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AHIs Good, Waveforms? Not So Much
#11
RE: AHIs Good, Waveforms? Not So Much
Turned off EPR last night. The machine settings show it was on, probably because I turned it back on about 2:45 this morning. Having EPR off did limit the central flags, but really brought out Hypopneas, RERAs and Flow Limits. Pressure was also substantially higher for that session.

All in all, that was a very unpleasant experience, one I don't want to go through again.

Here are a couple screen shots. Let me know if you want anything else.

Larry


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#12
RE: AHIs Good, Waveforms? Not So Much
Please Lofty,  why was it an unpleasant experience? Specifically what was bad?

Because of the flow limits your pressure will climb to the max value that is set.

Without EPR/PS we need to increase your pressure to see if we can treat your apnea.

Your apnea calls for the use of EPR or Pressure Support to best treat it, so the detailed answers to the above questions is very important.

Something to try that I don't think will work is to try a soft cervical collar and see if that helps.  I do not see the patterns in your charts that we see when a collar is normally suggested.  This is just an attempt to see if this helps.

A BiLevel has some additional controls that can be utilized but let's see if we can understand what your difficulty is.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#13
RE: AHIs Good, Waveforms? Not So Much
Hi bonjour,

Exhaling without EPR was difficult for me. It seemed like I was having to work really hard to sleep. Also, the higher pressures were causing more leaks, both around the mask and into my mouth. I'm currently using a ResMed F30 full face mask, but almost exclusively breathe through my nose. I can keep my tongue up against the roof of my mouth, but once the pressure gets above 15 or so air leaks into my mouth and I get chipmunk cheeks, which wakes me up. My sleep doc says I have a short palette, whatever that means. I can keep air out of my mouth at pressures up to about 15.

I've tried the N30i and the Respironics Dreamwear nasal masks. I don't have a problem usually with lip seal. When my cheeks inflate I wake up.

If you think I should try 20 cm H2O max pressure I'll give it a shot though. It's only one more night. Smile Exhaling with pressure support is a lot easier though.

Let me know if there are any other screen caps you want.

Thanks,

Larry
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#14
RE: AHIs Good, Waveforms? Not So Much
Bring EPR back in, I would suggest EPR =3 Full Time. Then back off pressure. The use of EPR should help you to hold a higher pressure without the chipmunk cheeks. We need to get it down at least to where that doesn't happen.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#15
RE: AHIs Good, Waveforms? Not So Much
Fred we suggested EPR off due to CA’s I would not recommend going back to EPR 3 maybe set epr at 1
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#16
RE: AHIs Good, Waveforms? Not So Much
I'll post 1 more screen cap from last night, which, in my mind, shows that what we're doing is changing waveforms just enough to keep software from flagging events.

To me this looks very "Stokesish". Probably not something that would be scored on a polysomnogram, but really is a manifestation of the same underlying process, whether it's called pattern breathing, Cheyne Stokes, or high loop gain breathing. But all I've ever dealt with is my own situation, and I don't know much yet. Smile

Thanks for looking, and let me know what to try next. 

Larry


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#17
RE: AHIs Good, Waveforms? Not So Much
Then use EPR= 1

looking back I see that you are seeing wide fluctuations in CA over time. That is fairly common.

If you post a copy of your overview it will give us an idea of how much fluctuation you are having.
Some of the detailed flows you posted indicated that your centrals maybe CO2 based. If so, there is a technique called EERS with which you rebreathe a small amount of CO2 to help minimize the centrals and allow a higher EPR/PS to manage your flow limits and RERAs
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
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#18
RE: AHIs Good, Waveforms? Not So Much
Here're the overview screen caps.

Thanks,

Larry


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#19
RE: AHIs Good, Waveforms? Not So Much
Thanks jaswilliams and bonjour.

I'll look into picking up pieces/parts to put an EERS together. Best case, I'll probably need a machine with better pressure support if I want to tackle flow limits.
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#20
RE: AHIs Good, Waveforms? Not So Much
It would seem that with the current machine, it's a balancing act to address events without inducing CA. Best case is we find the right combo of settings that reduce all events, especially those you would tell us are most disruptive to your rest. Note that CA has a consistent inconsistency quality to them. That's why I like to see trends. Example: Today you may think CA are effectively treated, but tomorrow there they are again.

Eventually, I see you headed to a VAuto or maybe the ASV due to CA and other events. I think you'll probably be better served with PS, but as is EPR is effective if we can find the right setting balance.
Dave

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