[Pressure] Do I need a Bi-Pap or higher pressure APAP?

[Johnnyde94]

I have to say even with the high min and max pressure I’m handing treatment very well and the results are life changing. The only issues I am having is that my ears pop when first turning on the machine and the neck pain with the cervical support. I got the 3M product and I lowered the center chin super part and that seemed to help a lot. I’m going to try and see if I can loosen the straps a bit and still get a good seal as I am feting some marks and irritation. I’m curious if I’m still having reras and that’s the only complaint I have with this machine. The humidifier tank is much larger a than the dreamstation and I’m not having to refil at night but, I do have a backup tank I will change out if I happen to wake up and the tank is gettting low.

I will raise the PS and see what that does to the flow limitation. What do you guys think about the min pressure I feel like it’s at a good enough pressure but if raising it will help lower RDI more I can try it.

[Johnnyde94]

   
Looking good!

[Sleeprider]

Considering where we started, this is great.

[Johnnyde94]

   
   
   
looking good but there are a few clusters for some reason.

[Sleeprider]

I'm just going to note for the record that your flow limitation acts in unusual ways and does not appear to respond to increased pressure support. Your results have not changed much in moving from PS 4.0 to 5.0 and 5.4. Flow limitation and snoring appear to vary randomly during the night and don't even seem to correspond to the small clusters of OA. On the other hand, you show no indication of central apnea and your overall results are greatly improved on bilevel vs CPAP.

[Johnnyde94]

Odd could trying to increase PS to 6 be a good idea to see if that gets the flow limitation under control. I don’t know enough yet to get a read on what the flow limitation is being caused by. Could it possibly be caused to the positional apena? I am using the collar though so that would he unlikely. Also could it be from the cover I have over my tube? I currently have two or 3 covers on it to keep it from raining out.

[Sleeprider]

If you are comfortable with it, so am I. There is nothing in your results that contraindicate the use of higher pressure support, there is no guarantee it will make a big difference based on the trend I have seen so far.

[Johnnyde94]

I know that too much PS can cause CA in some is that correct? I’m sorda confused on why the PS would help flow limitation

[Gideon]

The best explanation I can give.
Flow Limits typically to Flow Limitation and are a resistance to breathing.
EPAP (exhale pressure) is the accepted treatment for Obstructive Apnea which is accepted as the worst form of obstructive apneic events. Thus this is used as a base pressure.
Pressure support is a 'boost' in pressure to apply additional splinting on inhalation thus treating the Flow Limitation.

PS may cause CA in susceptible individuals by flushing out too much CO2.

[sheepless]

as often as it's been described on this forum, I can't tell you the physics of pressure induced ca (co2, apneic threshold...) other than a layman's assumption that we fight overventilation by not breathing.

flow limitation is a form of restricted breathing on the lower end of the continuum of obstructive apnea, all of which is treated with pressure & pressure support when available to overcome a physical restriction. ca won't respond positively to pressure the way it's delivered in cpap & bilevel machines because ca isn't caused by restriction, but as an interesting side note, asv treats ca with a relatively short burst of pressure, nudging us to initiate an inhale.