Could you please review ?

[koy23]

No read the article

Sorry I didn't see you sent me that article، that is awesome work! I'll study it and apply it in the 2 nights!
Thanks so much Fred, and good night!

[sleepyzzz]

She is much better now, the initial night was issue filled including a direct to bed in a critical care unit to monitor airway and admin steroids to shrink swelling from the surgery.

You have some flow limits, sufficient that you are reacting to it.  I suggest trying a series of experiments, each one should be at least 5 days long, 7 would be great.  1 night does not make a trend.  These are designed to conquer your flow limits, and as such any RERAs you may have.

current - Test 1
Mode: VAuto
Min EPAP: 4
Max IPAP 5
PS: 1

Test 2
Mode: VAuto
Min EPAP: 4
Max IPAP 6
PS: 2

Test 3
Mode: VAuto
Min EPAP: 4
Max IPAP 7
PS: 3

Test 4
Mode: VAuto
Min EPAP: 4
Max IPAP 8
PS: 4

Take notes on each of these, The one to use in the end, I won't be able to say because it will be determined by how you feel.

hi Fred,

following the experiment, on test 1 saw an OA, on  test 2 saw couple of OA and like 5 hypopnias. should i just continue the test as is or increase EPAP to 5 for the rest of tests ?
my sleep in test 2 was little better than one for the first half of the night, but i saw so many more flow limitations. 

I'll continue to experiment i just wanted to know if i should put base EPAP to 5 instead and then keep testing with increasing PS.

[Gideon]

The duration of each test is intended to give you enough time to ensure that you know how you feel without having 1 bad night spoil the result, also to give you time to adjust to the different settings.  If you feel that you have met that criteria, move on.

regarding RERAs you need to manually count them because your machine will not.

[koy23]

The duration of each test is intended to give you enough time to ensure that you know how you feel without having 1 bad night spoil the result, also to give you time to adjust to the different settings.  If you feel that you have met that criteria, move on.

regarding RERAs you need to manually count them because your machine will not.

I'm not rushing, I'll take the time , I only mentioned the EPAP because there was OA and Hypopnea in each night, (3 nights) I understand that EPAP is responsible for OA and hypopnea  so i wanted to take your opinion if I should set it to 5 and continue the rest of the expirement with same numbers you wrote but with EPAP 5 instead or you think I should just leave it to 4 as it was ?

[Gideon]

You are talking about a very small handful of events which means small AHI changes.  I do not like changing settings to adjust settings without seeing a chart.

Fred

[koy23]

You are talking about a very small handful of events which means small AHI changes.  I do not like changing settings to adjust settings without seeing a chart.

Fred

Ok I'll keep it the same for tonight as well, and report with charts tomorrow. 

Thank you

[sleepyzzz]

UPDATE:
i visited a different ENT today, he put the camera down my throat and he saw my vocal cords closing 8 times out of 10 he said.
he called it vocal cord dysfunction and i asked him does it happen when i sleep, he said he does not know, maybe.
searching online, other than normal cases that happen to female athletes mostly, the larynx could become hypersensitive from GERD(i have), LPR(i have) and rhinitis(i have).
this is a picture of how my vocal cords can close my trachea :


it still seems that i need the bilevel to breath at night, but if the reason why i am having sometimes flow limitations and sometimes no, all that is because my vocal cords are closing. the question is how can optimize my machine settings in this new light?
for FRED, do i still follow that experiment? would you modify anything ?
thank you

[Gideon]

The experiment is based on you finding comfort to help with your sleep. Your numbers are and were excellent. The intent is still sound. I don't think CPAP in any of its flavors may be able to help your vocal cords. I'll have to think and research.

What did your ENT suggest?

[sleepyzzz]

The experiment is based on you finding comfort to help with your sleep.  Your numbers are and were excellent.  The intent is still sound.  I don't think CPAP in any of its flavors may be able to help your vocal cords.  I'll have to think and research.

What did your ENT suggest?

The experiment is based on you finding comfort to help with your sleep.  Your numbers are and were excellent.  The intent is still sound.  I don't think CPAP in any of its flavors may be able to help your vocal cords.  I'll have to think and research.

What did your ENT suggest?

He suggested to see a speech therapist for breathing exercises which I'm try to find.

The missing link is he said this dysfunction of the vocal cords closing the trachea happens usually in day/awake time. He doesn't know why I have it when I sleep .
I also have the sleep study that showed I had 17 AHI, and 6 RERA/hr 

Also sleeping without a CPAP at all, prevent from even falling asleep, while using it let me stay asleep except for the RERAs that keep happening, that is why I said I know I still need CPAP to sleep.