OSCAR data review - Low AHI Still tired

[cwbolton]

I see, prima facie, that your flow limitations are highly co-incident with leakages that were recorded and with snoring.  There may be no correlation at all, but I wouldn't bet on it.

Even though i dont really understand what you're saying, does showing you a few nights more worth of data help?

[Gideon]

RERAs are a series of Flow Limitations that end in Arousal.  Flow Limitations in and of themselves frequently are not an issue,  Yours were combined with snores and should be at least somewhat lowered.  BUT if you are not feeling a difference with the changes, don't chase numbers.

[cwbolton]

RERAs are a series of Flow Limitations that end in Arousal.  Flow Limitations in and of themselves frequently are not an issue,  Yours were combined with snores and should be at least somewhat lowered.  BUT if you are not feeling a difference with the changes, don't chase numbers.

Understood, i'm not in a rush to get magic results and dont feel the need to go crazy with the settings, would you just suggest increasing my pressure by 1 and seeing how i feel over changing the EPR? So my flow limitations didnt end in arousal is that what the data suggests? Or do you think the flow limitation could be contributing to my daytime fatigue?

Thanks

[Gideon]

It could be. It's worth trying, and I wouldn't decrease the EPR.
Keep in mind that the EPAP pressure is the important airway splinting pressure when using ResMed with EPR, just as it is with a BiLevel.

[cwbolton]

Understood, ill raise the pressure by 1 and take it from there, ill reply back to this thread in a couple of days with the data.

I dont understand what you just said about EPAP pressure though.

Thanks for your help.

[Gideon]

It's the "low" pressure that splints the airway, and that is the purpose of a CPAP.

[cwbolton]

Oh i see now so its actually the EPAP pressure that keeps the airway open, hence the flow limitation being related to the EPAP pressure needing to be higher, which we are doing by raising the overall pressure.

Thanks

[Gideon]

Flow Limitation is actually treated by the IPAP the higher pressure, on a BiLevel I would have you increase PS to increase IPAP and maintain a lower overall pressure.

[cwbolton]

So the only way to increase the IPAP on my machine is to increase the overall pressure hence why were doing it, but if i had a BiLevel i could do it some other way is what i think you're saying.

So why we're we talking about the EPAP earlier? Is flow limitation not linked to the airway splinting pressure as i thought flow limitation causes the airway to narrow, hence needing a higher splinting pressure to avoid this?

[Gideon]

BiLevel titration protocol calls for increasing Pressure Support, the difference between EPAP and IPAP for Flow Limitation. So Flow Limitation is not hard linked to EPAP the basic Airway splinting pressure.
With CPAP without EPR your only choice is to increase Pressure. That single pressure is both EPAP and IPAP.
Your Elite CPAP machine when EPR is enabled actually acts like a BiLevel, up to 3cmw of PS. You just have to pay attention to what pressures do.