Raise or Lower Pressure for Flow Limitations?

[CPAPUserDave]

This here is a perfect example of flow limited breathing without a flow limitation in sight. I need higher pressure support and hopefully I can convince my doc of that on the 3rd of next month.

This was a minute before I woke up and took my mask off

i was also using the ResMed AirSense10 Auto with EPR at 3.0
now using ResMed AirCurve VAuto.

ended up purchasing BiLevel out-of-pocket, no more dealing with doctors/insurance for me.
so far, it seems like the purchase was wise. i think you'll like the extra features/settings you can get from the BiLevel
i still have some tinkering to do, but believe I am on the right track

good luck to you,

Dave

[CPAPUserDave]

Plateauing on the inspiratory curve on a few breaths, you had only two CAs and barely any leakage, so I don't see why you shouldn't slowly inch up your PS some more.

Your FL chart has also, unsurprisingly, gone down as you've increased PS
PS 4.6

PS 5.0

Ps 5.4

Love the way you organized the above three charts. really shows the progress. Thanks!

Sounds like some more pressure support within the coming days/weeks to see where that takes me. 
Anything I should look out for as increasing PS so not overdoing it?  CA's?

[JoeyWallaby]

Love the way you organized the above three charts. really shows the progress. Thanks!

Sounds like some more pressure support within the coming days/weeks to see where that takes me. 
Anything I should look out for as increasing PS so not overdoing it?  CA's?

CAs, aerophagia and the inspiration curve being extremely sharp are the three main signs I know of.

[Osiris357]

ended up purchasing BiLevel out-of-pocket

Thank you Dave, I’m probably going to do the same if I can’t get her to say it’s a medical necessity. My only hope is I can get her to write me a script for it. Otherwise I’m gonna have to hit the want ad sites and apps and search for another doc who will. I’ve never had a doc not go along with my suggestions as long as it wouldn’t hurt me but this time around might be my first.

[Sleeprider]

I think flow limitation is about out of the picture but there is a curious bump in the beginning of inspiration, and I have no good explanation for it. Maximum PS is whatever you tolerate comfortably or that does not result in over-ventilation that causes CA. You don't appear to be near either problem. If your Ti Min is still 0.3, take it up to 0.7 and see if that helps.

[CPAPUserDave]

ended up purchasing BiLevel out-of-pocket

Thank you Dave, I’m probably going to do the same if I can’t get her to say it’s a medical necessity. My only hope is I can get her to write me a script for it. Otherwise I’m gonna have to hit the want ad sites and apps and search for another doc who will. I’ve never had a doc not go along with my suggestions as long as it wouldn’t hurt me but this time around might be my first.

i used Supplier #2. check them out. no doc needed

[CPAPUserDave]

I think flow limitation is about out of the picture but there is a curious bump in the beginning of inspiration, and I have no good explanation for it.  Maximum PS is whatever you tolerate comfortably or that does not result in over-ventilation that causes CA. You don't appear to be near either problem.  If your Ti Min is still 0.3, take it up to 0.7 and see if that helps.

i will try Ti Min at 0.7 from 0.3

tried raising PS last night by 0.4, CA started to show up. will back off

Read/saw somewhere explanations of Ti Min/Max, Trigger, Cycle but now my searches are fruitless so far. anyone got a link?

[Sleeprider]

I use a high sensitivity for trigger if centrals start to arise out of use of pressure support, and in fact I use it for myself. I was averaging 0.8 to 2.5 AHI as mostly centrals for a while. That dropped to 0.0 to 0.5 with trigger sensitivity on high. It starts IPAP a fraction earlier with less spontaneous effort. I don't know if it applies to you, but no harm in trying. I was just trying to see if we could knock that bump out of your early inspiration by ensuring IPAP is on long enough for you to get well into the inhale cycle. It's a matter of comfort and experimenting with the settings to see what works best for you.

[Dormeo]

I think flow limitation is about out of the picture but there is a curious bump in the beginning of inspiration, and I have no good explanation for it.  Maximum PS is whatever you tolerate comfortably or that does not result in over-ventilation that causes CA. You don't appear to be near either problem.  If your Ti Min is still 0.3, take it up to 0.7 and see if that helps.

I think I need a scorecard!  If I'm tracking correctly, the curious bumps are on a chart belonging to Osiris, not the OP, who is CPAPUserDave.  Do I have that right??

[Osiris357]

Dormeo I think your correct. I posted that for a reference for what I was saying to the OP.

Sleeprider I wish I knew what they were also. They are posted in my thread towards the end also if you’d like to take a look again. Don’t wanna high jack this thread