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AHIs Good, Waveforms? Not So Much
#31
RE: AHIs Good, Waveforms? Not So Much
The EERS provides a measurable expiratory rebreathing volume only when the mask does not vent, and an adequate vent like the Whisper Swivel Vent is place a known volume from the mask. If the vent on the top of the N30i is capable of fully venting all expired air without allowing bypass into the CPAP tube, then that can serve as the EERS vent. The problem is, we don't know how venting is divided between the two vent points on that mask. We are looking for a vent rate of about 25 to 30 L/min at the EERS vent.
Sleeprider
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#32
RE: AHIs Good, Waveforms? Not So Much
That vent rate is important for the proper and safe functioning on an EERS system. I understand your logic but we do not know the physics of those vents. We can put a known vent there and then add a couple of 6 inch hose segments if indicated/needed.

Please refresh and verify your knowledge of any and all cardiac and breathing disorders you may have. The indicated CSR is like classic CSR but without the CA event between each cluster.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#33
RE: AHIs Good, Waveforms? Not So Much
Thanks sleeprider and bonjour. I've taken EERS off the table for now.

Known heart problems:
Moderate to severe aortic stenosis.
Trivial mitral valve leak.
Mild tricuspid valve leak.
45 to 50% ejection fraction.
Lung pressures 40 to 45.

No breathing disorders. No CHF.

Larry
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#34
RE: AHIs Good, Waveforms? Not So Much
2 nights of Cheyne Stokes in a row.


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#35
RE: AHIs Good, Waveforms? Not So Much
Generally central apnea and periodic breathing will respond to ASV, however there are two complications that can help reduce it with your CPAP. First, central apnea responds well to more stable pressure. A reduced range that reduces obstructive events to an acceptable level, without going so high as to increase CA events is far better. A pressure range of 10 to 13 appears sufficient to satisfy most of your obstructive needs. Secondly, CA is increased with higher EPR or pressure support. You have flow limitations and EPR is your friend in taming those, but can increase the CA events. I'd like to see you reduce EPR to 2.

Finally, you have fairly high leak rates, and we have seen the machines are much more likely to identify events, and your respiration is more likely to be unstable in the presence of leaks. We have seen this frequently, and finding a solution to leaks, often resolves the events without further changes. I hope you will continue to work hard to find a solution to the leaks. The use of liners like REMzzz or just getting a new model or size of mask be be what it takes.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#36
RE: AHIs Good, Waveforms? Not So Much
Hi Sleeprider,

I'll start with leaks. When I use my ResMed F30 mask I have almost no leaks, as seen in posts 1, 4, 11. However, flow limits and pressures are generally a lot higher, which is why I'm currently set at 9 and 17. In post 11 I turned EPR off, and flow limits really increased. It was also an unpleasant night. 

I switched back to the ResMed N30i as part of my ill-fated EERS experiment, and noticed generally reduced flow limits as well as pressures, which is why I've stuck with it the last 2 nights. I think I'm getting better at controlling leaks, so I think I'll fight it out with that for a bit longer. Hopefully leaks will improve, but if not I'll switch back to the F30 or the F30i I have ordered.

I did have central apneas and unquantified Cheyne Stokes breathing on my initial polysomnogram.

So for tonight I will try pressures of 10 and 13, with EPR set to 2 as you suggested, and work with the N30i at least for 1 more night.

Thanks very much for your help. I really appreciate it.

Larry
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#37
RE: AHIs Good, Waveforms? Not So Much
Last night's caps with EPR at 2, Min pressure 10, Max pressure 13.


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