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[Pressure] TheWallofSleep's Therapy Thread
#51
RE: Help Calibrating APAP Pressure
flat, sloping, jagged, m or w shaped tops of inhale waveforms indicate flow limitations. I don't see much of it in the 7:28 screenshot. I see both flagged and unflagged flow limitations in the two other screenshots. the flow limit stats in your charts that I've seen are good (close to 0 in the 95%tile column) but some people are more sensitive than others and we know the machines miss as much or more than they catch. IF, emphasis on if, flow limitations are truly affecting you, additional pressure support provided by the vauto could help.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#52
RE: Help Calibrating APAP Pressure
(06-15-2021, 10:54 AM)SarcasticDave94 Wrote: Here's the calculation using the same calculator I have my example from

372 mL
Tidal volume if target is 6 mL/kg, IBW 62 kg
496 mL
Tidal volume if target is 8 mL/kg, IBW 62 kg

So about 375-500 Vt AKA tidal volume

Compare both lines of mine, spreading my sample to show the same 2 lines...

426 mL
Tidal volume if target is 6 mL/kg, IBW 71 kg
568 mL
Tidal volume if target is 8 mL/kg, IBW 71 kg

So my Vt range is supposedly a bit more as I'm 4 inches taller

About 425-570 Vt for me except I'm not 71 kg but a bit over at 104.3 so my Vt would likely be even higher. I've also heard that since I was taller up until 4 years ago, major back problems, broken vertebrae and degenerative disc etc, I was about 6 foot tall about then, with my highest height being 6'2"in my twenties and early thirties. That shortening may have compacted my lungs, causing even more issues.

My Vt, seems on the lower end but within expected limits, so I will not take much concern with it. I would imagine compression of the lungs would exasperate problems with a preexisting sleep breathing disorder. Just something I am curious about, are the Resmed machines mechanically identical with different programming, or is the hardware inside of the APAP, VAuto, and ASV different? I do not know if the hardware inside the ASV/VAuto was more sophisticated than a CPAP/APAP or not. This would not surprise me either way. It appears as if they could make a machine do all of the above, they just choose not to, possibly to earn more money as well as to prevent patients from deviating from their prescribed therapy by using alternate functionalities of the machine.
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#53
RE: Help Calibrating APAP Pressure
I greatly appreciate all of the insight from all ends. I am still waiting on a detailed copy of both my PSGs from last week and November of 2019, I will share those here as soon as they email them to me. Right now, it really seems like I have three dimensions to analyze here: PLM/RLS, centrals, and flow limitations, all of which are inconsistent in how they behave and how they affect people. I know neither my FL nor centrals seem unnaturally significant, but I still feel sleep deprived, so either one or both must be contributing to some extent as well as PLM. I am not discounting PLM at all, but I am medicated, and have been at a higher dose in the past (which I lowered because I didn't think it made much of a difference), and I would imagine if PLM was the sole problem, I would have more good nights mixed in there. It seems like there are too many variables that consistently line up against me. I want to see what my lab results look like first, but If my numbers are better than the first study, I will push hard for a Vauto and may even still look at buying a used ASV later on. I hate spending money like that, but it may be necessary to isolate the problem since they each treat different things. I may find that the subtle FL are actually a bigger contributer, or maybe its my central index. I see my doctor in early July, I will also talk about increasing/changing medication for PLM. This is something that clearly needs to be tackled one axis at a time.

Edit: I will decide the order to approach these in once I receive my lab results. I may find something in there that changes the game board, for better or for worse.
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#54
RE: Help Calibrating APAP Pressure
Attached is the lab results from my 2019 study, still working on getting my 2021 study. I hope this clear enough to read, my doctor received it in a fax prior to sending it to me. Unfortunately, there is only about four hours of data to use.


Attached Files
.pdf   PSG2019 Redacted.pdf (Size: 875.71 KB / Downloads: 5)
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#55
RE: Help Calibrating APAP Pressure
Everything you've had on the test were Central or Hypopnea. I don't see 1 Obstructive.

Then on the Titration, they burned 155 non-supine and 45 minutes supine on a pressure of 6, netting 5 CA and 4 Hypopnea. At pressure 5, they burned 35 min netting 1 CA, 6 Hypopnea. They allowed 3.5 minutes for pressure 7 and didn't gather any data there. Then they quit. They wasted you time IMO by some bogus bad diagnosis of Obstructive Apnea.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#56
RE: Help Calibrating APAP Pressure
(06-17-2021, 10:13 PM)SarcasticDave94 Wrote: Everything you've had on the test were Central or Hypopnea. I don't see 1 Obstructive.

Then on the Titration, they burned 155 non-supine and 45 minutes supine on a pressure of 6, netting 5 CA and 4 Hypopnea. At pressure 5, they burned 35 min netting 1 CA, 6 Hypopnea. They allowed 3.5 minutes for pressure 7 and didn't gather any data there. Then they quit. They wasted you time IMO by some bogus bad diagnosis of Obstructive Apnea.

That's not the best part either. I had that sleep study done because I was complaining about how I did not feel any better from my APAP therapy. I kept insisting that there must be a component that we must be missing since it seemed that everybody who was on CPAP had their life changed, which was an experience I was yet to have. I was struggling to wear the mask for a long time, and was even declared "CPAP intolerant", which later sent me down the rabbithole for an oral appliance. My pulmonologist is doing the best to her ability, she is always willing to give referrals, but everything is always a month out from the next. Even after titrating up to 10cmH2O, the central and obstructive events are still consistently prevalent. I am probably going to bite the bullet and buy a used ASV to see if that helps.
The way I see it, I get an ASV to help fight complex sleep apnea, or VAuto to help with possible flow limitations. The latter I may be able to get through insurance if I push hard enough (I could make a case for CPAP intolerance), but the earliest appointment is 3 weeks out, and the only way to be certain is to try it. As I commonly hear on this forum, it is not worth chasing numbers.

Edit: If the ASV fails me, I can always resell it at a loss- just hopefully not a significant one. Does anyone have any experience selling back to one of the suppliers?
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#57
RE: Help Calibrating APAP Pressure
I don't myself, but the best shot would be Supplier #2 if the one you're attempting to resell would be low mileage.

On the VAuto, some with Centrals have used high or very high trigger and it's lowered their CA to a reasonable level.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#58
RE: Help Calibrating APAP Pressure
(06-17-2021, 10:44 PM)SarcasticDave94 Wrote: I don't myself, but the best shot would be Supplier #2 if the one you're attempting to resell would be low mileage.

On the VAuto, some with Centrals have used high or very high trigger and it's lowered their CA to a reasonable level.

Noted, I'll keep that page bookmarked. Part of the problem is that in theory, my centrals are under control. If ASV does a good job handling central events, does it do a good job handling OA and HA as well? By good, I mean, does it handle them as well as the AirSense 10 Autoset even though it is not it's primary function? Can you be worse off with an ASV, or is it always at least as good as the former option?
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#59
RE: Help Calibrating APAP Pressure
This may be worth noting as I have seen some older advice on here that states the contrary, Supplier #2 now requires a prescription. Until I receive that, I am dead in my tracks.
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#60
RE: Help Calibrating APAP Pressure
Give them a call. See what they state. Calling also gets you the best price and you can find out how many hours are on the PAP clock.

And FWIW, if you really are planning on buying an ASV, talk with you doc. Ask for a script stating that you're buying with cash. Maybe doc picks up the pen and scribbles on the script pad.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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