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

[aconcepts]

How do you interpret flow limitations? Tidal volume?

I was thinking about staying with the resmed for several weeks to see how I feel.

The comfort level between last night and previous nights was significant. The difference between tolerable and intolerable. I'm curious to see if it will last.

[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.

I edited this post while you were posting, so I am quoting to bring the new information forward.

If you want to really zoom in on your flow rate chart (2-minute segment), I can show you the flow limits. Otherwise, I think the edited post above answers your question.

[aconcepts]

"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."

Thank you Sleeprider - The above really helped me understand what's going on. Should I surmise that I could actually lower my pressure further?

BTW - My 95% pressure with PR was 8.5 consistently (but with significantly higher RERAs (22 events average). The PR was set at 4 min - 16 max.

[Sleeprider]

The pressure can be reduced until you start to see more OA. At that point you're into fine-tuning. I think you will do best with fixed pressure and EPR at 3 than to mess with any of the auto algorithms. Keep an eye on flow limitation and RERA as indicators you may be reducing pressure too far. With EPR at 3, your current pressure is 11/8. Take your time and get it right, you're approaching a good pressure, but lower is certainly a possiblity.

[aconcepts]

Thanks again. I'll fix my pressure at 10.5 tonight.

Do longer lines in the FL chart mean better or worse flow?

[Sleeprider]

Taller is more flow limitation. A I mentioned, you can zoom into the flow rate graph and see the flat and downward sloping peaks. In your case I think you are improved by "pressure support", the difference between IPAP and EPAP pressure, and a fixed bilevel would not be out of the question in the future for even better comfort.

[car54]

aconcepts,

 Here are charts with the Resmed. Notice how high the pressure is and the flow limitation graph. Also, there is a 2 minute screen shot showing how irregular my flow rate is. On the left of the graph it shows that my respiratory rate is 30.20. I believe that is because my flow rate is so ragged it was interpreting it as 2 breaths. My normal rate is about 16. My leaks are higher also. Because of the pressure being high, I was getting leaks that woke me often. I did not like the fact that the Resmed was interpreting the respiratory rate wrong. Because of this I switched to a Dreamstation which was more comfortable, I wasn't getting leaks and I was sleeping better with a slightly worse RDI index. So my point is compromise between good figures and good sleep

[attachment=5582]


[attachment=5581]







Also my Dreamstation does make a noise at the machine as the pressure goes up and down but it is livable.

Car54

[aconcepts]

Hi Car54 - My dreamstation made a noise at the mask. It seemed to echo up the hose. It was loud. It also made a slight noise at the machine, and the Airsense makes a little less noise at the machine.

How come my Sleepyhead data show AHI and yours shows RDI???
Isn't RDI a composite of AHI and RERA?


I understand your point - What I am having a hard time reconciling is compromising the oxygen level in my blood.

I am assuming that with lower AHI (RHI in your case) you get higher oxygen level.

I guess the question is, how much blood oxygen is being sacrificed from using the PR vs the ResMed


PR - AHI 0.75 / RERA index of 2.5 (20 events nightly) 
vs
Resmed - AHI 0.65 / RERA index of 0.6 (4.5 events nightly)

 
Writing out all this I see that we are basically talking about a difference of 15 RERA events a night (considerable?).


If RDI is a composite of RERA and AHI then:

PR - RDI of 3.30 / 95% pressure 8.5
vs
ResMed - RDI of 1.25 / 95% pressure 11.0


Which would my form members choose?

Car54, with the new lower pressure settings on the ResMed machine (thanks Sleeprider) I am thinking that sleep quality between the two may be similar. Not enough time has gone by to really tell.

Again thanks all. Let me know which you'd choose.

Phil

[car54]

aconcepts,
 You can change between AHI or RDI in sleepyhead, it is your choice. I picked RDI because it gives me a total amount of any disturbance. Go to file/ prefeences/cpap. It is in the upper right side corner.
Are you using an oximeter to check your O2 levels? I am guessing that your O2 levels are good because your apnea is being treated and your results are good. You can buy oximeters that record your data and it can be merged into sleepyhead(for peace of mind).

[Sleeprider]

aconcepts, this is the kind of graph I have talked about several times.  You can see Car54 was having very disturbed breathing with ragged flow-limited peaks.  This is another case where I would have suspected bilevel pressure support would be beneficial. I hope things look better today than this December graph shows.