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Increase in PS or EPAP for reduced thinning flow rate graph
#1
Increase in PS or EPAP for reduced thinning flow rate graph
Which of these two should be increased first if the flow rate graph is becoming thin ? I know EPAP controls OSA and hypopnea and PS is for flow limitation, snores and hypopnea but my question is how should one tackle a reduced flow rate graph when sleepy head registers ZERO obstruction events and/or ZERO hyponeas (although some sections of the flow rate graph clearly are reduced to almost nothing). Is this an EPAP or PS issue?

Thanks for any feedback
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#2
RE: Increase in PS or EPAP for reduced thinning flow rate graph
An image would help here, but you seem to be describing a lower flow rate. This can result from several causes; higher breath rate per minute, higher leak rate, higher flow limitation and simply shallow breathing. The appropriate response depends on the cause.
Sleeprider
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#3
RE: Increase in PS or EPAP for reduced thinning flow rate graph
I don't necessarily have a current graph of this example since my previous data got wiped out. I was just trying to educate myself better on sleepyhead. 


Based on your response though, I will say for a fact that in my situation in the past, my respiratory rate was always around 15-17 and my leak is near ZERO most of the night. As a 6'1 male 205 lbs, my tidal volume is very low (around 360-400 on most night) regardless of how much pressure support I add and the Minute Vent is low for my size  too which is usual around 5.6- 6.3 on most nights. What can be the reason for this? Can it just be normal sallow breathing or there may be a bigger issue?
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#4
RE: Increase in PS or EPAP for reduced thinning flow rate graph
Normally, I would expect to see tidal volume and minute vent respond positively to an increase in PS. There should be no reason to increase EPAP unless a restriction is present. At your size, I would expect to see a tidal volume in excess of 500 mL and minute vent of 7+L/min. I am in the same height range and routinely have 620-700 mL and 9-10 L/min. That is not a reasonable target for you, but higher pressure support should bring you routinely above 400 mL and 6-7 L/min.

What are your settings, including PS, Ti min, Ti max, and trigger/cycle sensitivity? What is typical for I:E ratio?
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: Increase in PS or EPAP for reduced thinning flow rate graph
Pressure support is 4 (although I tried higher to increase tidal volume but never get past 420), EPAP min is 9, Ipap max is 25.

Triggeris very fast
Cycle is medium
Ti settings are on default settings (I believe 2.0 and. 3)
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#6
RE: Increase in PS or EPAP for reduced thinning flow rate graph
Based on zero apnea and hypopnea, you can reduce EPAP. I think it may be worth trying a lower EPAP and higher PS. Let's start at EPAP min 8.0 and increase PS to 5.0.
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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#7
RE: Increase in PS or EPAP for reduced thinning flow rate graph
Ok I I'll do so and post my charts. Thank you as always sleeprider
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#8
RE: Increase in PS or EPAP for reduced thinning flow rate graph
Sleeprider, these are not my typical settings (I just tried it for a quick 2 hour nap) but i posted a sample of the shallow breathing that happens alot. Actually this shallow breathing does not look as bad as what I'm use to seeing (i dont have screenshots of my old sessions anymore) but I just wanted to provide a screenshot. EPAP min was increased to 10 on this day. Don't mind the leak rate either because I tried a different mask this day just to try but my normal mask I get near Zero leak everynight. The typical shallow breathing last much longer than this and is way more shallow without it receiving a hypopnea or OSA flag.


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#9
RE: Increase in PS or EPAP for reduced thinning flow rate graph
Michael, you were using Sleepyhead software before, so your old SD card data should be in the backup. In Windows, Sleepyhead stores data in My Documents under a Sleepyhead directory. The name may vary depending the version you are using. Find the data folder and look under Profiles and your user name and the machine (My Documents/Sleepyhead Data/Profiles/Michael6/Resmed_xxxxx/Backup). That backup folder is the last image of your SD card. You can copy it to any SD card or mount it as a virtual SD Drive and import the data to Sleepyhead. You should see all the years of Datalog, Events and Summaries. Also in that folder are any screenshots you previously saved.

As far as your nap data, I will stand with my previous recommendation to increase PS and decrease EPAP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
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Beginner's Guide to Sleepyhead

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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#10
RE: Increase in PS or EPAP for reduced thinning flow rate graph
You may find that deep sleep stage has the small thickness and rem has the larger or spiky. I hardly ever say this, because most people under pressure. Sleepride said about reducing epap. You might try dropping down in pressure to 9 and PS4. See if the med, 95% and max still stay very close or if there is a bit more movement. Were you titrated on epap10 and would explain it? If you aren't over pressure, I like to have my Med and 95% close.

You can adjust tidal if you want to. start slow and stop with any discomfort, but finish up with it on epap 10, min PS10, rise time 150 and min Ti 1.1 for an hour and see the result. You would have to look up the suggested tidal volume for your height, but with minute vent 6.5, breath rate 15 and tidal 420, it may be an option, not urgency and are within normal range
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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