IanD - Therapy Thread

[IanD]

Thank you for the feedback! Should show the flow limit on these now. Let me know how it looks!

[IanD]

Hi everyone! It has been awhile since I last posted and wanted to provide some updates and changes that I have made with my therapy. 

I am now using an N30i nasal mask with mouth tape and find it much more comfortable and seem to be sleeping with it better as opposed to the Dreamwear but I am still battling with getting the right pressure dialed in and making sure there aren't any leaks. 

As you can see in the OSCAR screenshots the first is with auto 8-12 pressure, fixed pressure of 8 in the second, and fixed pressure of 9 in the third. 

I'm not sure which has given the best results so far but if any of you had any thoughts or advice that could be shared on how I can improve my therapy that would be much appreciated. 

Thank you!

[IanD]

Hello,

I've adjusted my pressure settings to apap 8-10 as I feel like 12 might be too high but wanted to provide a screenshot of the data from a few nights ago. However, I have been feeling more exhausted and foggy so i'm not sure if it is helping. I do see that I only wore it for about 5 hours so that could also be the reason.

 Any thoughts on how it looks? Thanks!

[IanD]

Hi everyone!

Any thoughts on my OSCAR data from last night?

[IanD]

I made some changes with the EPR and set it to 1. This seems to be working better for me and I feel like i'm not starving for air. However, I have been taking my mask off during the night. 

Can anyone look at my data and offer any advice?

[IanD]

Bumping

[unadvisedfun]

Short answer: consider going back to EPR 3 and try some higher pressures to address the air starving problem.

It looks like APAP is increasing pressure due to the flow limitations (anything greater than about 20% will trigger pressure increases in a resmed device). This can usually be addressed with EPR (or a higher IPAP and lower EPAP like what bi-level can accomplish).
Consider increasing EPR back to 2 or even 3 as originally recommended. Check out the flow limitation page on the wiki.

Increasing EPR lowers the expiratory pressure, so you may need to raise the minimum pressure as a result.

Are you feeling air starved on inhale or like you can’t exhale against the pressure?

Some settings to consider trying might be:
Min 10 EPR 3 (EPAP 7)
Min 11 EPR 3 (EPAP 8)
Min 12 EPR 3 (EPAP 9)
Min 13 EPR 3 (Epap 10)
Min 14 EPR 3 (EPAP 11)

If flow limitation and how you feel doesn't improve you may want to consider trying bi-level.

You can try this in smaller increments than I mentioned. Based on APAP making drastic increases I find it usually means significant under-titration or that it is the wrong mode of therapy.

[OpalRose]

You went from EPR 3 down to 1. This caused the 95% FL to rise from 0 to .11

Flow Limitation will cause your pressure to rise and the result of that pressure increase may be what's causing you to wake up.

You need a happy medium... try EPR set at 2. We'll look at the effect on FL, and your comfort level.

[IanD]

Thank you both for the input!

I went ahead and put my EPR back to 3 and I think it might be working. I'm feeling more rested but still struggling with awful brain fog most days. 

My pressure settings are now between 10-12 with an EPR of 3. I've attached some recent data below. 

How do you think my nights are looking? Anything else you would recommend or suggest I change?

Thank you.

[IanD]

Anyone have any thoughts? Thanks!