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Papit, are you actually not sleeping during the night?

avi123 wrote:Papit, can you please show up- todate graphs of your treatment in ResScan Report?
Similar to the following but add the Leak and Snore graphs and cover the whole night.
Can you omit the Flow graph but still show the Flow Limitation?
Please indicate at what mode the machine was set. . . . (earlier image)

The mode my machine is set for is "ASV" (vs. "ASV Auto" which is another available mode selection). Here are the graphs for (7/1/13) yesterday. I'll show SH's first because they cover the 6-hour sleep clearer than ResScan. ResScan's graphs follow SH's. But notice that ResScan graphs include the portion of the previous (6/30/2013) day's sleep up until the 12:00noon cutoff. So the stats are slightly different and the latter graphs a little bit confusing. My treatment for these first 3 weeks on the ASV are shown at bottom in the Report's Summary graphs.

SleepyHead


ResScan Report graphs



First 3 weeks treatment on ASV 6/10 - 7/1/13 (Topmost graph is Tidal Volume)

Papit, can you please show up- todate graphs of your treatment in ResScan Report?
Similar to the following but add the Leak and Snore graphs and cover the whole night.
Can you omit the Flow graph but still show the Flow Limitation?
Please indicate at what mode the machine was set.

Thanks Dori, Randy, SirNoddinOff. This clearly is outstanding technology. Fortunately I have good insurance to cover most of it. But for anyone who doesn't, and what I was going to do if there was an insurance problem, they can consider used and open-box unused machines at lower prices at SecondWindCPAP.com and there are other similar websites. SecondWindCPAP advertises that they clean used equipment, check machine calibration and apply your Rx pressure settings before shipping. And of course there is Craigs List and others, but you need to be able to do your own settings, etc. however the prices are often quite reasonable.

Anyone who has used secondwind want to tell us what their experience has been?

DoriC wrote:

Randyp1234 wrote:Whoo Hooo!!! Good feeling isn't it? I had a couple 0.0.nights recently also. . . . Randy

Congrats!! So the worst that can happen is that the machine "malfunctioned" and you really had an AHI=0.1!

Sir NoddinOff wrote:The results you are getting with your machine are often the results one sees with modern ASV technology. . . . However, for me, the real miracle is how anyone can afford an ASV machine. Example https://www.cpap.com/productpage/pr-60- ... anced.html
And that's without a hose, humidifier or mask PS... there was one being sold in the SF Bay area recently for $500. Wonder what happened to it?

StuUnderPressure wrote:

DreamDiver wrote:

Papit wrote: -Nate and DreamDiver, you put me on the right track with your comments and questions. I can now bring up both Flow and Flow Limitation in the Detailed Graphs.

Me smacking my forehead. "!" I should have remembered the first thing to check is whether or not some graphs are simply omitted from the graphs section. Simple solution.

I can also see both the Flow & Flow Limitation in the Detailed Graphs in my plain vanilla S9 AutoSet.
As some have already said, all you have to do is choose to include them.
So, if you are not now seeing some graphs you hear others refer to, you may have to simply go in & "choose" to see those graphs.

Exactly, but it sure was easier said than done. It took multiple attempts and finally worked for me only by going through the Reports path. Also, as Nate pointed out, each user must make sure he has selected his machine type (cpap, apap, bipap, or asv) in the right place in his Profile.

Any other ASV users seeing very high Flow Limitation spikes once pulling up that graph? If so, while I'll run it by my doc, I do believe that John has it right that they are merely an artifact of the ASV algorithm. If that's so, they should note in parenthesis "(not for ASV)". You'll notice that they inserted parenthetical notes next to several other graph selections in the list of available graphs.

DreamDiver wrote:

JohnBFisher wrote:...

JohnBFisher wrote:I find the Quattro FX mask quite comfortable. I use a mask liner, which helps the seal hold. And when it does not, it tends to not be as loud when it leaks.

I've got a quattro that I've been using the last few nights because my go-to mask seems to be wearing out (large leakage for no visible reason). I have been thinking about trying the Quattro FX. Thanks.

