Need set-up help for ResMed Airsense 10 for Her

[Sleeprider]

The Respironics Auto machines are very poor at raising pressure with flow limitation which is a main feature of your sleep. We mentioned flow limitation before. Resmed increases pressure much faster on flow limitation, and the For Her model specifically targets FL.

Are you saying that the Respironics AUTO machines raise pressure is poor but RESMED is better?  I was considering asking for the For Her model but not if air flow is limited.  Sorry to be so dumb....I THINK I want to ask 'what is flow limitation?'
Thanks. Lynneat  
Newbie question:
You wrote:

The Respironics machines are unfortunately nferior at treating most obstructive sleep apnea including flow limitation when compared to the Resmed.  Flow limitation in particular responds better to bilevel (separate inhale and exhale) pressure. The Resmed exhale pressure relief (EPR) is bilevel, but limited to 3-cm. The Respironics Flex are slight pressure modifications for comfort during inhale or exhale transition but is not bilevel.  In addition, the Resmed autoset algorithm is much faster to respond to flow limitation, and the For-Her model is specifically designed to help with flow limitation. Here is how for her is different from standard autoset:

[duncanblizzard]

I'm now using my Aircurve 10, but I'm tossing and turning during the second half of the night and waking up tired.  I think the data is saying I still have flow limitations and need to raise the pressure.  I would guess that means go to 13/6 with pressure support of 5.

Chart 2 shows the settings, but I think you can guess those from the data.

Thoughts?

[Sleeprider]

The posted charts are for a PRS1 60 Series APAP. Maybe post something from the Aircurve 10?

[duncanblizzard]

Sorry.  These should be the right charts.

[jaswilliams]

Sorry.  These should be the right charts.

Reduce the height of the events graph and include the flow limitation graph. But I see nothing major here

[duncanblizzard]

Maybe you can help me understand what adding those does to help understand my data.

[Gideon]

Flow Limits are important because
1. when Flow Limits raise in level pressure is algorithmically increased.  In your detail graph you can see 2 small bumps in the flow limit and in the pressure graph your pressure is increasing in response.

2. Flow Limits can be disruptive to your sleep at times.

3. Flow Limits at times lead into RERA which by definition is a series of flow limits ending in arousal.  Eliminate Flow Limits and you eliminate the RERA arousals.

Event Definition Apnea, Hypopnea, Flow Limitation
Apnea: 80% to 100% reduction in airflow for >= 10 seconds
Hypopnea: 50% to 80% reduction in airflow for >= 10 seconds
Flow Limitation: <50% reduction in airflow for >= 10 seconds

These events represent different degrees of similar events. All of these may be disruptive.

[duncanblizzard]

I never really got an answer last weekend, so I've been making changes on my own.  First I changed to 12/5 with PS 5.  Then I changed to 12.6/5 with PS 5.  I'm making changes because I'm tossing and turning a lot at night and for comfort reasons.  I'm trying to figure out when and why the arousals are happening.

I've attached four charts.  This is the overall.  I was at full pressure longer than I wanted to be which might have affected me.
   

Chart 2 shows a period of erratic flow rate.  There is no corresponding flow limitation.  Is there a way to tell what is causing this erratic flow?
   

Chart 3 are the two CAs listed.  I'm not sure if there is a cause for these.  I believe the amplitude of the flow rate is how deep I'm breathing.  Is that correct?  If so, am I right in understanding that I'm going from shallow to deeper and deeper breathing over this period?  Why is the pressure not rising over this period? Does the Aircurve not respond to CAs -- only to OAs and flow limitations?  And I'm wondering if and arousal is happening at 2:31:45 which leads to my deepest breathing on this chart?
   

Chart 4 seems to show a flow limitation trigger a high pressure and shallower breathing from me.  Am I right in attributing the cause of this to the flow limitation, or is the flow limitation the effect because it appears to have a small lag from my shallow breathing?  Then for some reason I breathe deeper perhaps because I'm turning to the other side because of an arousal due to the higher pressure?
   

[Sleeprider]

I think you have taken your pressure support high enough. The tidal volume is very high and there really isn't any flow limitation showing in the wave form. At PS 5.0 over 5.0 to 12.6, your practical range is only 10/5 to 12.6/7.6, so you are working a very narrow pressure range. Since you don't have any OA, there is no need to add to the maximum pressure. Pressure does not rise for CA, and may even drop.

[duncanblizzard]

Sleeprider, can you help me understand the tidal volume.  What is the impact of a high tidal volume?

My sleep doctor changed my settings on Monday.  The machine was not in synch with my breathing rhythm and was causing chest pain.  His changes have definitely improved that.

My settings are now

Max IPAP:  14
Min EPAP:  5
PS:  6
Ti Max 2.5s
Ti Min 0.8s
Trigger Low
Cycle High

He also said I might need a machine with back up, but we'd try this first.  What is back-up and why is this important?

Also, I am seeing regular varying disturbances all night.  Many of them appear cyclical.

My flow limitations are pretty much gone.  Why would I be having irregular breathing?  And is the cyclical pattern of concern?  It doesn't rise to the definition of periodic breathing, but I don't know if it still has meaning.

Thanks!