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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]
Sorry was away. Can you post some examples of using PSmin of 2.5, I want to see how the data compres.

I do have one counterpoint to think about as I think there is a bit of placebo effect going on here. When you use fixed PS of 3 or 3.5 you got PS of 3 or 3.5 all night. On your good nights using a PS range your min pressure was still 3.5 and average PS was only slightly higher. If you use a range of PS and average PS is 3.5 then that is pretty similar to using a fixed PS of 3.5 (exception is if there are obvious periods the machine used higher PS to fight centrals etc).

If the machine was fighting centrals then the range could be advantageous but I don't see data of the machine fighting centrals with PS. It appears to me like backup rate alone has been enough to deal with the odd centrals you used to be having.

My gut feel is that fixed PS of 3/3.5 or a small PS range (2.5 or 3 to 4) might be your best setting. Something that keeps max PS low enough that it doesn't degrade spontaneous breathing rate.

I think those Ti and Rise Time settings are ok as is.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Ti and Rise time should be ok. These typically will be found in higher level models including most all ventilators, ResMed's VAuto and ST-A, Stellar and Astral, Respironics SV Auto to name a few.
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]
Oh and a home sleep study is useless at this point. All they are capable of is indicating if you may or may not have have sleep apnea and to give you an idea of severity. Completely and utterly useless for the UARS issue you are worried about (need PSG and specifically EEG data).

The only type of sleep study that could potentially be helpful is an in clinic titration study. That is a study that you use CPAP during and they adjust the pressures to try and find ideal settings. They monitor all sorts of data and can see if you are having RERAs etc indicative of UARS or if say a fixed PS of 3 treats all your breathing issues and if something else might be causing sleep quality issues.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(09-07-2021, 09:10 PM)Geer1 Wrote: Sorry was away. Can you post some examples of using PSmin of 2.5, I want to see how the data compres.

I do have one counterpoint to think about as I think there is a bit of placebo effect going on here. When you use fixed PS of 3 or 3.5 you got PS of 3 or 3.5 all night. On your good nights using a PS range your min pressure was still 3.5 and average PS was only slightly higher. If you use a range of PS and average PS is 3.5 then that is pretty similar to using a fixed PS of 3.5 (exception is if there are obvious periods the machine used higher PS to fight centrals etc).

If the machine was fighting centrals then the range could be advantageous but I don't see data of the machine fighting centrals with PS. It appears to me like backup rate alone has been enough to deal with the odd centrals you used to be having.

My gut feel is that fixed PS of 3/3.5 or a small PS range (2.5 or 3 to 4) might be your best setting. Something that keeps max PS low enough that it doesn't degrade spontaneous breathing rate.

I think those Ti and Rise Time settings are ok as is.
"Using a PS range your min pressure was still 3.5 and average PS was only slightly higher." - I got curious and made a quick table, including all data from 20th August to 7th September. Left is PS min, right is PS med.

PS 3.5 - 12.5
3.63, 6.38
3.50, 4.13
3.88, 6.25
3.50, 6.00
3.63, 5.25
3.75, 6.75
3.50, 6.00
3.50, 5.00
3.50, 4.63
3.50, 4.50
3.50, 6.25
3.88, 6.00

PS 2.5 - 12.5
2.75, 5.75
2.63, 6.00

PS 3.0 - 12.0
3.00, 4.50
3.00, 5.13
3.50, 9.00

When looking at the few nights where I get windows without timed breaths, I still get a PS of 4.5 often enough for it to seem important.

I can attach some PSmin 2.5 data if you still want to see it given the above?

(09-07-2021, 09:18 PM)SarcasticDave94 Wrote: Ti and Rise time should be ok. These typically will be found in higher level models including most all ventilators, ResMed's VAuto and ST-A, Stellar and Astral, Respironics SV Auto to name a few.

Thank you both for responding, and for clarifying Ti and Rise time. I'll ignore those then!

(09-07-2021, 09:20 PM)Geer1 Wrote: Oh and a home sleep study is useless at this point. All they are capable of is indicating if you may or may not have have sleep apnea and to give you an idea of severity. Completely and utterly useless for the UARS issue you are worried about (need PSG and specifically EEG data).

The only type of sleep study that could potentially be helpful is an in clinic titration study. That is a study that you use CPAP during and they adjust the pressures to try and find ideal settings. They monitor all sorts of data and can see if you are having RERAs etc indicative of UARS or if say a fixed PS of 3 treats all your breathing issues and if something else might be causing sleep quality issues.

A week ago I tried keeping EPAP 7 and setting PS to a constant 4. That night I slept well, other people noticed, so I checked the data and it looked good - RERAs / abnormal flow rate was much better than it is on lower pressures, but CA hadn't gone up! I decided to stick with the settings for a week and not check any data until today because I had an awful, awful day with my symptoms. Turns out my CA events increased each day, last two days were a bit lower but much worse than that first day. So it seems like it was just a fluke and I've not adapted to TECSA over the last few weeks of having higher PS. But my flow rate was far more consistent at PS 4 than at 3.0 or 3.5. 