I have a lightly used Quattro FX you can have, DreamDiver, if you can use a size Medium. If so, send me your address. If it doesn't work for you, send it on to Pugsy's box to donate where needed.

DD,

Symptoms related to obstructive sleep apnoea are common in subjects with asthma, chronic bronchitis and rhinitis in a general population
L.-G. LARSSON, A. LINDBERG, K.A. FRANKLIN, B. LUNDBÄCK

Received 8 November 2000; accepted 9 February 2001.

Abstract

The purpose of this study was to examine the prevalence of self-reported snoring, apnoeas and daytime sleepiness in relation to chronic bronchitis, recurrent wheeze, physician-diagnosed asthma and rhinitis.

This was a questionnaire study in a representative sample of a general population. The study was a part of the Obstructive Lung Disease in Northern Sweden Studies (OLIN). A total of 5424 subjects aged 20–69 years, born on the 15th day of each month, participated in the study. Eligible answers were obtained from 4648 subjects (85·7%).

Having snoring as a problem was reported by 10·7%. Among subjects with chronic bronchitis it was reported by 25·9%, with recurrent wheeze by 21·3%, with physician-diagnosed asthma by 17·9%, and with rhinitis by 14·7%. Relatives' concerns of witnessed apnoea was reported by 6·8% of all subjects, while among subjects with chronic bronchitis it was reported by 18·1%, with recurrent wheeze by 17·1%, with physician-diagnosed asthma by 14·3%, and with rhinitis by 9·1%. After correction for age, gender and smoking habits, chronic bronchitis, rhinitis, asthma, and current smoking were significantly related, with snoring as a problem and with relatives' concern of witnessed apnoeas. Symptoms of daytime sleepiness were significantly related with concern of witnessed apnoeas, chronic bronchitis, snoring as a problem, recurrent wheeze and age 50–59 years.

In conclusion, respiratory symptoms and conditions affecting mainly the lower respiratory tract, such as chronic bronchitis and asthma, were related with symptoms common in obstructive sleep apnoea.

Keywords: snoring, sleep apnoea, chronic bronchitis, rhinitis, asthma, epidemiology.

No full text is available. To read the body of this article, please view the PDF online.

f1 Correspondence should be addressed to: Lars-Gunnar Larsson, M.D., Department of Medicine, Division of Respiratory Medicine and Allergy, Sunderby Central Hospital of Norrbotten, SE-971 80 Luleå, Sweden. Fax: +46-920 283350; E-mail: lars-gunnar.larsson@nll.se PII: S0954-6111(01)91054-6

doi:10.1053/rmed.2001.1054

© 2001 Harcourt Publishers Ltd. All rights reserved.

« PreviousNext »Respiratory Medicine
Volume 95, Issue 5 , Pages 423-429, May 2001.

This link does not work:

http://www.resmedjournal.com/article/S0 ... 6/abstract

Check also:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125056/

Also:

Respir Med. 2001 May;95(5):423-9.

Symptoms related to obstructive sleep apnoea are common in subjects with asthma, chronic bronchitis and rhinitis in a general population.

Larsson LG, Lindberg A, Franklin KA, Lundbäck B.

avi123 wrote:The Flow Limitation (FL) graphs that we see in ResScan graphs from ResMed's machines has nothing in common with the Flow graph. While the Flow graph is an analogical respiration value of the flow rate over time, the FL is a symbolic indication bar diagram of the levels of the Flatness of the respiration waves. The machine picks waves at random and assign an out of roundness scale of the top wave shape from a sinusoidal shape. The higher the RERA the UAR and the Flow Limitation, in the upper airway (nose, mouth, throat), the flatter the respiration waves shapes become.

The following is a schematic illustration how it's done:
IMAGE

Just to be whether I'm on the right track: How similar is the partially-obstructed wave to something like asthma or bronchitis?

