unadog, Are you suggesting that the Adapt SV might be sensing ballistodillionographical artifacts?

SleepingUgly wrote:I think he meant what he said...

Hmmm...maybe you have found the key to my ASV PSG stutters: sleep dilloniated breathing (SDB)?

blizzardboy wrote:

Muffy wrote:Just about every breath gets a double hit.

I am trying to understand what the algorithm is attempting to acheive during these periods of "double hitting". I suppose, given the flow-metering nature of CPAP, that mid-inhalation the machine senses a partial exhalation followed by the completion of the inhalation cycle i.e. stutter, thus demonstrating the rapid nature of the ASV response to respiratory variations and its charter to maintain tidal volume.

At the risk of microanalyzing your microanalysis, and keeping in mind that this is offered as a possible explanation for something you did once (recurring theme of solitary events that don't need to be bludgeoned to death), if the CPAP Flow is clipped at 0.0 volts to allow only the + portion, then this should expose only the inspiratory limb of the breath:



Keep in mind that I don't believe this to be a ResControl signal because of the reasons previously mentioned (and because of the behavior of the Snore Channel, I believe they employed a PTAF2 system), and if so, doesn't represent in the strictest sense what the AdaptSV actually "sees".

So anyway, what I think is happening is that you're having Flow Limitations that slow to the point where the AdaptSV thinks your flow has (briefly) ceased, switched to EEP, then back to IPAPwhatever nearly instantaneously. This completes a single inspiratory effort, but registers as a "stutter" vis-à-vis Respiratory Rate.

As an aside, you're in SWS and sleeping through this whole thing. Since the event that brought all this up also occurred at the beginning of the night where your SWS normally appears, I think the same thing happened there.

As a further aside, man, you gotta put some salve or something on that alpha intrusion.

Muffy

blizzardboy wrote:Are you suggesting that the Adapt SV might be sensing ballisto...graphical artifacts?

Exactly!



Muffy

Muffy wrote:Keep in mind that I don't believe this to be a ResControl signal because of the reasons previously mentioned (and because of the behavior of the Snore Channel, I believe they employed a PTAF2 system), and if so, doesn't represent in the strictest sense what the AdaptSV actually "sees".

Hi Muffy, ('scuse me if I'm being obtuse) the dB channel was recorded with a microphone located above my bed and I am sure I remember the Adapt SV having that unit attached to the back and wires disappearing into the wall. Very nice to see the inhalation portion of the flow channel - thank you, clearly shows the likely source of the supercharged resp rate, eh?

Muffy wrote:So anyway, what I think is happening is that you're having Flow Limitations that slow to the point where the AdaptSV thinks your flow has (briefly) ceased, switched to EEP, then back to IPAPwhatever nearly instantaneously. This completes a single inspiratory effort, but registers as a "stutter" vis-à-vis Respiratory Rate.

i.e. for the Adapt SV the interpretation of respiration status becomes tricky as the flow rate drops below some threshold (and further complicated by the presence of ballisto...graphics)?

Muffy wrote:As a further aside, man, you gotta put some salve or something on that alpha intrusion.

Hmmm...so is there a line up of usual suspects as perpetrators of these intrusions? Cheers,

Muffy wrote:Exactly!

So we are seeing cardio ballistics coming through here, right?

For the past couple of weeks I have had a permanently blood shot left eye ball, in the top outside quarter. Pretty sure this is not associated with air leaks due to the location on eye ball and I have had no foreign bodies in my eye that have bothered me. The redness does not cause me discomfort in spite of looking like someone king hit me. I have never had this type of redness in my eye before. I still continue to have sore feet, hands, neck, knees and ankles on waking. I wonder if this redness in my eye could be associated with CPAP use like I suspect my joint pain to be? Maybe, maybe not.

blizzardboy wrote:

Muffy wrote:Keep in mind that I don't believe this to be a ResControl signal because of the reasons previously mentioned (and because of the behavior of the Snore Channel, I believe they employed a PTAF2 system), and if so, doesn't represent in the strictest sense what the AdaptSV actually "sees".

Hi Muffy, ('scuse me if I'm being obtuse) the dB channel was recorded with a microphone located above my bed and I am sure I remember the Adapt SV having that unit attached to the back and wires disappearing into the wall.

I doubt dB was taken from the microphone because filtering out the "snore" portion of the waveform results in a breathing waveform. This is most clearly seen in the obstructive apnea:



where some of the highest "snoring intensity" would be occurring where you aren't moving any air (which is impossible). Rather, dB mirrors CPAP.

While the settings of the AdaptSV were undoubtedly manipulated using a ResControl (otherwise they would have to walk into the room to change settings) I don't believe the resultant waveforms were fed into the PSG (what we are viewing here). If they were (and/or were properly calibrated) then the CPAP channel would accurately reflect the delivered pressures of the AdaptSV, which as you see, does not.

Muffy

Muffy wrote:Rather, dB mirrors CPAP.

I've been thinking that the microphone was picking up the Adapt SV getting noisier as it ramped up the IPAP, hence the correlation between the dB and CPAP channels during these occasions. Did you manage to find your DOS 5 1/4"s to reinstall your OS?

blizzardboy wrote:Did you manage to find your DOS 5 1/4"s to reinstall your OS?

8-inch, actually.

Muffy

blizzardboy wrote:

Muffy wrote:Rather, dB mirrors CPAP.

I've been thinking that the microphone was picking up the Adapt SV getting noisier as it ramped up the IPAP, hence the correlation between the dB and CPAP channels during these occasions.

Upon further reflection, that must have been what happened:





Muffy

Muffy wrote:Upon further reflection, that must have been what happened...130db=AdaptSV ramping up IPAP

Ah, yup, good point...like I said:

blizzardboy wrote:...('scuse me if I'm being obtuse)

blizzardboy wrote:Very nice to see the inhalation portion of the flow channel - thank you, clearly shows the likely source of the supercharged resp rate, eh?

It's an absolutely certain maybe.

blizzardboy wrote:i.e. for the Adapt SV the interpretation of respiration status becomes tricky as the flow rate drops below some threshold (and further complicated by the presence of ballisto...graphics)?

If you're talking about the respiratory rate thing, keep in mind that you did that once, and it had no clinical significance.

If you're thinking that ballistocardiographical artifact can mess up the algorithm, I doubt it. That waveform is undoubtedly filtered in machine analyses (in the same manner I have turned the snore channel into a breathing channel) so BCA is attenuated. We are able to see it now because I don't think that's a ResControl data channel.

blizzardboy wrote:Hmmm...so is there a line up of usual suspects as perpetrators of these intrusions?

As you've probably noted through your research, the jury's still out on the clinical significance of alpha intrusion.

Did you run alpha intrusion by your sleep people?

Muffy

Muffy wrote:If you're thinking that ballistocardiographical artifact can mess up the algorithm, I doubt it. That waveform is undoubtedly filtered in machine analyses (in the same manner I have turned the snore channel into a breathing channel) so BCA is attenuated. We are able to see it now because I don't think that's a ResControl data channel.

With a little bit of LP filter applied to that same BCA, and



Muffy

Under similar magnification:





Oh no!

Only 7 more to go!

Muffy