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[CPAP] A little advice
#11
RE: A little advice
The flow limitation chart confirms my suspicions and I really want to see you incorporate EPR into the therapy. All the comments by DeepBreathing are spot on.
Sleeprider
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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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#12
RE: A little advice
Thanks so much for the response.  I will post updated graphs when the EPR is on full time in the data.
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#13
RE: A little advice
[attachment=6398][attachment=6399][attachment=6399][attachment=6400][attachment=6399]

Many thanks to the Forum members for the great advice.  At your suggestions, I have altered pressure to 16/20 with an EPR of 2 full time and appear to be getting good results.  The attached files show what is generally a typical night and although I feel OK, I would very much appreciate the experts of the forum commenting if they see room for improvement.  As stated earlier, my AHI in my sleep test in February was 81.  My concern is the Flow Limitation.  I'm not sure what I am looking at and if it is satisfactory or not.  Once again, many thanks for your help. (sorry about the duplicated charts)
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#14
RE: A little advice
Looks pretty good by the AHI numbers, but you have some really odd things happening for a large block of the session from 03:00 to 06:00. In this period your respiration rate is variable between 12 and 33 BPM, flow limits are on the high side, and we see a generally shorter expiratory time and higher inspiratory time.  All of this is mainly seen in the lower tidal volume and higher resp rate during that time.  Do I have a clue why?  Nope!

I think you can take your EPR to 3 to try to deal with the flow limitation and hypopnea, and hopefully some of that respiratory weirdness will diminish.  So while your AHI looks great, I'm not so sure that you are comfortable until we address that loss of tidal volume and increase in resp rate.  If you have any idea what was going on from 3:00 to 6:00, I'd be interested. To me it looks like an increase in upper airway restriction.
Sleeprider
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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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#15
RE: A little advice
Thanks Sleeprider for your expert response. 12 years ago I had successful open heart surgery but contracted pneumonia while in hospital.  I was given a gizmo called an incentive spirometer (I think) to exercise and increase my lung capacity.  When I was discharged from hospital I unfortunately abandoned my lung capacity exercises.  My better half who sleeps with me again now that I don't snore anymore, says that before CPAP therapy I was always a shallow breather when asleep, never seeming to fill my lungs.  Perhaps this may have something to do with the "respiratory weirdness" that appears on my Sleepyhead charts.  Perhaps I may have to drag the spirometer gizmo out and dust it off.  Tonight, at your suggestion, I will increase the EPR to 3, but overall I am happy with my results.  Your thoughts are much appreciated.
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#16
RE: A little advice
You seem to be adequately ventilated with tidal volume at 500 mL. Not bad. The EPR can make inhaling seem easier because the inhale pressure is higher than exhale pressure. I don't think you need a bilevel, but this might make your sleep more comfortable and should help with the hypopnea which accounts for most of your events. No worries.
Sleeprider
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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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#17
RE: A little advice
[attachment=6443][attachment=6444][attachment=6445]

Thank you Sleeprider and other forum advisors.  At your suggestions for some minor adjustments including setting my EPR to 3 full time, I have achieved my best ever result after nearly 4 months of CPAP therapy.  Had an extremely peaceful sleep with results showing it.  Early days, but I hope I can keep it up.  Thanks again.
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#18
RE: A little advice
Looks good!
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#19
RE: A little advice
Your addition of EPR improved most of the problems I pointed out before. There is only a brief period from midnight for about 1/2 hour where your resp rate increases and tidal volume decreases, and the degree of that is much lower. These are fantastic results, and in your case, this would only be possible with a bilevel machine or the Airsense 10 Autoset. With a Philips you would be plagued with intractable hypopnea, flow limitation and other events. I mention this because if you ever change machine, you NEED a machine with bilevel capability, even if that is limited to 3-cm of pressure support. Don't let anyone ever dispense something less.
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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#20
RE: A little advice
Thanks for the great advise Sleeprider. Last night was another good night with similar results.  My health insurance here in Australia gives me the choice of any machine and pays the first $600.  I shouldn’t be needing a new machine in the short term but will remember your advise. Thanks again.
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