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Can't leave things alone.. Just had to change something.
#1
I haven't made any changes to my settings in 45 days or so. Everything has been looking pretty good. Ahi usually around .5 or less, several times a week zero. The Sleepyhead happyface still intimidates me, so I like it best when I have at least 1 lousy hypop or something. Pressure staying nice --- average around 11 in my range of 9.6 to 14. Leaks ok. Not great, but below the magic line most of the time.

All in all, everything doing fine.

So I decided I should shake things up a little.

The one thing that appears to be a little weirded out (technical term) is my "flow limit." As that is something we've been kicking around here lately, I thought I might like to see what I could do to calm it down some. Now, granted, with emphysema and a "normal" lung fev1 of 23% of normal, I figure my flow limit, or darn near anything else might be a little weirded out. So I don't get too worked up about it. But, like I say, things have been a little quiet lately.

So I increased my "minimum" pressure from 9.6 to 10.6. That's it. Nothing else. What I wanted to accomplish was a slight increase to my average pressures, and I didn't figure increasing the max would do anything. So I increased the minimum. I left the EPR at 2, meaning my exhale pressure would be more like 8.6, not 7.6 as it has been.

Last night was not good............ I couldn't get to sleep, I felt like I was fighting to breath, or exhale, or something.... ---- it was crummy. On a scale of 1 to 10 it was a -4.

At 4:00 am I got up and re-thought everything and increased my EPR to 3. That worked. Now I was back to where I was before I started screwing around. So 4:00 on, sleeping was fine. Just as it has been for the 45 days or so before I decided I had to fool with stuff.

But did I get the desired results? Well, the flow limit looked a little happier after 4:00 am than it was before, and overall last night looked better than the day before.. But I won't really know for a day or two. The average pressure came up to 11.46 from 10.86. AHI still boringly absent. But, I had one hypop, so no happy face on the old Sleepyhead report!

If it aint broke, don't fix it... Good advice.... Sometimes I wish I would take it.

The bigger message is even a small change can make a substantial difference, good or bad. So when Robysue lovingly nags us to just change one thing at a time, and only by a little bit, she's right!

It also suggests that even when we think everything is about as good as it can get, we might be able to carefully adjust things and do a little better. We should not quit 5 minutes before the miracle.

I have attached a copy of last nights stuff just because I can.

Besides, this is my 1,000th post on ApneaBoard. You'd think I'd find something else to do. Like futz with my settings or something.


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#2
I am kind of struggling trying to understand the flow limit deal. Mine seems to peak out at all the way to the top (1.00) around 20 times per night. Is this bad?? My overall numbers are pretty good, AHI from .5 to 2 normally and pretty decent with my leaks........better with the Nuance Pro, but I like the P10 better for comfort. So do you think it's something I need to explore further??

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#3
Retired Guy -- good thing you've never worked on cars that had a carburetor.
It's easy to get way off by adjusting two things at once.

Actually, your graphs look pretty good. You got the one hypo you wished for. Your flow limitation really isn't bad. It's a simple scoring of the inhalation waveform. A rounded waveform scores low; a flat-topped is scored as a flow limitation. The S9 autos will raise pressure as it's a precursor to OSA.

Remember, with "with emphysema and a "normal" lung fev1 of 23% of normal" you are not normal. You may be more sensitive to tweaking the settings.

If it ain't broke, don't fix it. [Image: oops.gif]
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#4
Retired_guy, I'd like to see your pressure graph along with your pressure statistics: min, med, 95th percentile, and max.

Do you feel you are sleeping ok, or do you wake up during the night a lot? The reason I ask is because I wonder if your pressure is too high and it's waking you up either by bothering you or by causing leaks (with of course are also a bother) or both.

I think setting your EPR at 3 is a good idea as it seems to simply make it easier for you to breathe.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
(07-27-2014, 05:22 PM)Buckeyedog Wrote: I am kind of struggling trying to understand the flow limit deal. Mine seems to peak out at all the way to the top (1.00) around 20 times per night. Is this bad?? My overall numbers are pretty good, AHI from .5 to 2 normally and pretty decent with my leaks........better with the Nuance Pro, but I like the P10 better for comfort. So do you think it's something I need to explore further??

It's really hard to say with the little bit of information you've given us. Why do you have the VPAP Adapt instead of a simple CPAP machine?

