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Machine: ResMed AS 10 Mask Type: Full face mask Mask Make & Model: ResMed AirFit F30i Humidifier: Built-In with ClimateLine CPAP Pressure: APAP 12 to 15, EPR 3 CPAP Software: OSCAR
(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 13, Big Sur, Windows 10 (Parallels 16), FlashAir 16GB W-04,
Contec CMS50F Pulse Oximeter
Machine: ResMed AS 10 Mask Type: Full face mask Mask Make & Model: ResMed AirFit F30i Humidifier: Built-In with ClimateLine CPAP Pressure: APAP 12 to 15, EPR 3 CPAP Software: OSCAR
(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?
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.
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.
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.
Machine: ResMed AS 10 Mask Type: Full face mask Mask Make & Model: ResMed AirFit F30i Humidifier: Built-In with ClimateLine CPAP Pressure: APAP 12 to 15, EPR 3 CPAP Software: OSCAR
(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.
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.
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.
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.
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?