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Need help on cpap settings
#51
RE: Need help on cpap settings
(09-27-2020, 08:03 AM)Sleeprider Wrote: "Your 95% flow limit remains quite high at 0.18 and the better solution for this is pressure support, but I would not hesitate to try higher pressure to see if that can improve things."

Sleeprider, what number do you generally consider the upper limits of acceptable for the 95% flow limit?
MacBookPro Catalina, Windows 10 (Parallels 16), FlashAir 16GB W-04, FlashPAP,
Contec CMS50F Pulse Oximeter (08/2020), Hardware v2.0.0, Software v2.0.5, 
Smart Device Assistant 3.1.0.1
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#52
RE: Need help on cpap settings
(09-27-2020, 12:46 PM)Bobaloo Wrote:
(09-27-2020, 08:03 AM)Sleeprider Wrote: "Your 95% flow limit remains quite high at 0.18 and the better solution for this is pressure support, but I would not hesitate to try higher pressure to see if that can improve things."

Sleeprider, what number do you generally consider the upper limits of acceptable for the 95% flow limit?

I see you thoroughly answered this a few hours ago here: http://www.apneaboard.com/forums/Thread-...#pid368001
MacBookPro Catalina, Windows 10 (Parallels 16), FlashAir 16GB W-04, FlashPAP,
Contec CMS50F Pulse Oximeter (08/2020), Hardware v2.0.0, Software v2.0.5, 
Smart Device Assistant 3.1.0.1
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#53
RE: Need help on cpap settings
Bobaloo, thanks for linking in the other thread.  That is exactly how I see your results as well.

Quote:In general, Any flow limitation showing up in the median statistic is a significant problem. I look for 95% flow limitation above 0.2 as needing more pressure or pressure support, therapy, below 0.15 as marginal, 0.1 as good, with levels below 0.05 as excellent and rarely associated with other therapy problems. The maximum statistics are not as significant.

Your last chart shows a 95% flow limit of 0.18 and I think your issue is either positional or you may benefit from bilevel.  Let's look at the chart with the mask pressure and talk about a particular problem.  Where flow limitation starts to be severe, your Airsense 10 is triggering IPAP twice in one breath. See the double peak and much shorter overall pressure peak? This is the result of your inspiratory effort being so weak, or the airflow resistance so high, that the machine can't tell what to do.  The most likely answer to this particular problem is to remove the airway resistance with a soft cervical collar that prevents chin tucking.  The alternate way is to use inspiratory pressure support from a bilevel to overcome the airway resistance.  Unlike EPR on your Airsense 10, the PS on the Vauto can be set to a minimum time of inspiration so it doesn't shut down once it starts for a minimum amount of time. Its sensitivity to inspiratory effort can be increased, and you can use more than 3-cm of increased inspiratory pressure (pressure support) to help overcome resistance or flow limitation.  This is the benefit of bilevel.  I'm not suggesting you jump to bilevel, but rather that you determine whether the flow limitations originate from a positional issue you can resolve without bilevel, and whether this happens frequently enough to be a worthwhile consideration. 

Another option may be to allow some pressure increase, by allowing your Autoset to increase pressure in a range of 12 to 14 cm and see if that helps.  I think we previously determined your flow limitations are frequent enough that, no matter what range we allowed, the machine would seek the maximum pressure and stay there.  That would be another indicator that bilevel would be beneficial.
Sleeprider
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#54
RE: Need help on cpap settings
Thanks for explanation. . Sleep worse over the years, tired of waking up every 1-2 hours every night. I would get the bi-level if needed, now will try chin strap, ssc first. May try increasing my pressure upwards if the positioning isn't affective.
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#55
RE: Need help on cpap settings
(09-27-2020, 01:39 PM)Sleeprider Wrote: Bobaloo, thanks for linking in the other thread.  That is exactly how I see your results as well.

Quote:In general, Any flow limitation showing up in the median statistic is a significant problem. I look for 95% flow limitation above 0.2 as needing more pressure or pressure support, therapy, below 0.15 as marginal, 0.1 as good, with levels below 0.05 as excellent and rarely associated with other therapy problems. The maximum statistics are not as significant. 

Thanks Sleeprider. I responded in my own thread here: http://www.apneaboard.com/forums/Thread-...#pid368032
MacBookPro Catalina, Windows 10 (Parallels 16), FlashAir 16GB W-04, FlashPAP,
Contec CMS50F Pulse Oximeter (08/2020), Hardware v2.0.0, Software v2.0.5, 
Smart Device Assistant 3.1.0.1
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#56
RE: Need help on cpap settings
            First night with Bridgenight chin strap. Stopped the mouth leaks(great), but more hypopnea and oa. Flow rate up even more. I will experiment with chin strap positioning and tension. I may have had it too far back( will move closer to chin), and try loser tension on strap. do wonder about waxing and waning of flow rate.
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#57
RE: Need help on cpap settings
In your case the waxing and waning flow is related to flow limitation, and this cluster in particular is positional. The choices are higher pressure or a soft cervical collar. With leaks under control with the Knightsbridge dual chin strap, higher pressure is back on the table.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#58
RE: Need help on cpap settings
I have increased the IPAP to 14, after couple days flow limitations seem unchanged. Leakes improved with chin strap, only wearing it first 4 hours then it interrupts sleep( working on wearing longer). Chart here shows apneas last night. Do we worry about length of apnea even when total AHI are low? How long of apnea time wise are worrisome?


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#59
RE: Need help on cpap settings
Data from last few changes in Rested settings. Any suggestions?


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#60
RE: Need help on cpap settings
Daily charts please.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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