But since your AHI is low, if you feel like you're not getting a good night's sleep maybe you should discuss the flow limitation with your doctor.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#6
(07-27-2014, 06:24 PM)justMongo Wrote: Retired Guy -- good thing you've never worked on cars that had a carburetor.
It's easy to get way off by adjusting two things at once.

Cars don't have carburetors? How come? They used to. Where'd they go? Next thing you know they won't have brake shoes.....

(07-27-2014, 06:24 PM)justMongo Wrote: Actually, your graphs look pretty good. You got the one hypo you wished for. Your flow limitation really isn't bad. It's a simple scoring of the inhalation waveform. A rounded waveform scores low; a flat-topped is scored as a flow limitation. The S9 autos will raise pressure as it's a precursor to OSA.

Remember, with "with emphysema and a "normal" lung fev1 of 23% of normal" you are not normal. You may be more sensitive to tweaking the settings.

If it ain't broke, don't fix it. [Image: oops.gif]

(07-27-2014, 07:27 PM)Sleepster Wrote: Retired_guy, I'd like to see your pressure graph along with your pressure statistics: min, med, 95th percentile, and max.

Do you feel you are sleeping ok, or do you wake up during the night a lot? The reason I ask is because I wonder if your pressure is too high and it's waking you up either by bothering you or by causing leaks (with of course are also a bother) or both.

I think setting your EPR at 3 is a good idea as it seems to simply make it easier for you to breathe.

Yep, I'm sleeping way good. I usually take a short break once a night, but not always.

Pressure graph attached:
................

Thanks guys!

(Darn... I'm not at "1,000" anymore)
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#7
(07-27-2014, 07:59 PM)retired_guy Wrote: Yep, I'm sleeping way good. I usually take a short break once a night, but not always.

Pressure graph attached:

I think you're in good shape. You must be doing something right. Rolleyes

Tinker away ...
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#8
(07-27-2014, 07:31 PM)Sleepster Wrote:
(07-27-2014, 05:22 PM)Buckeyedog Wrote: I am kind of struggling trying to understand the flow limit deal. Mine seems to peak out at all the way to the top (1.00) around 20 times per night. Is this bad?? My overall numbers are pretty good, AHI from .5 to 2 normally and pretty decent with my leaks........better with the Nuance Pro, but I like the P10 better for comfort. So do you think it's something I need to explore further??

It's really hard to say with the little bit of information you've given us. Why do you have the VPAP Adapt instead of a simple CPAP machine?

But since your AHI is low, if you feel like you're not getting a good night's sleep maybe you should discuss the flow limitation with your doctor.

I'm one of the lucky Central Apnea contestants!!! I feel like I sleep pretty well, but just haven't really "felt" the difference too much. The doc said that sometimes the Central Apnea patients don't feel much different even though the treatment is working. I may have a chat about the flow limitation with her. I'm still trying to get my head around what exactly that means.

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#9
(07-27-2014, 05:22 PM)Buckeyedog Wrote: I am kind of struggling trying to understand the flow limit deal. Mine seems to peak out at all the way to the top (1.00) around 20 times per night. Is this bad?? My overall numbers are pretty good, AHI from .5 to 2 normally and pretty decent with my leaks........better with the Nuance Pro, but I like the P10 better for comfort. So do you think it's something I need to explore further??

Hi Buckeyedog,

I would suspect a higher Min PS setting (like 3 or 4 if that would be higher than the setting your machine is presently using), and/or a higher Max EPAP setting, would lessen the Flow Limitations and would improve the AHI. (Something to discuss with your doctor.)

I suppose you are using an S9 VPAP Adapt REF# 36037, because my older S9 VPAP Adapt REF# 36007 (on which EPAP is fixed, it cannot automatically adjust EPAP within a range) does not report Flow Limitation when using ResScan. (Are you using ResScan?)

What are your machine's settings for:
Min EPAP (can be between 4 to 15)
Max EPAP (can be up to 15)
Min PS (usually at least 3 but can be between 0 to 6)
Max PS (usually at least 10 but can be between 5 to 20, as long as Max EPAP + Max PS is not higher than 25)

What settings were working fairly well on your previous machine? (Before your present ASV machine.)

Take care,
--- Vaughn


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#10
(07-27-2014, 08:50 PM)Buckeyedog Wrote: I may have a chat about the flow limitation with her. I'm still trying to get my head around what exactly that means.

You can google Flow Limitation and find links with illustrations or graphs, like these:

https://www.youtube.com/watch?v=3Ehb7U78P5w

http://www.sciencedirect.com/science/art...1105003744

Take care,
-- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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