Lorrubdb Therapy Thread: Fine-tuning therapy with Oscar

[SarcasticDave94]

The stats look good so it's all about how you felt. The SpO2 dropped briefly below 90, but not enough for any alarms to go off. I'd suggest watching it, recording. If it were to get bad, tell the doc, in fact I'd mention sometime in the near future. To get it on record. Maybe they'd do a SpO2 test of their own.

No changes that I can see. Just keep at it. Best to your success.

[Lorrubdb]

Hi, my stats were up last night with increased CAs along with a batch of high limit flows.

My SP02 dipped down again below 90 briefly and hovered around 90 for quite awhile which can't be good. Similar to the night before.

Yesterday and today my breathing felt more restricted, like I struggled to breathe at times and head was a bit foggy. All that was much improved so disappointed although still feel better than before CPAP. Trying not to panic but it is concerning. 

I'll definitely inform my doc of the O2 sats when I talk to him next week. He was talking about maybe I need CPAP and Oxygen since desaturations were so bad on apnea test. Not sure how that would work. 

Wonder what you think of my chart? How high can I raise my minimum pressure? Any other suggestions?

Thank you       








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[SarcasticDave94]

Myself, I'm not seeing anything in the chart to suggest editing the settings. Even at total AHI of 2.4, this is still twice as good as medical therapy success.

As for how CPAP and supplemental oxygen work? Best answer is to get a specialized hose that has a built-in oxygen bib at the machine end. Example, if you're on a ResMed 9 or 10 series machines, there's a ClimateLine Air OXY.

[Gideon]

You can also get an AB filter, remove the filter, with an oxygen connect.

[quiescence at last]

I noticed your recent change of min pressure from 10, down to 8.6. That gives the machine more room to adjust when it detects flow limitations. Your setting of algorithm to Autoset For Her makes it take longer to push up the pressure.

I agree there is not much reason to make more adjustments.

If you do want more to try, you might gradually adjust the max pressure 0.6 at a time, to see what that gives you at those times of higher flow limitations.

QAL

[Lorrubdb]

First of all, I want to thank you all so much  for all your excellent suggestions and guidance-you're all amazing and so knowledgeable-I have learned a lot but think I'm going rogue on my own adjusting the min pressure up and down, sometimes during the same night -I have been having problems sleeping and wake up a lot. As they say a little knowledge can be dangerous and I'm worried I'm doing it wrong and maybe causing harm. My goal is to keep AHI and especially my flow limit low which is my big problem. It trends very high and seems to dictate how I feel the next day. If low at night, I breathe effortlessly and have great energy but if high struggle to breath and feel awful all day. I know to fight high flow limit by adjusting  EPR but also that it is a balancing act with increased CAs so keep changing the settings. My concern now is that I have the min pressure too high. I started at 8, went to 8.6, then to 10.2 with EPR 2 which seemed to be good for awhile-like for almost two weeks.  I even had zero one night! I know it doesn't mean a trend -and never did have it again but have to admit it was exciting! So now my flow limits and CAs increased and I raised the min pressure to 10.4, the max is 14. Is that too high? I'm not really sure how the machine works and am concerned I'm not giving it enough room to adjust correctly despite generally pretty good numbers. Also it looks like my pressure is all over the place, used to be a steady 10 with 8 min pressure.  Gideon-I did just see your post about keeping it at 8.6 and maybe trying to increase by .6 increments but unfortunately missed that and just kept bumping it up higher-even as high as 11!. Also you mentioned the algorithm set for ResMed auto for her -should I change it to auto and go back to 8.6?  So don't think I know what I'm doing and Need your help!! I attached 3 charts at different min  min pressures-there are previous charts I posted in the 8 range. Please let me know if it would help to post more charts as I'm limited to 3 as you know. Thank You!  

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[Lorrubdb]

Please help. Waiting impatiently-sorry know you're busy , don't feel well

[SarcasticDave94]

The CA is there but seemingly not too high, maybe about a 1 CAHI. I'd consider giving more consideration to the flow limits as they're driving pressures upward. The occasional leaks may be a source of disturbances too.

In my opinion, I'd try lowering min pressure back to about 8-9, maybe trying EPR 3 unless it made CA go up a lot. When the pressure gurus comment go by their recommendation.

[Lorrubdb]

Thanks Dave.  Will change settings per your advice for now until I hear different from the pressure gurus . I just can't seem to get those limit flows to stay down.

[Gideon]

Set your EPR=3 fulltime then let's see what happens. If we can't get flow limits down then a BiLevel may need to be looked at it.