Lower 95% pressure higher RERA index. Higher pressure lower RERA index.

[Walla Walla]

Ron, It's pretty easy. Drop the words maximum pressure and use the words inspiratory pressure. Example: reducing the EPR reduces the inspiratory pressure/IPAP.

[aconcepts]

Hi all - Ok I hope by clicking on the icon you can see the large size screenshot. I struggled with the directions.

It puzzles me how I can be awake in bed breathing normally and machine is at 10.6 pressure. Shouldn't be at min pressure (8)?

http://www.apneaboard.com/forums/attachm...bnail=5552    

[Sleeprider]

aconcepts, this confirms exactly the situation I discussed in Post #6. You have a fairly high rate of flow limitations which causes the machine to increase pressure, even when you don't have apnea events.  It's not your fault, and there is not much you can do about it, your machine will always seek out the maximum set pressure.

You need to ignore the chatter that has been in this thread and keep EPR in your settings.  You are currently using EPR of 1, and I would encourage you to use 2 or 3 as this actually helps with flow limitation.  You had a very low rate of apnea and hypopnea so I do not suggest reducing pressure, but if you add to the EPR we will watch to see if that allows more events.  I assume the lower maximum pressure is more comfortable for you, and it certainly is effective.

If you're interested in learning more about flow limitation, it is discussed in the Beginners Guide to Sleepyhead http://www.apneaboard.com/wiki/index.php...imitations  Also, if you want to zoom in to your Flow Rate graph, showing only a 2-minute segment of time, we can explain your breathing dynamics and discuss what flow limitation looks like, and some of the causes.  This is not a severe example, but your breathing wave-form will have flat or downward sloping peaks.  This shows how you can zoom into the flow rate, and it is also explained in more depth in the Organizing Your Sleepyhead Charts Wiki.

[Walla Walla]

Sorry if I confused things. I totally agree with Sleeprider's advice.

[aconcepts]

Thank you Sleeprider.

What I fail to understand is why the Phillips Respironic machine keeps my 95% pressure at 8.5 and the Resmed keeps it at near max when both machines are set to 4 min and 16 max.

I have fewer ERAs with the Resmed at the higher pressure while the AHI's are in a comparable range.

I seem to sleep better with the Phillips Respironics but I think I experience mild morning headaches with it.

How can I find out what is restricting my airflow?

[aconcepts]

Apparently the Philips Respironics machine does not react to the flow limitations like the Resmed does. Is that why my RERAs are higher with the PR machine?

I am more comfortable with the PR machine but maybe that's because its not doing its job as well as the Resmed since my RERAs are higher? Am I correct in this reasoning?

Sleeprider - I set my era to 3 and lowered my pleasure to 11 because the thing with the higher pressure is that it makes me want to breath through my mouth. I think that is what the large leaks might represent (40 large leak events!).

Sure not happy with any of this but at least I might be starting to understand. Sounds like it might mean back to taping... ugh...

[Sleeprider]

Lower pressure and higher EPR is fine in your case. There is no way around it, since you have the FL, your maximum pressure will simply become a fixed pressure with Resmed. I still think it is the best solution outside of Bilevel.

[car54]

Aconcepts,
 I also have a flow limitation problem. I did not know this until I tried a Resmed airsense auto which graphs the flow limitations. The Resmed did a great job at reducing them. It always went to the high limit of pressure which gave me leaks and woke me up often. The way I see it Resmed went for the jugular to reduce limitations. I am now using a PR dreamstaion which is not as agressive and I sleep better. My Rera's and apneas were a bit lower with the Resmed. I decided to sleep better over statistics.

car54

[aconcepts]

Sleeprider- I changed the EPR to 3, lowered max to 11 and it was much more comfortable. Thank you for that tip - I really appreciate it.

Thank you Car54 (where are you? LOL - I remember that). It's comforting to know someone else has dealt wit this.

I think I'll be going back to a PR machine.

I had a Dreamstation and it made a lot of noise at the mask. Does your machine kind of drone through the mask?

So far my best result has been with a PR RemStar Auto. It was a loaner from a friend - his back up machine. I'm going to try and buy a used one.

An anesthesiologist told me I had a narrow throat. I guess this creates the flow limitation. Or is it something with the nasal passages?

Here is last nights chart (It includes a nap). Pretty good but I woke up in the night with a slight headache. Is waking up with a slight headache common?

http://www.apneaboard.com/forums/attachm...bnail=5561

Thanks everybody - you form members are a great resource.

[Sleeprider]

Looks great, but if you're comfortable and well-treated I don't understand why you would change machines. Worth a try I guess, but I think the difference in inhale/exhale pressure would help. If you compare your last two charts, you will see flow limitation is lower in the statistics, and tidal volume is slightly improved, and especially RERA is improved. That is a pretty good outcome.

The narrowing of the throat is not uncommon, and your condition could be accurately diagnosed as upper airway restriction syndrome UARS. This is exactly the scenario where we obtain pretty good AHI efficacy with lower pressures, but the maximum pressure must be limited, or it will run-away on flow limits. That is also true for the PR machines, and if you successfully used one in the past, it certainly was not set to a maximum of 20 cm. The Resmed actually uses a limited pressure support (EPR) to help with the UARS and I generally have seen better success using the Resmed with EPR or going to a bilevel which offers even more pressure support to overcome upper airway restriction.