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Lorrubdb Therapy Thread: Fine-tuning therapy with Oscar
#41
RE: AHI CA/UA still high, EPR changes
Looks to me like there was a fairly consistent mouth leak pattern, a rather flat, sometimes rounded leading edges look. This was about 28 on the leak chart and I'd like to think this may be enough to hinder therapy feel, at least some. It can hinder PAP accuracy I suppose as you've crossed over ResMed's leak redline of 24. And then this leak may increase arousal or disturbances. There's also some nasty flow limits on occasion too.

OK regardless of this for a minute. Your 2.x AHI session, how did you feel? What was good and bad overall? Not using any data numbers, how did it differ in feel from the prior low AHI night?

An overall goal is to build a several days long string of good comfort trends. There will be days AHI is higher, but 2.x isn't "sky is falling" bad by the numbers. That's an improvement well beyond what Dr. Dolittle's looking for at 5 AHI being treated. For myself when my last PAP gave decent therapy, my good nights were AHI under 3.0. I didn't feel any better at 1 vs 3, nor even a zero AHI was notably better than an AHI of 3 for me.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
#42
RE: AHI CA/UA still high, EPR changes
good catch on the leak dave, I missed that. The big problem here is the Flow Limits.
Note that the UA cluster you highlighted was just 1 cluster. That isn't going to wreck your night unless you want it to. The Flow Limits are spread out enough to possibly have an impact on your overall night.
Test: How do you fight flow limits?
#43
RE: AHI CA/UA still high, EPR changes
Thanks for your reply Dave. I feel best when it's around or under one.. Like yesterday at .16 I had more energy and no breathing disturbance or feeling of not getting enough air like I have if closer to 3 or above. I had a similar improvement of symptoms at 1.38 so seems  when it's over 2 I  feel worse. Even though as you said under 5 is considered okay.

But I don't feel terrible today-like I did when it spiked to 6.8 -just not as good as yesterday, feel more tired with a bit of breathing disturbance. I'm surprised about the leak bc the previous night there was minimal to no leaks with the same mask so not sure what happened. It does feel small around my mouth so maybe I moved around a lot and it slipped off. Maybe will try the medium tonight. So hard to find a mask that works! So regarding nasty flow limits-why since it was good before and what can I do about that? Increase the EPR? Or just continue on with current settings and see how it goes?
Lorie
#44
RE: AHI CA/UA still high, EPR changes
Thanks Gideon- guess I failed the test, how DO I fight flow limits?! All I can think of is increase EPR? 
So you're saying it looks ok despite higher AHI since the flow limits are spread out and the UAs are just one cluster?
#45
RE: AHI CA/UA still high, EPR changes
That's right, increase EPR to manage Flow Limits.
1 or 2 disruptions a night is not going to ruin your night unless you let it.

do this, Write down how you feel before you know anything about what the numbers say. This is just to 'keep you honest' since you need to tweak more on how you feel than what the numbers say. Yes it is a hard change.
#46
RE: AHI CA/UA still high, EPR changes
Ok will do. So how much do I increase EPR each time I have increased flow limits like this-by one or two? Thank you!
#47
RE: AHI CA/UA still high, EPR changes
Your EPR has 3 levels only, so I think you were at 2 recently. You can go up to 3 and see if it helps FL. Gideon is far better at this than I am though, so see what he says. And I agree with answering how you feel before swaying your answer with seeing data. Answer the feel inquiry then look at OSCAR.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
#48
RE: AHI CA/UA still high, EPR changes
set EPR=3
#49
RE: AHI CA/UA still high, EPR changes
Got it. Thanks!
#50
RE: AHI CA/UA still high, EPR changes
Got a good score 1.73, did my feel check first as suggested and felt a little breathless at first, but better after taking a few deep breaths and energy pretty good so matches up!

Think there's something wrong with machine-over an hour is missing right after going to sleep when I know I was using the machine and didn't get up. Will call today, maybe they'll send me a new one? Who knows what happened during that time but assuming/hoping it was ok.

I did increase EPR to 3 and think it helped but still looks like have some high limit flows? 



Thanks Wink  Shy Rolleyes














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