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18 mths of apap: need help optimizing settings to feel better [ASV]
RE: 18 mths of apap: need help optimizing settings to feel better
(10-12-2019, 04:24 PM)sheepless Wrote: at risk of overkill, here is another example of why I think plm is the source of most of my fragmentation and sleepiness (as opposed to uars, I guess)....it may occur this relationships, indeed, including in so many pacients mentioned by Dr. Barry Krakow, that is, it may happens once you treat properly PLMS sleep stabilizes (Barry Krakow's book).
However, the point I have been made is: why not treat FL, before everything, as this is quite simple thing to get with BPAP?

A curiosity: what would be the reason of increased pressures during PLMS kicks?

Good luck.
 
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RE: 18 mths of apap: need help optimizing settings to feel better
I think I've addressed these questions above and elsewhere; apologies if this is repetitive.

"However, the point I have been made is: why not treat FL, before everything, as this is quite simple thing to get with BPAP?"

mostly because I don't have easy access to a bpap to experiment with. meanwhile, asv has bilevel capabilities so I'm assuming rightly or wrongly that adjusting min ps for flow limitations on asv is more or less the same as adjusting min ps on vauto. in addition, asv treats my mixed apnea whereas vauto isn't designed to address centrals.

secondly, plm appears to me to be a much more prominent feature of my flows than flow limitations. in fact, much of my flow limitation is directly caused by plm, occurring in most breaths between jerks. I'm of the mind that plm causes the flow limitations, not the other way around. I'm also suspicious that cpap pressure is even capable of overcoming flow limitations created by my forceful (often verbal) response to plm. therefore, I contend I'll get more bang for the effort by reducing plm first.

"A curiosity: what would be the reason of increased pressures during PLMS kicks?"

others will correct me to say how it's a function of tidal volume. I'm not tuned in enough to tidal volume to know one way or another. what I do see is ps rising in response to both sharp inhales and flow limitations. it rises and falls with every kick-sharp inhale-groan-flow limited breaths (as a single event). again, it's my contention that the flow limited breaths following a kick and sharp inhale are too forcibly limited to be successfully treated by cpap and that the only way to stop those flow limited breaths is to stop the plm. because of this, leaving max ps uncapped leads to scores of swings up to 25cmw with no hope of resolving the flow limited breaths before the next kick, contributing to leaks and aerophagia. that's why I've tended to keep my max ps at 9 or 12cmw. I agree the swings are probably disturbing even if I'm not aware of them and believe that stopping plm will stop the ps swings.

I do have flat ragged topped flow limited inspirations unrelated to plm throughout each night. these appear much less significant to me and much less disturbing than plm. my thinking is to reevaluate them after getting plm under control. proof in my mind is the success I had in first week or so with ripinirol reducing plm and significantly improving fragmentation, but unfortunately the benefit at my current dosage is fading fast. I'll have to get increased dosage prescribed or try a different med.

thanks for your continuing interest mper (and others). I look forward to reading more about your methods and progress in your current thread as well.

edit: possible correction; reading another thread I see reference to minute ventilation. I referred to tidal volume at top of this post when maybe I should have said minute vent, IDK either way.
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RE: 18 mths of apap: need help optimizing settings to feel better
fyi.  I have been concerned that the effect of ripinirol for periodic limb movement has been waning and it has.  however, I forgot to take it last night.  the result was hours of plm, increased fragmentation and increased pressure.  pressure was 1-2cm higher than usual. tidal volume leaped from a rough average of 480 - 500 to 640. respiration was lower, minute ventilation higher.  even had an entry in the 95% column for flow limitations. in addition to the obvious mask off events, there were several to many other awakenings that I masked through.

this screenshot is a good indication of a) plm causing fragmentation; and b) how max pressure support ineffectively responds to inhale spikes and flow limitations caused by plm, the higher pressure itself a potential source of arousals, leaks and aerophagia.

edit: I referred to obvious mask off events but failed to provide a pic which I'm adding to this post.
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RE: 18 mths of apap: need help optimizing settings to feel better
HI, sheepless
That was no good at all....
….I would love to see your RR and TV curves; they look essential for me; I am pretty much unarmed without them….
…. But, you know, likely you keep on not agreeing, and I am going to stay at same bottom: (a) it looks would be able to sleep through your PLMS, like thousand people, including myself; (b) your main problem would be UARS, rather than PLMS; © you would be on the wrong machine; ASV as opposed to BPAP. ASV would be responding, increasing pressure, when you hold breath during PLMS; this is crazy!
Let us see more details on RR and TV.

Good luck.
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RE: 18 mths of apap: need help optimizing settings to feel better [ASV]
The posts dealing with Vauto, PLM, FL & Mixed Apnea  have been split off into their own thread, here:

http://www.apneaboard.com/forums/Thread-...ixed-Apnea
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RE: 18 mths of apap: need help optimizing settings to feel better [ASV]
(11-12-2019, 10:23 PM)SuperSleeper Wrote: The posts dealing with Vauto, PLM, FL & Mixed Apnea  have been split off into their own thread, here:

http://www.apneaboard.com/forums/Thread-...ixed-Apnea

Those guys are getting really deep in the weeds and I quit following a while ago, when mper and will were hatching homegrown theories and spreadsheet scattergram analyses.  Hopefully someone can give me the Cliff Notes version when they work it out.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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