The Flow Limitation (FL) graphs that we see in ResScan graphs from ResMed's machines has nothing in common with the Flow graph. While the Flow graph is an analogical respiration value of the flow rate over time, the FL is a symbolic bar chart of the levels of the Flatness of the respiration waves. The machine picks waves at random and assign an out of roundness scale of the shape of the top of the wave from a sinusoidal shape. Resmed combines the RERA and the UAR under the Flow Limitation, graph.

The following is a schematic illustration how it's done:

DreamDiver wrote:

JohnBFisher wrote:... DreamDiver, this graph is the waveform graph from a Respironics ASV unit in Encore Basic. That particular graph does not show what is scored as an obstructive or central apnea. I use it only as an example of how much my ASV units must sometimes help me. And in this case, I refute the point from the Resmed Spokesman that with an ASV unit there will be no central apneas. Point is, the apneas can and will occur. But the machine will intervene (as mine did). But the apneas can still occur. It's a different definition. But I think it's an important difference. I think my definition is more realistic with less "sales speak".

Okay, I misunderstood and thought you were saying PR actually does mark CA's, when in fact, like the ResMed equivalent, they've elected to not mark them. Like you, I believe it would be more useful if they would. At the very least they should include shaded area that shows when SV attempts to circumvent an upcoming apnea. ...

No, no. Respironics with the Encore software (including Encore Basic) DOES identify central apneas. This particular graph does not. That's all.

DreamDiver wrote:

JohnBFisher wrote:Yes, you are correct that I was also struggling with a large leak. I ended up changing my mask cushion. But those apneas were not the result of the leak. In my case, I sometimes struggle with horrible sleep. It comes and goes .. but not on any pattern to which I can identify. But when it's bad, the apneas are more like that graph than not.

No doubt. If you find a pattern, I hope you'll share. It's been a while since I've used a PR machine and am trying to catch up my understanding. Thanks. ...

If I find a pattern, I'll be certain to let folks know. I'm starting to think I see one, so I'll try to remember to update everyone.

DreamDiver wrote:

JohnBFisher wrote:I find the Quattro FX mask quite comfortable. I use a mask liner, which helps the seal hold. And when it does not, it tends to not be as loud when it leaks.

I've got a quattro that I've been using the last few nights because my go-to mask seems to be wearing out (large leakage for no visible reason). I have been thinking about trying the Quattro FX. Thanks.

I like the FX much more than I do the Quattro. I had to use the Large FX mask, since my mouth tends to hang open during sleep. The Medium (default size) FX mask would end up in the middle of my mouth, instead of below my mouth. The large FX fits me better. So, you might want to be certain you can return the FX if you get the medium. .. Just an FYI for you.

JohnBFisher wrote:... DreamDiver, this graph is the waveform graph from a Respironics ASV unit in Encore Basic. That particular graph does not show what is scored as an obstructive or central apnea. I use it only as an example of how much my ASV units must sometimes help me. And in this case, I refute the point from the Resmed Spokesman that with an ASV unit there will be no central apneas. Point is, the apneas can and will occur. But the machine will intervene (as mine did). But the apneas can still occur. It's a different definition. But I think it's an important difference. I think my definition is more realistic with less "sales speak".

Okay, I misunderstood and thought you were saying PR actually does mark CA's, when in fact, like the ResMed equivalent, they've elected to not mark them. Like you, I believe it would be more useful if they would. At the very least they should include shaded area that shows when SV attempts to circumvent an upcoming apnea.

JohnBFisher wrote:Yes, you are correct that I was also struggling with a large leak. I ended up changing my mask cushion. But those apneas were not the result of the leak. In my case, I sometimes struggle with horrible sleep. It comes and goes .. but not on any pattern to which I can identify. But when it's bad, the apneas are more like that graph than not.

No doubt. If you find a pattern, I hope you'll share. It's been a while since I've used a PR machine and am trying to catch up my understanding. Thanks.

JohnBFisher wrote:I find the Quattro FX mask quite comfortable. I use a mask liner, which helps the seal hold. And when it does not, it tends to not be as loud when it leaks.

I've got a quattro that I've been using the last few nights because my go-to mask seems to be wearing out (large leakage for no visible reason). I have been thinking about trying the Quattro FX. Thanks.