I was looking into what my options are, and if medication can impact things, and came across EERS. I'm not sure if it's worth trying in my case?

Oh, and I had a terrible night last night. My partner said that I was on my side when they woke me up - and I had an imprint in my face where my mask straps had been pushed against my face. Whenever I have those imprints, I wake up feeling like death and taking over an hour to get out of bed, and I'm really dysfunctional. If my partner checks, it's always happened when I've been on my side at some point. One time I woke up feeling good, turned onto my side, slept for another hour, then woke up like this. I do wonder if side sleeping is causing me to awkwardly push the mask into my face and causing issues that complicate things. My best nights I also feel like I've barely moved, I wake on my back and my partner has never reported me side sleeping on good days. I'm curious to try a nasal mask, as I've used mouth tape the past two or three weeks and it works well - no more dry mouth.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
If it was just one night then that was just a bad night. You need to focus on treating average nights, you will always still have the odd bad night no matter what your settings etc are.

Medication or EERS are not worth trying imo. I have never seen anyone actually benefit from these although a few have tried. If results aren't satisfactory you need to get a better understanding of why and unfortunately about the only way that happens is with one if not multiple titration studies to see if/what is and isn't being treated effectively by your CPAP treatment. When it comes to UARS these guess and check methods rarely seem to work and imo it is because there if often more at play than just a simple breathing issue.

Position could be having an effect. All you can do is try to test the theory (sleep on side as test to see if always sleep poorly that way etc) and try to avoid positions that create issues.

Have you ever tried a reduced PSmin and range yet? Say 2.5 or 3 min and 4 or 5 max? That is the main thing I would be curious to try if I was in your shoes.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(09-19-2021, 05:31 PM)Geer1 Wrote: If it was just one night then that was just a bad night. You need to focus on treating average nights, you will always still have the odd bad night no matter what your settings etc are.

Medication or EERS are not worth trying imo. I have never seen anyone actually benefit from these although a few have tried. If results aren't satisfactory you need to get a better understanding of why and unfortunately about the only way that happens is with one if not multiple titration studies to see if/what is and isn't being treated effectively by your CPAP treatment. When it comes to UARS these guess and check methods rarely seem to work and imo it is because there if often more at play than just a simple breathing issue.

Position could be having an effect. All you can do is try to test the theory (sleep on side as test to see if always sleep poorly that way etc) and try to avoid positions that create issues.

Have you ever tried a reduced PSmin and range yet? Say 2.5 or 3 min and 4 or 5 max? That is the main thing I would be curious to try if I was in your shoes.

Thanks Geer, I agree with all of this. I'll avoid testing positional stuff and try to stick to sleeping on my back to keep everything consistent for now.

PSmin and range may have been reduced once or twice a while ago but never with BPM on. Shall I try 2.5 to 4 and see how it goes? Even if it gets stuck at 4 for some reason, it wouldn't be any worse than the constant 4 I've had all week.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Might as well, it isn't going to hurt anything and gives some more data points.

I think you only need higher PS at certain times and that for some reason (combination of your type of restricted breathing and PR ASV programming) this machine targets too high of a PS at times causing more harm than good. Hopefully this small range and handcuffed PSmax will allow it to help a bit when needed but stop it from going overboard.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(09-20-2021, 12:38 AM)Geer1 Wrote: Might as well, it isn't going to hurt anything and gives some more data points.

I think you only need higher PS at certain times and that for some reason (combination of your type of restricted breathing and PR ASV programming) this machine targets too high of a PS at times causing more harm than good. Hopefully this small range and handcuffed PSmax will allow it to help a bit when needed but stop it from going overboard.

Thanks Geer, I tried it last night, and will go for a week. I'll post the data tonight just to have day 1 on here. 

You mention my specific machine, and it's come up before. Given the recall, I want a new machine anyway. 

Is there a machine you'd recommend? I might not get it really soon, but the sooner I can order one the better.
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RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
That is the DreamStation SV Auto, correct? The ResMed AirCurve 10 ASV is what I had and what I'd suggest you request.

Also, note that you don't need to quote everyone that replies to you. Please consider just posting your response.

See this quote abuse thread if you wish.
http://www.apneaboard.com/forums/Thread-...ting+posts
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]
Thanks Dave! I completely agree, I just thought it might be necessary for notifying those involved in the conversation.

I've found a "ResMed S10 AirCurve ASV" - I imagine this is the one and ResMed just use SX to determine number? 

Could this machine also make use of non-ASV modes?

As for last night at the new settings Geer suggested, I kept BPM off and figured I'd get data on that first. I've attached full day and two zooms. One shows irregular flow rate, but not necessarily anything wrong with it..? and the other just shows centrals. My H events are just centrals, and there's 97 pressure pulses, many of which look like untagged centrals. I have good flow a lot of the time. Also at PS 4 or very close to it most of the time.


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