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Flat Topped Flow; Help With Chart Please
#11
RE: Flat Topped Flow; Help With Chart Please
you can also adjust ti min & max to shorten or length inhale & exhale time, independent of the trigger setting. I had to do this after setting my trigger to very high. the manual explains what each setting does (I don't remember well enough to provide details).
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#12
RE: Flat Topped Flow; Help With Chart Please
Good morning everyone, I hope everyone slept well Smile

Here are a few screenshots from last night. I have included a couple of examples of the rough or jagged flow I had that preceded an arousal. (Mask pressure looks better here.)

I have trigger set to medium here, and it seems to look better on the chart. I was pretty tired last night so I can't comment too much about how I felt with trigger on medium. 

I have timax at 3 seconds, but I did forget to mention that previously, so I did not change that last night. I did adjust those before trigger, so maybe I need to adjust them further, thanks!

I increased min EPAP to 5.8, and can keep increasing a bit at a time. I have not increased my max IPAP, but since my 95% pressure was close to map IPAP, I think I probably should increase it later on. 

I'd love any feedback on the rough topped flow that leads to an arousal, please Smile

Thanks!


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#13
RE: Flat Topped Flow; Help With Chart Please
Your machine appears to be properly triggering IPAP, however the periods you zoomed in on show pretty serious flow limitation with relatively long inspiratory time where you continue respiratory effort to get the volume you crave. Both periods of zoomed flow limitation end with RERA, and the CA event at 23:59 is the result of recovery breathing hyperventilation. With PS 6.0, I don't know how productive additional increases will be, but it's fine to try changes in EPAP min or PS. Your median EPAP is nearly 7.0, and it's hard to say how prevalent FL is in your therapy. The zoomed sections don't seem to be reflected in your full-night statistics.
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#14
RE: Flat Topped Flow; Help With Chart Please
For the zoomed in sections I had 3 big-ish sections like that last night. The first was for half an hour, and the second two for an hour each. The flow limit part of the graph for those sections is pretty low and sometimes zero.  But since the rough flow totals around two and a half hours (last) night I wondered if it could be affecting how I feel the next day.

Most nights my 95% flow limit is around 0.1, and some nights are closer to 0.05.  The night I used the full face mask recently my 95% flow limit was 0.21. The flow limit present during rough flow rate times fluctuates. Sometimes nothing, and sometimes 0.1-0.5 ish range.

I am not sure if any of this helps, or if you are just trying to say in a nice way for me to stop being so picky with therapy Tongue


Thank you very much Smile
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#15
RE: Flat Topped Flow; Help With Chart Please
Suz, there is a point where I will flatly tell a member to get their obsessive compulsive face out of the data, but you're not there yet. Smile

You did improve machine response by switching trigger to Medium, and the failure to trigger IPAP was actually a new problem to me. Have not seen that before, and I've seen a lot. We have had a very few members that have not obtained full relief of flow limitations with PS 6.0, and like yourself, the flow limits looked like crushed cars at a wrecking lot, and were present periodically rather than constantly. At some point, we just had to say that bilevel was very helpful in mitigating the problem, but in her case (Plmnb) we never really did resolve the problem, even using Bilevel ST. http://www.apneaboard.com/forums/Thread-...-with-ST-A That case taught me, we sometimes accept "good enough" when it comes to flow limits, and the goal needs to be comfort and efficacy rather than a focus on eliminating all traces of flow limitation. I will offer, that a changing pattern of flow limitation may suggest a positional issue or a physical upper airway restriction that may respond or not to things like a soft cervical collar, but my fall back now is to work for comfort.
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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#16
RE: Flat Topped Flow; Help With Chart Please
Haha I am glad you would tell me to stop analyzing data if I needed it!

I have been meaning to try a soft collar, thank you. I feel like I saw one mentioned that most men thought was too small but the petite women liked, I will have to go read some reviews on amazon later and try to find one. Thank you for mentioning. I had kind of forgotten that I wanted to try that. 

I have been feeling like if my headgear is too tight then it will kind of keep my head position tucked and I am not able to really stretch my neck and look at the ceiling. If I loosen too much though I am sure you know what happens, leaks. 

Maybe tonight I will use my p30i and see what I notice tomorrow. Just for different headgear that puts pressure on a different spot.  I was not loving the one size frame and headgear (I am female petite), so that's why I switched back to my nasal mask.

Thanks for your help!!
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#17
RE: Flat Topped Flow; Help With Chart Please
Here are some screenshots from last night with the p30i, but no collar as I just haven't ordered one yet. Maybe there is a settings change that might help in the mean time though. 

