(06-28-2014 09:19 AM)MastiffMom Wrote: if you look around 1 am the pressures are close to max but no events are showing.
The machine is detecting serious snoring and a significant amount of flow limitations at the same time a that pressure spike right at 1 am. Those two things explain the pressure increase: The S9 responds very aggressively to snoring and flow limitations so as to proactively prevent OAs and Hs from happening. You can see this is what is happening by comparing the activity in the Snore and Flow Limitation graph to the activity in Pressure graph
Quote:When he first went to sleep he had a cluster of OCA but then none the rest of the night (same the night before) but the pressure remain running close to max (12). He says the mask is not leaking.
The S9 is very quick to INCREASE the pressure, but it decreases the pressure rather slowly. AND between 0:00 and 1:00 when there are no events, but the pressure remains close to 12cm, the machine is continuing to pick up quite a bit of Flow Limitation. (Look at how jagged the FL graph is.) At this scale it looks like every time the S9 tried a test decrease in pressure, the machine detected more flow limitations, which then drove the pressure right back up to the max setting of 12.
Quote:I'm attaching a report. about every hour or so something makes hubby wake and take the mask off. He leaves it off for a while, puts it on and it happens again.
Hubby needs to work on NOT doing this. I know it's hard, but he is unconsciously fighting the need for the mask, and that makes the adjustment more difficult.
Quote:He took the mask off for a while and when he put the mask back on the pressure pretty much climbed immediate to the 10ish range.
As soon as hubby put the mask back on at 2:00, machine detected serious snoring and a significant amount of flow limitations. Those two things explain the pressure increase at 2:00: The S9 responds very aggressively to snoring and flow limitations so as to proactively prevent OAs and Hs from happening. You can see this is what is happening by comparing the activity in the Snore and Flow Limitation graph to the activity in Pressure graph
My guess is that hubby woke himself up with snoring, realized the mask was off, put the mask back on, but the snoring and flow limitations continued just long enough for the S9 to detect them and respond pretty aggressively to them.
Quote:After his experience with over inflated lungs and having a worthless doc we are both terribly gun shy.
A lot of us have had bad experiences with docs. The answer is fire the doc and get a new on.
Also, the feeling of "over inflated lungs" is not uncommon at the beginning of PAP. Sometimes it just takes a bit of time to get used to the pressure. Sometimes it takes figuring out whether the therapeutic pressure setting can be safely lowered.
Quote:Shouldn't the pressure drop back to minimum until it senses an event? Any idea why it constantly remained higher? I thought maybe snoring was the problem but it doesn't seem that high most of the time.
No the pressure does NOT drop back to the minimum setting as soon as the apneas/hypopneas are over.
The way the machine is designed to work is this: After a cluster of 2 or more OAs or Hs that occur very close to each other, the machine will raise the pressure to prevent additional events from happening. The machine will keep the pressure at its new setting until the breathing pattern is very stable---as in NO snoring and NO flow limitations
. Once the breathing is very stable, the S9 will gently and slowly start lowering the pressure back down towards the minimum. But if snoring or flow limitations are detected, the pressure will be increased once more.
Quote:He says the mask is not leaking.
The leak graph says other wise. Between 0:00 and 1:00 there is an hour long middle-sized leak. While it's well below the Redline that indicates Large Leaks, it still looks like an hour of mouth breathing. If hubby is also complaining of a dry mouth, that's more evidence of mouth breathing. It could be that these middle-sized mouth breathing type leaks are disturbing hubby's sleep enough to cause him to wake up. And the dryness of his mouth may be (part) of what's causing the discomfort and leading him to take the mask off.
Quote:What does flow limitation mean?
A flow limitation is a change in the shape of the inhalation part of the Flow curve that indicates the airway is partially collapsed or in the process of collapsing. The reduction in airflow in a flow limitation is not severe enough for the event to be scored as a hypopnea or an apnea. But studies have shown that significant amounts of flow limitation are strongly associated with an increased risk of airway collapse. So flow limitations are often regarded as "precursor" events to hypopneas and apneas. And that's why the S9 responds pretty aggressively to them by increasing the pressure. The idea is that if the pressure is increased enough to minimize the flow limitations, then the chance that the airway will actually collapse goes way down.
Quote:He is a slow deep breather with a long exhale (his description) can that be causing this?
. Unless his exhalations are consistently longer than 6 seconds or so, this is NOT likely to be the source of the problem. The usual source of the flow limitation problem is labored inhalations.
Quote:We are thinking about lowering the max pressure a bit to see what happens. Even if it doesn't keep him from having some events if it helps him overcome his fear of getting his lungs over inflated again it will be worth it. Then hopefully we will have a better doc and we can go from there.
Does hubby have EPR turned ON? If not, that's actually the first thing that I'd suggest trying. And counter intuitive as it sounds, increasing the minimum pressure a smidge may help because that will help prevent the flow limitations and snoring that are triggering the sudden increases of pressure in the first place.
If you do decide to change the pressure settings, go slow. Only change one setting at a time, and only change it by 0.5-1.0 cm at a time.