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About flow limitations not solved with CPAP and waveforms on OSCAR
#1
About flow limitations not solved with CPAP and waveforms on OSCAR
Hello!

It has past so much time since I made my first post (I'm the same guy that posted this http://www.apneaboard.com/forums/Thread-...for-advice). I did not reply anymore there because didn't want to revive an old post.

Having said that, the first thing I did was saving up for getting an Resmed S9 machine as Bonjour told me to do. Once I got the machine, I tried a lot of settings, getting great numbers that I had not had before. I still felt every single day as if I was crushed by a truck. But I noticed a curious thing. It seems that I'm having some kind of limitation that is not relief by the CPAP, and no matter how I set it up, I always see the same weird waveform everyday (which is not something I have seen before too much), and it sometimes is flagged as a hypopnea, sometimes it is not (and believe me, the waveform is like that the whole night unless I'm awake due to the arousal):

[Image: THttdlW.png?2]
[Image: 1Gagx2T.png?1]

I have tried several settings, including: 

CPAP mode
Spontaneous Timed mode (ST) with different Pressure Support of 4 / 5 / 6 / 12 (IPAP minus EPAP) at different pressures, as low as high, and everything is the same. But when I switched to only Spontaneous mode, (S), (which works by myself triggering the IPAP and EPAP with my own breathe patterns), my AHI soared to 10.63 AHI! with the same pattern as always, with a little change in the length of the waveform (worst night):

[Image: FzJJItr.png?1]

I have read some stuff about obstructions that can't be treated with CPAP as a floppy epiglottis or a palatal prolapse, for example this post http://www. [[ Auto Word Filter: links to DME-owned sites not allowed ]] .com/viewtopic/t171982/Mystery-solved-ever-heard-of-quotpalatal-prolapsequot-new-article.html, but I'm not sure if one of those was my case. I have an appointment with a new ENT, do you consider wise asking for a DISE based on this "evidence"? I'm a little afraid that they reject my petition due to a "lack" of evidence since they only consider AHI and oxygen drops to start treatment, and are unaware about UARS and SDB that is not the typical sleep apnea.

If you also need more data, please let me know. Thank you!
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#2
RE: About flow limitations not solved with CPAP and waveforms on OSCAR
The type of flow limitation you are experiencing is probably related to your reliance on the machine for inspiration trigger, in other words, you appear to breathe on the timed inspiration of the ST machine. The UA events when set to S mode are likely central apnea. We really didn't get a good idea of your therapy or sleep study results from your previous thread, and the images in this post lack the statistical information of the left column because of the small size and monthly calendar (please minimize by clicking the triangle in the date line).

Your ST provides fixed pressure, and my impression is that you should be on ASV. I want to see more data before drawing any firm conclusions. These zoomed views definitely show flow limitation, but that is common where an individual relies on pressure support for the breath. I really want to see the remaining respiratory data.
Sleeprider
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#3
RE: About flow limitations not solved with CPAP and waveforms on OSCAR
I wish the FL was due to it, but I have also tried CPAP mode, S, ST... nothing worked Sad and I do not think it's central apnea, because on CPAP mode, I never got CA. All the waveforms look kinda the same. I forgot to mention that some of my family say that I seem to be breathing weird as if I got something stuck on my throat (they even recorded it for me when I was asleep. LOL). I'm uploading the rest of the data. Also I could try to upload the data files from OSCAR if you want me to. I must say that it seems not so compatible with my machine. It always shows incorrect modes (it shows VPAP S/T while I'm using it only on S mode, or CPAP mode... etc). But the rest is okay, I believe. Same data from ResScan  Grin Grin Grin 

[Image: 7QGevXM.png?1]
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#4
RE: About flow limitations not solved with CPAP and waveforms on OSCAR
You are using very high pressure support that CPAP cannot match. This can induce CA events and you end up breathing on the backup rate of the ST. It appears you have the backup set at 12 BPM. In the image above, PS is 8.0 which is sufficient to do the work of respiration on each breath. I think this may be a case of self-treatment without appropriate professional guidance. You should consult your doctor regarding your diagnosis and positive air pressure needs. The ST machine is not intended for the purposes you are using it, and your use of very high pressure support and a backup rate without an appropriate diagnosis and titration has me at a loss to support this. My advise is to start over with an appropriate machine or CPAP mode, and work through some titration protocols. I would be a lot more comfortable working with a VPAP S or Vauto, both of which offer Easybreathe™ which smooths out the pressure support.
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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#5
RE: About flow limitations not solved with CPAP and waveforms on OSCAR
Mentioned before I was using it on CPAP and also S mode, which is for non compliant patients if I recall good (also ST a few times to obligate myself not to have expirations for more than 3.5-4 sec, but not always). What I believe is that CPAP won't work for my type of obstructions, so I will have to convince the doc for a DISE. Thanks a lot for the help though!
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