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Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(08-31-2021, 09:53 AM)Crimson Nape Wrote: If they work for you, "Go For It!".   The object is to obtain the best therapy you can achieve.


Thank you for responding - Although since we're taking a "one change at a time" approach, and i imagine settings would have a different impact on someone after using tape to prevent mouth breathing, I'm not sure if it's a good idea. But I could be wrong. My issue is that "best therapy" is alluding me/us so far, and something subtle like mouth strips isn't worth throwing off progress on settings overall.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Think of this as a process of error elimination. You mouth taping eliminated one slight problem/annoyance. Now, you can start addressing another area.
Crimson Nape
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(08-31-2021, 10:45 AM)Crimson Nape Wrote: Think of this as a process of error elimination.  You mouth taping eliminated one slight problem/annoyance.  Now, you can start addressing another area.

I agree! I just didn't know if that was at the expense of our current investigations! But I appreciate what you're saying and you did prompt me to actually have a look. 

I've attached last night, a zoomed 25 minute area, and a zoomed hour. 

- Flow rate looks very stable! Especially for me.
- 724 timed breaths, the lowest they've been since starting with the ASV and autoBPM. Yesterday was 1024.
- Tagged FL events recorded to be 2, the lowest it's been. Yesterday it was 12. 

I slept for almost 5 hours - I can feel I should have slept more, but my brain fog was much lower, random aches had decreased, clearer headed all day. Which isn't uncommon when I have a decent night on the machine with too little sleep. BUT! I've been more social, had more motivation for chores I usually put off, and even itch to exercise, eat healthier, pursue hobbies, etc. This is a massively pleasant surprise, and is not usual for me regardless of my SDB/UARS treatment so far. I almost don't trust it, fully expecting it to be placebo or something. It was weird walking to work without a dried out mouth, I couldn't stop noticing it lol. 

I understand this is a single night and maybe a fluke, we'll see I suppose. But I'm thinking that mouth tape for this second week is a good test if nothing else.


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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Yesterday was great, with 4 hours 50 minutes sleep.

Today I lost all positive. Woke with gray circles/bags under my eyes, full of wrinkles, it's never looked so bad. I also felt really exhausted all morning. 

I woke up feeling good for a few seconds, then slept for another hour.

I've attached the day. No zooms - not sure anything is important that we don't already know. I had alarms on at 7.30, 8.30, and 9ish. Hence the breathing changes after 7.30.

Much more timed breaths. Average PS was higher. 

Considering my CA events were at like 1 an hour, having so many timed breaths is a bit strange, and with 2300 timed breaths last night I'm not convinced it's getting better anytime soon.

On constant PS my worst days had gone, but I never had good days. On these settings, my best days are better than usual, but I get worse days again. It's like the range is bigger in both directions, rather than trending to the better / more treated side of things.

All that being said.. just carry on..?


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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
To go back is OK, do you have enough to call this a success or failure, or do yopu wish to defer that call until after the more conventional approach WO ASV?

if so
Mode = "S"
EPAP =7 (same as on ASV)
IPAP = 10.5 (PS= 3.5 the Min on ASV) the intention is to gradually, very gradually increase PS/IPAP)
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(09-01-2021, 04:00 PM)Gideon Wrote: To go back is OK, do you have enough to call this a success or failure, or do yopu wish to defer that call until after the more conventional approach WO ASV?

if so
Mode = "S"
EPAP =7 (same as on ASV)
IPAP = 10.5 (PS= 3.5 the Min on ASV) the intention is to gradually, very gradually increase PS/IPAP)

I experienced a "treated" day, providing a good reference, and hope. But treatment has been more inconsistent with lower lows.

Overall, I'd say this is still inconclusive as there's things from Geer1 and SarcasticDave for us to try that we ignored for the sake of changing one variable at a time, right? So it's not necessarily a success or fail yet. I wonder if I should try PS min 3 instead of 3.5, like Geer1 suggested, to see if the number of timed breaths goes down? 

I think no ASV isn't a good plan - I'd been trying that for 8 months without much progress. I just checked, I had a constant PS of 3 from Feb 16th to April 13th, and CA didn't improve at all. In fact I had the same CA at PS 4 a little later. I tried PS 4.0 - 5.0 on ASV (but no backup rate I believe), I had a much higher CA. Same as our tests this last week. I think that my centrals just skyrocket with ASV for some reason. I guess the odd central sparks a PS raise that makes a PS -> Central -> PS loop. 

Anyway. I think our options are:

- Traditional constant PS slowly moved upwards.

- Try to adjust ASV as per Geer1's suggestion that minimum PS might be too high.

- Try to set the backup rate to prevent the excessive timed breaths, as per SarcasticDave's suggestion.

Geer1's comment implies that setting the backup rate isn't the issue. I've checked my PS and even a PS of 2 doesn't lower the centrals, but I'm not sure if that's relevant to the overall idea presented.

So I'm a bit lost. A part of me thinks gathering data on this current setup with a lower minPS is a good idea, following Geer1. Unless you have any insight/advice? What would you do?

Edit: At this point, I'm happy to try different machines or whatever else if that helps.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
The untreated CA will have the consistently inconsistent attribute until or unless ASV treats. So I'm not surprised. Your choice to exhaust all possible solutions. This way doc and insurance can label the current PAP a fail.
Dave

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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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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
We have pushed your CO2 levels with ASV,. And because of ASV eliminated centrals. Complete the 2nd week.

Then try the EPAP 7 IPAP 10.5 and see what we get. With luck you will have somewhat adapted and can handle PS3.5 without ASV. We would need to see what centrals do.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(09-01-2021, 06:13 PM)SarcasticDave94 Wrote: The untreated CA will have the consistently inconsistent attribute until or unless ASV treats. So I'm not surprised. Your choice to exhaust all possible solutions. This way doc and insurance can label the current PAP a fail.

Thank you Dave. Being from the UK and self treating, there's no insurance or doc on my end unfortunately. It does sound like ASV is definitely necessary from a CA perspective then? Do you agree with Gideon's comment quoted below, or have a different opinion? 

(09-01-2021, 06:19 PM)Gideon Wrote: We have pushed your CO2 levels with ASV,. And because of ASV eliminated centrals.   Complete the 2nd week.

Then try the EPAP 7 IPAP 10.5 and see what we get.  With luck you will have somewhat adapted and can handle PS3.5 without ASV.  We would need to see what centrals do.

Okay, thank you. I think I'm near the end of the second week anyway - is there anything I could do to be more useful with the resulting information? I imagine a table of each day and the corresponding number of timed breaths for sure, but is a weekly mean, or hour by hour manual count, or anything like that important? 

If I don't adapt to 3.5, then this doesn't bode well does it? Since any UARS treatment with ASV that sets PS over 3.5 will likely still cause issues.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
I'm in agreement with Gideon. Sorry I actually forgot what you were on, a DreamStation SV Auto. That's why my comment was a bit of a disconnect.
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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