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Home Sleep Study - Low AHI but significant desat
#31
RE: Home Sleep Study - Low AHI but significant desat
Yes, EPR edits would be the thing to try in order to affect CA. Keep us updated on the progress via a hour you feel and an OSCAR. If they're going to respond it's going to be seen right away after an edit typically.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#32
RE: Home Sleep Study - Low AHI but significant desat
Looking at the desats be aware of this.
Pressure Support, EPR on your machine, is increased to increase volume to your breathing. This increase in volume is what improves your sats, but it also decreases your drive to breathe by flushing additional CO2 from your system.

In other words, decreasing EPR will decrease your CAI but will also likely decrease your oxygen sats at the same time.

What are your expected tidal volume and minute vent. These require your size, height, weight, and sex to calculate.
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#33
RE: Home Sleep Study - Low AHI but significant desat
Yep another teeter-totter, to address one symptom for the good, another symptom goes down to the worse.

Best case scenario is find a happy medium for this.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#34
RE: Home Sleep Study - Low AHI but significant desat
(04-28-2021, 07:30 AM)Gideon Wrote: Looking at the desats be aware of this.
Pressure Support, EPR on your machine, is increased to increase volume to your breathing.  This increase in volume is what improves your sats, but it also decreases your drive to breathe by flushing additional CO2 from your system.

In other words, decreasing EPR will decrease your CAI but will also likely decrease your oxygen sats at the same time.

What are your expected tidal volume and minute vent.  These require your size, height, weight, and sex to calculate.

Oh boy, you nailed this.  I decreased the EPR to 2 and had such a bad night that I ended up taking the mask off in the middle of the night - something that I told myself I wasn't going to do.  My CAs went up and my O2 went down.  Everything went the wrong direction.

After reading your post with the questions about tidal volume and minute vent, I just spent way too long going down that rabbit hole.  But I am learning a lot!   Smile

Using an online calculator that takes into account my current weight rather than the "ideal body weight" (something I've never been, even when playing intercollegiate sports and on active duty in the Air Force), my expected minute vent (female values) at 6-8 mL/kg would be in the range of 462-616 mL.  What I can't figure out is how that translates to a setting on my machine.  Do you know of any links or references that might help me understand that last link in the chain?

I've attached the ugly Oscar data from last night, that includes the SpO2 data even after I took the mask off.  I mostly held my own after removing the mask, but could see it deteriorate over the final hour or so.  I also zoomed into one set of CAs and attached it.

Ugh - tonight I'll go back to the settings that previously worked best and learn and think a bit more before I go winging the dials again.   Oh-jeez 

          
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#35
RE: Home Sleep Study - Low AHI but significant desat
Well that went a bit ugly. Have we talked about consideration for the ResMed VAuto since it has the full range PS? PS may be helpful to keep things going correctly IMO.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#36
RE: Home Sleep Study - Low AHI but significant desat
(04-28-2021, 12:19 PM)SarcasticDave94 Wrote: Well that went a bit ugly. Have we talked about consideration for the ResMed VAuto since it has the full range PS? PS may be helpful to keep things going correctly IMO.

We haven't talked about that specifically, but I've picked up on the possibility from multiple other posts.  

I bought the current machine out of pocket because insurance wasn't covering it with the super-low AHI.  However, if I can ever get the referral appointment scheduled with the pulmonologist (I still don't have a callback from him...grr), I plan to push him to help me get coverage based on the additional complication of low oxygen saturation.  If, at that point, it appears that the VAuto is the right answer, I'll be able to use insurance to get it.  It's a pretty big expenditure otherwise.
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#37
RE: Home Sleep Study - Low AHI but significant desat
OK I copy that. In 2017 when I was waiting on approval and delivery of my ASV, I made a call to the doc or DME's office every day. I figured it might quicken the delivery by way of them getting tired out from hearing from me.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#38
RE: Home Sleep Study - Low AHI but significant desat
At the risk of jinxing myself, I think the current settings (the ones I returned to, not the reduced EPR) are going to work very well. Great night last night.  Very few O2 drops, and only down to 89% for a total of one minute.

I'm posting the chart, but it will probably be my last one for a bit if the current results hold.

Thanks for everyone's help.

Dancing

   
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