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Need help figuring where I am at
#1
Question 
Need help figuring where I am at
I have posted one photo of my pressure at 6-15 and then due to an oxygen sensor saying I was still getting in the 80's I bumped it up to 7.8-20.... Not sure what I am doing wrong I just want to feel better. Any advice is appreciated and I can send more data.


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#2
RE: Need help figuring where I am at
I see 2 things that are affecting your therapy. Your ramp was active for 50 minutes, so there was no effective therapy during that period. You have leaks over the limit for effective therapy for 9.5% of the time. Others will give you more specific suggestions.
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#3
RE: Need help figuring where I am at
Should I raise my starting pressure then?
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#4
RE: Need help figuring where I am at
On the ramp, I'd suggest considering turning it off. Even if it's on Auto, it's stealing therapy time as you frequently stop and restart therapy.

Mask and leaks are another issue. Consider reviewing your mask strap tension. If it's too tight, it adds pain or discomfort. It also will distort the cushion, adding more leaks. Some leaks are patterned after mouth leaking, so you may need tape or a chin strap, or a different sized cushion or altogether a different mask. Some leaks are the spikey mask itself leaking pattern.

Also, it appears at times there's some event clustering that may signify chin tuck. Do you have a thick pillow? Changing that you a thinner one may help. Also a soft cervical collar may be needed to keep your chin from tucking in and kinking off the airway. Have you noticed if your sleep position promotes your chin to point towards your chest? If so, this is akin to kinking the garden hose.
Dave

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#5
RE: Need help figuring where I am at
You should shorten the ramp time, and try to get your leaks under control. If you are having mouth leaks, a soft cervical collar could help. Some people here use tape to reduce mouth leaks.
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#6
RE: Need help figuring where I am at
There are 2 things I see. First you had what appears to be positional apnea. You see positional apnea when there are groups of apnea (except central) grouped together. 

Positional apnea is when you sleep in a position that cuts off your own airway. No pressure changes can help. You need to identify why and stay out of that position sometimes it is sleeping onn no your back or to thick of a pillow. In those positions you chin tuck when you drop your chin to your sternum, cutting off your own airway. 

If simple things don’t work you would need a collar. Please look at the link in my signature on collars. 

Problem higher than optimal flow limits. Flow limits are apnea (obstruction) that is treated with EPR. YOU ALREADY have it in full time. keep it there 

But your low pressure needs to be raised so the EPR can fully work.  I would set the min to 8. 

The way EPR (exhale pressure relief) lowers the exhale pressure by the EPR. The lowest any pap machine pressure can go is 4. 

Your min 6 minus EPR 3 can’t happen because the machine can not get less than 4.   Raiding the min to 8 would give you an inhale of 8 and exhale of 5.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: Need help figuring where I am at
Hi. I am going to suggest more research and/or experimenting.

1. First, please tell us if you have any record of what your at rest and active oxygen level is while awake.  I assume you know the O2 because you have an oximeter.
(by the way, putting the oximeter data in line with your Oscar data [or loading it directly into Oscar] will show us when the oxygen level is decreasing so much, and what breathing flow issues may be associated with the drop in O2.)

2. Your EPR of 3, as staceyburke mentions, would normally result in the sweeping of more CO2 out of the lungs, and theoretically should increase the gas exchange leading to more oxygen in the blood.  But the oxygen needs to stay in proximity of lung alveoli long enough to do proper gas exchange.  It turns out that there must also be enough CO2 in that same region in order to do proper gas exchange, too.  Once you have a good setup to see the oximeter data, try a couple nights of EPR 3 and then a couple nights with EPR 2, and see if the EPR 2 results in increases in spO2, and also note if there is any difference in the minute vent values (either the reduction in variation or the general increase of minute ventilation.)

See picture at http://pedilung.com/pediatric-lung-disea...-alveolus/

QAL

ps. if low oxygen persists it should be brought up to the physician and may result in change of therapy or addition of supplemental oxygen.
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