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Help deceasing flow limitations
#1
Help deceasing flow limitations
I am using a airsense 10 autoset.  I recently raised my minimum pressure to 10(from 8) as recommended by the forum.I am using an EPR of 1.  I have always had a large number of flow limitations and even though my AHI on this night is very good,is there something I can do to decrease the fl?
Thanks for your advice.
I am using the for her algorithm since my last sleep study showed a significant residual and RERA  events.
RERA  101
RDI     17.9

I don't wake up refreshed at all.

https://i.imgur.com/93gS4Ez.png
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#2
RE: Help deceasing flow limitations
Yankees, what we are going to do is treat your CPAP like a bilevel. Set EPR at 3, and add 3 cm to the pressure that stops obstructive apnea. It appears your current median EPAP of 9.8 does a very good job, so this means your minimum pressure would be set to 12.8 with EPR 3.
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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#3
RE: Help deceasing flow limitations
Thanks sleep rider.  I already raised my min pressure from 8 to 10.  Going to 12.8 seems like a large jump.  Also an 
EPR of 3 might raise my CA's? 
Really appreciate your help, would more screenshots of other days help?
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#4
RE: Help deceasing flow limitations
You're fine. We just use the minimum EPAP pressure on Autoset as a starting point. It is the pressure difference between EPAP and IPAP that gives you the pressure support to deal with flow limits and hypopnea. I'd rather that you use the information and make your own decision, than to just take a suggestion I make verbatim. Let us know how it works out.
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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#5
RE: Help deceasing flow limitations
Sleeprider,  Just to understand you,do you usually start with epr of 3 and add it to the median EPAP pressure to get to the minimum pressure (IPAP)and then see how you do? Then if CA's appear then you would reduce your epr?
Right now with my median EPAP of 9.8 and my epr at 1, my ipap of 10.0 is too low I am thinking.I think I understand what you mean that my starting pressure is too low to respond to flow limitations.  Am I thinking this clearly.
If so,how do you determine the median epap to use?  Do you take an average of a weeks data of median epap's or do you look at the ahi over time to determine this number? Really want to understand this as my sleep doctor is no help.
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#6
RE: Help deceasing flow limitations
That is a pretty accurate description of what I'm doing. Your case is a little more difficult because we are yet to find a consistently good solution, and the approach I describe really only works if centrals don't become an issue. I try to think of the Autoset as a limited capability bilevel (aircurve). EPAP needs to be set at a level that controls OA. If we still see hypopnea and flow limits, then add 3 cm to that EPAP for the minimum pressure. That protects EPAP when EPR of 3 is used. The result is an effective EPAP for OA with pressure support of 3-cm for the flow limits...convoluted thinking, but it works more often than not.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#7
RE: Help deceasing flow limitations
Really appreciate your help and advice.  I will get back in a few days with more data.
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