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Positional Apnea and going for CPAP
#21
RE: Positional Apnea and hesitant about CPAP
Flow limits are persistent and lead to respiratory effort related arousals. It's nice to have a perfect AHI, but I couldn't live with these settings. I take back my previous settings and raise you to 7.0 minimum, 10.0 maximum EPR 3. This will start you at 7/4 pressure and allow up to 10/7 pressure. All of these flow limits and arousals are due to pressure being too low to maintain the airway and support good respiration. Zoom into your flow rate at about a 3-minute resolution and you will see a bunch of flattened inspiratory waves where you are essentially sucking for air like drinking a milkshake through a narrow straw. If you will accept my suggested settings, it will be more like the milkshake being pumped through the straw to assist your effort. As far as feeling better, that comes in time, and you haven't resolved the arousals. Look at the inspiratory flow spikes.
Sleeprider
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#22
RE: Positional Apnea and hesitant about CPAP
Thanks so much for your explanation.

Attached is a zoom in on a point where the machine detected flow limitation and raised the pressure. To my untrained eye it doesn't look like anything major is going on at that moment. The second waveform from the very left hand side at 01:13:00 looks much worse, but the machine did nothing. Could you educate me on what to look for?

Also, when I look at the zoomed out view I sent yesterday, I don't see that the flow limitations go away after the machine raises the pressure. Isn't that what we would expect to see?


Attached Files Thumbnail(s)
   
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#23
RE: Positional Apnea and hesitant about CPAP
OK I think I get why the FLs are being flagged in the screenshot in my previous post - because the flow curve is flat-topped, right?

However I still don't understand why FLs don't reduce after the machine raises the pressure?
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#24
RE: Positional Apnea and hesitant about CPAP
BTW on the OSCAR chart I resized the FL y axis, so it goes up only to 0.3
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#25
RE: Positional Apnea and hesitant about CPAP
Excellent graph. Here we see a respiration flow rate that has a downward sloping peak, sometimes with a jagged or double peak. This is a classic form of flow limitation, and the Autoset is responding to it by increasing pressure by about 1-cm through the period.  We can see the exhale pressure remains at 4.0 cm through the entire period while inhale pressure increases.  Once pressure reaches 7.0 cm, the full EPR 3 will be realized, and then the EPAP pressure will finally rise.  My recommendation is pretty standard. Start the minimum pressure at 7.0 and leave maximum pressure at 12.0 so that your inhale and exhale pressure move together and can properly address both the flow limitation and relieve obstruction. Based on what we see here, the minimum pressure of 7.0 with EPR 3 will avoid the flow limits we see at the lower pressures, and I don't think you will see much variation in pressure above that.   The flow limits do respond once IPAP pressure his at 7.0 and EPR is finally maximized.  

[Image: attachment.php?aid=44438]
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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