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[CPAP] how to reduce leaks, full face mask
#41
RE: how to reduce leaks, full face mask
It's within reasonable parameters. How did the therapy and the day after feel? Any improvements you'd want addressed? The CA are elevated a small bit but it's a big improvement over your last OSCAR shot.
Dave

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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.
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#42
RE: how to reduce leaks, full face mask
I don't understand what is causing the wide fluctuation in respiration rate in the first half of the night. The second-half looks better, but I suspect we are looking at an uneven respiration, not a real change in respiration rate. I'd like to see a 3 -minute zoom during a period of higher and fluctuating respiration rate and one where things look calmer. Would you be interested in trying fixed pressure? It might help us to narrow in on your optimum therapy pressure, and reduce disruptions.
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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#43
RE: how to reduce leaks, full face mask
(03-10-2021, 10:32 PM)SarcasticDave94 Wrote: It's within reasonable parameters. How did the therapy and the day after feel? Any improvements you'd want addressed? The CA are elevated a small bit but it's a big improvement over your last OSCAR shot.

Therapy felt fine, and felt good the day after. I feel like I'm close, not sure if I can get things much better, but would like to try to minimize leaks and get AHI as close to 0 as possible.


(03-11-2021, 08:10 AM)Sleeprider Wrote: I don't understand what is causing the wide fluctuation in respiration rate in the first half of the night. The second-half looks better, but I suspect we are looking at an uneven respiration, not a real change in respiration rate.  I'd like to see a 3 -minute zoom during a period of higher and fluctuating respiration rate and one where things look calmer.  Would you be interested in trying fixed pressure? It might help us to narrow in on your optimum therapy pressure, and reduce disruptions.

Attaching screenshots; first is high and fluctuating, second is low and steady. I'll try fixed pressure tonight or tomorrow night, maybe 9 or 10?

   
   
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#44
RE: how to reduce leaks, full face mask
Both are severely flow-limited and would benefit from pressure support to smooth out and increase tidal volume, however you have enough CA events, that more pressure support may be a problem. I don't know the root cause of the erratic respiratory wave, but I have seen similar respiration respond to pressure support by ST and ASV machines. Both images are actually close to 14 bpm, but the machine does not know how to properly detect the trigger to inspiration and cycle to expiration in the first chart. If you look at the mask pressure for the Airsense 10, you will see that the mask pressure flow mirrors the respiratory flow rate, so it does not really support this respiration, it just follows along and flails, thus higher EPR won't be much help. This is an example of respiration that can benefit from relatively high pressure support that has the time of inspiration set to at least 0.8 seconds, and in your case probably more like 1.6 seconds to provide inspiratory support throughout inspiration before cycling to EPAP, or a modality that can target tidal volume. The Resmed Aircurve 10 Vauto can be set to a minimum inspiration time like this, but if it increases CA events, then the move would be to ST-A or ASV with inspiratory timing controls or a tidal volume target. The Resmed ASV does not have that feature, but the Philips AVAPS and SV do, as well as the Resmed ST-A.

Are you aware of any dysfunction that affects you like this in daytime, or is this strictly a sleep event? I think if you were to pursue a medical opinion on this issue, a sleep specialist is NOT going to be helpful. This is a pulmonology matter, and sleep doctors are not wired to understand that complexity. The odd wavering flow has been present since the beginning of this thread and we have speculated about pressure support or EPR, leg movement and other possibilities. You seemed to do better with EPR at 3 for a while until CA events increased. I don't even know if what we are looking at is a problem. How do you feel?
Sleeprider
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____________________________________________
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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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#45
RE: how to reduce leaks, full face mask
(03-10-2021, 10:32 PM)SarcasticDave94 Wrote: It's within reasonable parameters. How did the therapy and the day after feel? Any improvements you'd want addressed? The CA are elevated a small bit but it's a big improvement over your last OSCAR shot.

(03-12-2021, 08:48 AM)Sleeprider Wrote: Both are severely flow-limited and would benefit from pressure support to smooth out and increase tidal volume,  however you have enough CA events, that more pressure support may be a problem.  I don't know the root cause of the erratic respiratory wave, but I have seen similar respiration respond to pressure support by ST and ASV machines. Both images are actually close to 14 bpm, but the machine does not know how to properly detect the trigger to inspiration and cycle to expiration in the first chart.  If you look at the mask pressure for the Airsense 10, you will see that the mask pressure flow mirrors the respiratory flow rate, so it does not really support this respiration, it just follows along and flails, thus higher EPR won't be much help.  This is an example of respiration that can benefit from relatively high pressure support that has the time of inspiration set to at least 0.8 seconds, and in your case probably more like 1.6 seconds to provide inspiratory support throughout inspiration before cycling to EPAP, or a modality that can target tidal volume. The Resmed Aircurve 10 Vauto can be set to a minimum inspiration time like this, but if it increases CA events, then the move would be to ST-A or ASV with inspiratory timing controls or a tidal volume target.  The Resmed ASV does not have that feature, but the Philips AVAPS and SV do, as well as the Resmed ST-A.

Are you aware of any dysfunction that affects you like this in daytime, or is this strictly a sleep event?  I think if you were to pursue a medical opinion on this issue, a sleep specialist is NOT going to be helpful. This is a pulmonology matter, and sleep doctors are not wired to understand that complexity.  The odd wavering flow has been present since the beginning of this thread and we have speculated about pressure support or EPR, leg movement and other possibilities.   You seemed to do better with EPR at 3 for a while until CA events increased.  I don't even know if what we are looking at is a problem. How do you feel?

Thanks for the detailed reply! I haven't been experiencing any dysfunction in the daytime; I feel generally good, sometimes a bit low energy, but not significantly.
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#46
RE: how to reduce leaks, full face mask
I am starting to accept that your high respiration rate and wonky inspiratory flow is a Class 3 inspiratory flow limitation, and likely results from instability in the airway that causes a tissue vibration or in other words, during inspiration turns flow off an on. This could be nasal or in the throat, but flow is on and off at a fairly high frequency. I don't know the solution yet, but you're not alone. This thread is dealing with the same problem http://www.apneaboard.com/forums/Thread-...atory-rate

Who knows, maybe we are onto the beginning of a new research project.
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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