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Erratic pressure flow
#1
Erratic pressure flow
Hi,

I am curious as to why my pressure graph looks so erratic with micro increases and decreases. I fall into the UARS category and I don't think I can improve much more on my flow limitations however I'm wondering if this may be causing the pressure changes and unconsciously affecting my sleep. Although my AHI is  consistently reported as being under 1 my sleep quality is so so. I often become aware of my cheeks filling with air (I tape my mouth shut) or trapped air in the back of throat which I burp to remove. 
Your thoughts and ideas would be much appreciated or maybe this is as good as it's going to get.







   
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#2
RE: Erratic pressure flow
The Autoset increases pressure in response to flow limitations as well as in response to snoring or apnea events. So it is the flow limitations causing the pressure increases and decreases.

I don't know whether the pressure changes might be disturbing your sleep. Have you ever tried using a fixed pressure, perhaps at 9.6 cmH2O? That would eliminate any pressure variations.

I don't know anything about UARS, so if this is a terrible idea, please ignore it.
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#3
RE: Erratic pressure flow
Have you tried EPR 3?  If no I would give it a try to lessen the flow limits.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Erratic pressure flow
It’s often best to make one change at a time. I think I’d recommend trying the EPR at 3 first and see what happens. It might smooth things out enough to make using a fixed pressure unnecessary. But if it doesn’t, then you could set your min = max. The suggestion of 9.4 sounds like a good place to start.
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#5
RE: Erratic pressure flow
I really think setting pressure to 10.4 minimum, 10.4 maximum and EPR 3 will give you the most restful sleep. Even though the chart is erratic for pressure, you did not mention if it disrupts your sleep. Fixed pressure has a lot of advantages to help us narrow in on pressure that continue to provide good AHI and relief for your aerophagia. EPR should help that as well.
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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#6
RE: Erratic pressure flow
Switching to mode "soft" makes the machine react less "aggressive".
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#7
RE: Erratic pressure flow
Thank you everyone for your suggestions. 

I have tried EPR 3 but on both occasions I had a panicked arousal from sleep as I thought that I was never going to breathe in ever again and consequently stopped the machine and removed the mask in a fluster. Possibly I was having a central apnea but there was nothing on OSCAR that would suggest that. I have since stuck with EPR 2 as I seem to tolerate it well and I'm a bit too nervous to try EPR 3 again. It wasn't a pleasant experience.

I was wondering that even though I have continuous FL throughout the night that they are in fact low enough not to be too bothersome. With my anatomy I don't think I will ever be rid of them.

I would like to get off APAP and will try straight CPAP this weekend at the pressure suggested.

Thanks.
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#8
RE: Erratic pressure flow
It helps to know you had a problem with the higher EPR. Looking at your chart shows that your pressure stabilized at 9.6 cm for most of the night. Do you think you can tolerate an addition 1-cm of pressure? If so, I would recommend a minimum pressure of 9.6 and a maximum pressure of 9.6 with your EPR at 2. This will completely remove any disruption from changing pressure. If you are comfortable with your current settings and just don't like the look of fluctuating pressure, it is not hurting anything and your therapy is excellent. Setting a fixed pressure eliminates the changing pressure.
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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#9
RE: Erratic pressure flow
Thank you for all the advice.

I tried APAP at 9.8/9.8 EPR 2. I had a much more comfortable night and decide this was the way to go although looking closely at OSCAR I thought I may have had a few more arousals than normal. The next night I tried again at these settings but woke in a panic one hour after falling asleep (I thought someone was in my bedroom) and stopped the machine. I decided to up the pressure to APAP 10/10 EPR 2 as I wondered whether the 9.8 was a little too low. Again I woke in a panic about an hour later and stopped the machine. I gave up and returned the settings to APAP 8.6/10.4 EPR 2. It was an okish night with lots of unpleasant dreaming. I'm not sure if this was because of the changes I made or because I'd had a cup of tea during the evening or my dinner had been a bit too spicy so I am going to try again at some point. Below are the OSCAR charts. 



           
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#10
RE: Erratic pressure flow
A stable pressure seems to provide good efficacy and less disruption to your sleep. In the end, you have to be the judge of what is most comfortable and works best for you. The results with a limited range of variable pressure and fixed pressure are both very good from the standpoint of AHI.
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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