Help evaluating flow rate despite cardioballistic artifacts

spacemustard · Post by **spacemustard** » Mon Feb 17, 2025 2:12 pm

Hey Everyone,

I've been using a Resmed Autoset 10 for the last ~5 years and I'm trying to understand if my pressure and EPR are set properly. I have AHI under 1.5 most nights, low leak, and low flagged flow limits. I also have a really pronounced cardioballistic effect. It goes away during parts of REM but otherwise I have bumpy exhales and inhales and find myself unable to understand if pressure or EPR changes are helping or hurting.

Here's an example from last night where I my pressure was set to a flat 10.6 EPR=3 and I was using the Phillips Dreamware Nasal Cushion.

Whole Night

: whole_nightscreenshot-20250217-140636.png (346.22 KiB) Viewed 3926 times

And then here's a zoom to a random part of the night to show what my flow is typically like. Would you say that I should keep raising pressure to see if I can get more sinusoidal inhale flow, or this is plenty and I'm stressing about "M" shaped top deformations that are likely just cardioballistic artifacts?

: zoomscreenshot-20250217-140619.png (313.35 KiB) Viewed 3926 times

ChicagoGranny · Post by **ChicagoGranny** » Mon Feb 17, 2025 2:59 pm

If you feel good during the day, have a reasonable level of energy, no excess sleepiness, and fatigue at bedtime, but are not stressed, you should quit reading charts and continue with life.

Lots of CPAPer would love to have charts like the one you posted.

robysue1 · Post by **robysue1** » Mon Feb 17, 2025 3:50 pm

Want to simply say that I agree with Chicago Granny: If you're feeling good during the day, have a reasonable amount of energy, don't feel excessively sleepy or fatigued during the daytime, then you shouldn't be stressing out about what you're seeing when you try to micro-analyze your charts when they look like the ones you posted do.

spacemustard · Post by **spacemustard** » Mon Feb 17, 2025 6:32 pm

Thank you both. I have high BP and was holding out hope that addressing residual flow limitation would help improve it. I agree that on the whole my CPAP treatment is working well and I’m probably looking for improvement past the point of diminishing returns. I work with data for a living and it has been frustrating to not be able to conclusively read my flow due to the cardioballistic artifacting. I’ll try not to overly fixate on it.

Nocibur · Post by **Nocibur** » Tue Feb 18, 2025 3:22 am

IYAM, that looks more like palatal interference than CBA. You might try looking at known wake or central apneas (before FOT kicks in) and see what the waveform looks like. CBA is most pronounced during end exhalation (Rapaport made on living on this phenomenon).

spacemustard · Post by **spacemustard** » Tue Feb 18, 2025 7:24 am

Hi Nocibur. I’m not familiar with palatal interference. Would palatal interference change how I approach treatment, or it is just something to note but doesn’t impact settings or treatment?

Nocibur · Post by **Nocibur** » Tue Feb 18, 2025 7:39 am

My mantra (one of them anyway) is:

A problem is a problem only if it's a problem.

What you have to do is look over the waveforms and see if the airway disturbances cause arousals or respiratory events and/or desaturations. If you're sleeping w/o interruption then attempts at treatment would be pointless cause there's nothing to treat.

What you should do is look for signs of palatal prolapse. They'll still out by appearing as a sudden and sustained doubling of respiratory rate. There are examples of that around here someplace.

Nocibur · Post by **Nocibur** » Tue Feb 18, 2025 7:41 am

Here ya go:

https://sites.google.com/view/palatal-prolapse/

Nocibur · Post by **Nocibur** » Tue Feb 18, 2025 8:03 am

This is a little more what CBA looks like:

Nocibur · Post by **Nocibur** » Tue Feb 18, 2025 8:06 am

: desktop_36782a93-872a-4f40-ac0e-2c9ebdd6964d.jpg (224.93 KiB) Viewed 3820 times

spacemustard · Post by **spacemustard** » Tue Feb 18, 2025 8:24 am

Thank you, Nocibur. I don't see anything as dramatic as the flow graph at the top of that site you linked. No sudden flatline palate blocks during expiration. Just bumpy inhales and exhales. I have noticed that higher pressure the last few days made my palate sore. Perhaps it's flopping around and with more pressure it flops more and gets sore?

Good mantra. Overall my sleep is decent most nights. Some insomnia and a small number of awakenings with nearly all flagged events during REM. I've discovered that heavy cardio exercise during the day makes it less likely to have arousals out of REM so I've been trying to do that more often but it's a challenge.

I'll go back down on pressure to 9 since 10 is only giving a slight reduction in flow limitations but is leaving me with a sore palate and making it more difficult for me to fall asleep. I was hoping a higher pressure would smooth out my inhales so I can confirm lingering flow limits aren't a problem but if it's palate vibration then higher pressure seems unlikely to help.

Here's a more normal looking night at a flat 9 and EPR=3

: whole_night_screenshot-20250218-081747.png (344.73 KiB) Viewed 3818 times

And a view of what I consider to be average flow for me when sleeping

: zoom_average_screenshot-20250218-082012.png (310.86 KiB) Viewed 3818 times

And then here's some REM where a lot of the bumps tend to go away, at least for parts of REM

: rem_screenshot-20250218-082200.png (308.9 KiB) Viewed 3818 times

spacemustard · Post by **spacemustard** » Tue Feb 25, 2025 7:56 am

This breathing from when I was awake in bed at the start of the night confirms CBA, right? The squiggles when flow is otherwise flat between breaths.

I also see some indents at other points in the flow like the first two inhales in the graph so I guess that could be some kind of floppy soft tissue like my palate or something else in addition to the CBA.

: cardio_ballistic_screenshot-20250225-075152.png (328.67 KiB) Viewed 2590 times

Nocibur · Post by **Nocibur** » Tue Feb 25, 2025 1:33 pm

Yup, great, clear example. Blow it up:

: cardio_ballistic_screenshot-20250225-075152.png (33.07 KiB) Viewed 2549 times

Help evaluating flow rate despite cardioballistic artifacts

Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Re: Help evaluating flow rate despite cardioballistic artifacts

Machine	Mask

Machine	Mask

Machine	Mask

Machine	Mask