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[Diagnosis] Clear airway questions
#31
RE: Clear airway questions
for me, easing of my acid reflux was the most noticable benefit to starting cpap. I was still a long way from recovered from other apnea effects, but within weeks I stopped taking prescribed meds, over the counter & home remedies for heartburn. I probably learned to avoid some foods during the worst of it as well, but there's no question in my mind cpap 'fixed' my gerd.
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#32
RE: Clear airway questions
(03-18-2020, 10:56 PM)mratliffe Wrote: thanks again to everyone helping with posts.....

to Sleep rider I have two questions -

1.  Do the spikes in flow rate or respiratory rate indicate an arousal?
2.  What do tidal volume and minute vent mean?    at what numbers are we shooting for....

I am sorry, I know this is elementary for you guys, just trying to wade my way through it all....


I would like to mention again that I wear a Tap 2 oral device with CPAP, have been for eight year...

I will do my best to answer, however much of the cause and effect of the change I recommended is speculative.  You started with CPAP therapy at 20 cm.  Your chart indicated a tidal volume of 340 mL/breath and a minute vent of 9.25 L/min based on an astonishing 26.8 breaths per minute.  In my view, this showed very shallow, rapid breathing that was likely related to high pressure and inability to complete expiration efficiently. 

I recommended that you lower pressure to 18/14 in bilevel.  The idea was to first see if we could reduce the respiratory rate and increase volume, and second to see if you would experience more or fewer apnea events, particularly central.  Your results quickly showed an immediate stabilization of the respiration rate which settled at a median of 18.8 BPM with an improved tidal volume of 560 mL/breath and minute vent maintained at 10.3 L/min.   Subsequently, I have suggested a more significant reduction in pressure, while maintaining the 4-cm pressure support, and we will see what that brings.  I don't have a "target" in mind for your tidal volume or minute vent", but rather I want to see a normal and relaxed respiration rate and an indication of respiratory efficiency.  We are getting close.

The spikes in respiratory flow rate are reflected in the mask pressure chart, momentary increase in respiration rate, and in some cases, a leak spike.  This suggests a change in physical position or physical movement. There may be arousal, but this kind of movement is not abnormal, and is not preceded by a reduction in airflow, flow limitation or other indicators of respiratory effort related arousal.  At this time, we are trying to identify your MINIMUM threshold of effective treatment pressure to ease the disruption to your sleep and improve your comfort.  Your subjective feedback on how you feel will help us to get there.

The use of your TAP device may not be necessary, and once we stabilize your therapy settings, I would like to work with you to remove it. Mandibular advancement can be uncomfortable, alter your normal bite, and have other adverse side-effects.  It is used to prevent obstruction at the back of the throat that results form the same physical positioning of your head and neck that we have resolved in many cases by using a soft cervical collar. Please read the wiki linked in my signature to understand how this works http://www.apneaboard.com/wiki/index.php...cal_Collar

Finally GERD.  Very high pressure can cause the lower esophageal sphincter (LES) to open and make reflux and related aerophagia much worse.  Many people find reflux becomes worse with CPAP, and we have worked with many members to identify lower pressures that are below the threshold for breaking the LES seal.  It is important to avoid creating reflux through high pressure, because it is the silent reflux that eventually weakens the LES and allows the condition to progress. The fact you don't suffer from aerophagia at the pressure you were at previously tells me your GERD is not severe or advanced, but we don't want to create a condition that aggravates it.

Hope this helps to understand where some ideas are coming from and makes this complex issue simpler to understand.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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