I am wondering if I should keep adjusting ti min? I had ti from 1.5 -3 last night, but maybe a higher min would help the jagged flow?

Thanks for any feedback Big Grin


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#18
RE: Flat Topped Flow; Help With Chart Please
I would turn timin down to 0.3 so we can see what your spontaneous breathing looks like. I would bet it is more likely your high Timin is causing the problem than helping fix it.

Timin forces IPAP (higher pressure during inhale) to be held for a minimum amount of time. Higher values of timin are only required if your spontaneous breathing is not maintaining IPAP on it's own. This will show up as short little breaths in which your mask pressure does not build up to IPAP pressure (epap plus ps).

Timax sets a maximum time for IPAP pressure. Shortening this is only needed if your spontaneous breathing is not switching to exhale on it's own. Decreasing this forces the machine to reduce pressure encouraging you to exhale.

Trigger sensitivity affects how early IPAP pressure starts to build. The higher the sensitivity the earlier it will increase. If it seems like increase in pressure is late then increase sensitivity, if it seems like increase in pressure is early than decrease sensitivity.

Cycle sensitivity is the same idea but is the change from IPAP to EPAP. Increase sensitivity to start initiating exhale earlier, decrease it to make exhale occur slightly later.

How did you come to conclusion to use PS of 6? Titration study or just trying different settings like these other settings?

Here is my thought on your situation/settings. Your ps of 6 causes a large change in pressure between exhale and inhale. I think it is the large variance in pressure that you find bothersome more so than the time it occurs at (which is due to sensitivity settings).

I would reset machine to default settings then set min EPAP at 6, ps at 3 and try that. Turn ramp off if it is on (not sure about default setting). Post results and then get members to help fine tune your settings from there. It will be easier to point you in the right direction as right now it seems bad settings are your biggest problem (like your very low sensitivity which was causing machine not to cycle to ipap).
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#19
RE: Flat Topped Flow; Help With Chart Please
Ps some of these strange flow waveforms are due to the leaks that are occuring. I would start by changing to settings I just proposed to see if that helps with leaks (might be mouth leaks due to bodies discomfort with settings). If it doesnt help you need to figure out a way to reduce leaks.
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#20
RE: Flat Topped Flow; Help With Chart Please
I did not see your recommended settings changes before I slept a couple nights, I am sorry! 

I do tape up my mouth at night; but it is cloth tape (two layers), so maybe I can add a layer of plastic tape to the front to make it completely impenetrable to air, =P  I am not sure how to stop the leaks otherwise. I am a pretty petite female and none of the masks I have are an awesome fit for me (p30i, n20, liberty, f30).  I was debating between the dreamwear full face with a small frame or quattro air (has XS) for full face masks  to help to stop the leaks, but then I think the more spots the mask has to seal the more it will just leak.. so then I cant decide between pilario/brevida/dreamwear gel pillows/nasal prong/bleep masks... 

I will try the default settings tonight and see.  I did slowly change the settings based on how I was feeling and looking at my chart. I can post charts from the beginning when I was on default settings for trigger/cycle/ti ... if you like. It was a combo of headaches and breath being cut off, and seeing if it was related to any settings that I could change. You are probably right that it is something to do with those settings. 

I will leave ramp on, but thank you for the suggestion :Smile I know some people think it's a waste because they aren't getting the required therapy for the ramp time, but I am very sensitive to central apneas when I am falling asleep.  I even saw a bunch of O2 desaturations one night when I was in between resmed machines (so no pap that week), but I was wearing my CMS 50something pulse ox tracker. So I am pretty sure it is not pap related and just a part of my complex sleep apnea situation. On nights where I dont manage to fall asleep during the ramp I see a giant cluster of central apneas after; and for that period of time where I am being constantly jarred awake by an anti death reflex, I am pretty sure that I am actually dead and trapped in hell.  It feels like waterboarding but with sleep, and a heck of a lot worse. So I just stick with a 15 min ramp and hope to heck that I can fall asleep immediately lol Too-funny


I did not have a titration study, I am in canada, and they just did a home sleep study. The clinic I rented a machine through for a month adjusted and oversaw my settings, but she was really bad so I purchased a machine online vs through her "clinic".  I was having lots of flow restrictions and flat topped flow (with EPR 3) that I was trying to "fix", so I got the aircurve vauto instead of the airsense 10 autoset for her.

My flow restrictions have decreased, but my flow rate shape is still pretty crappy :| 

I won't bother with posting any screenshots from the last couple of nights now, but I will move back to defaut-ish settings. I prob will keep the max IPAP the same. My med and 95% pressures are very close to the max IPAP, and I don't want to accidentally give myself centrals all night lol.

Thank you for the help Big Grin
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