Papit wrote:

Papit, a couple comments.

First, it would not do any good to call the technical support folks and talk about a SleepyHead graph. Since SleepyHead is open source, it's not something with which Resmed would be able to help you. Further, even with ResScan, I doubt you would be able to get help at the detail with which you are examining your graphs.

Second, I think the "flow limitation" is an artifact of the algorithm used to identify possible limitation of flow and a precursor to snoring.

Rather than worry about the flow limitation graph, the pattern of the flow rate is more informative. In particular we see:


Note the decrescendo that occurs over and over again. You start with a large breath and then the respiratory gradually decreases until to stop breathing. While the ASV unit is doing it's job, this pattern tends to repeat. It is NOT a Cheyne-Stokes Respiration. It appears more as if you respiratory drive just is not what it should be.

Now within that pattern we see some occasional "hiccups" in the flow rate. The software interprets those as flow limitations. I doubt seriously that's what they were. It just appears that respiratory drive was fizzling out a little early, but regained normal downward slope after those 'events'.


Is there something you need to worry about? No. If you were not using an ASV unit, I would worry for you. But your ASV unit helps with the respiration even when you are not able to do so. As long as you are feeling fine, I would not worry too much. If you start to feel horrible, then you will probably need to discuss your situation with your sleep doctor.

Hope that helps.

DreamDiver wrote:

Papit wrote: -Nate and DreamDiver, you put me on the right track with your comments and questions. I can now bring up both Flow and Flow Limitation in the Detailed Graphs.

Me smacking my forehead. "!" I should have remembered the first thing to check is whether or not some graphs are simply omitted from the graphs section. Simple solution.

I can also see both the Flow & Flow Limitation in the Detailed Graphs in my plain vanilla S9 AutoSet.

As some have already said, all you have to do is choose to include them.

So, if you are not now seeing some graphs you hear others refer to, you may have to simply go in & "choose" to see those graphs.

DreamDiver wrote:

JohnBFisher wrote:...
Well, that might be the Resmed Spokesman's definition of no central apnea, but if you have serious enough problems, a central apnea WILL occur. I offer my own example. This was from a PR System One ASV unit, which does not pretend that no central apnea occurs.

IMAGE
Sure, even when I stopped breathing there was some air movement because the unit quickly ramped up the air pressure. But the point is that my body was not responsible for that. I was in the middle of a series of central apneas.

JohnBFisher, I am unfamiliar with some of the stuff I'm seeing on the PR graph you provided. Excluding wave forms, which ticks/markings depict centrals? Also, am I right in seeing that you have large leak all the way through? Is the quattro fx comfortable on the nose bridge for you?

DreamDiver, this graph is the waveform graph from a Respironics ASV unit in Encore Basic. That particular graph does not show what is scored as an obstructive or central apnea. I use it only as an example of how much my ASV units must sometimes help me. And in this case, I refute the point from the Resmed Spokesman that with an ASV unit there will be no central apneas. Point is, the apneas can and will occur. But the machine will intervene (as mine did). But the apneas can still occur. It's a different definition. But I think it's an important difference. I think my definition is more realistic with less "sales speak".

Yes, you are correct that I was also struggling with a large leak. I ended up changing my mask cushion. But those apneas were not the result of the leak. In my case, I sometimes struggle with horrible sleep. It comes and goes .. but not on any pattern to which I can identify. But when it's bad, the apneas are more like that graph than not.

I find the Quattro FX mask quite comfortable. I use a mask liner, which helps the seal hold. And when it does not, it tends to not be as loud when it leaks.

Hope that helps.

DreamDiver wrote:

Papit wrote: -Nate and DreamDiver, you put me on the right track with your comments and questions. I can now bring up both Flow and Flow Limitation in the Detailed Graphs.

Me smacking my forehead. "!" I should have remembered the first thing to check is whether or not some graphs are simply omitted from the graphs section. Simple solution.

Comment,

Is it possible that Papit was not familiar with your "ResScan Video Tutorial"?

ResScan Video Tutorial: http://tinyurl.com/8yf7g7q