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Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
#31
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Yes, this is looking for comfort. CA shouldn't change more than it's normal variation since EPR isn't changing.
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#32
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(07-29-2021, 01:36 PM)Gideon Wrote: Yes, this is looking for comfort.  CA shouldn't change more than it's normal variation since EPR isn't changing.

I think I understand, but there's a reasonable chance I won't see this amount of CA in the longer term, right? I feel pretty bad today and couldn't keep working long term with this sort of mental slowness, headache, etc.

I'm not sure a lower EPAP will be an increase in comfort, purely because I don't find it uncomfortable at all! I'm lucky that I'm not one to be bothered by my machine/mask/treatment in that sense.
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#33
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
This is just validating your best pressure with you evaluating. These lower pressures are really just tests

It is the PS that should be important for your comfort. To increase PS you need to adapt to it. That means you need to ignore these CA events for a while

The alternative is we increase your min PS to treat your UARS and boost yourax PS to manage the CA that will be big and heavy. Realize you failed this earlier.
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#34
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(07-29-2021, 02:55 PM)Gideon Wrote: This is just validating your best pressure with you evaluating.  These lower pressures are really just tests

It is the PS that should be important for your comfort. To increase PS you need to adapt to it.  That means you need to ignore these CA events for a while

The alternative is we increase your min PS to treat your UARS and boost yourax PS to manage the CA that will be big and heavy.  Realize you failed this earlier.

Ahhh, lightbulb moment!

Thanks for being patient with me.

Following EPAP 5 test:

- Sit at PS 3.5 for weeks/months, hoping CA decreases.
- Raise PS by 0.5
- Repeat above two steps until either the chart looks good, sleep/symptoms subjectively improve, or CAs don't go away, whichever happens first. 
- If CAs won't go away or no PS seems to help my flow rate issues, consider alternative therapy.

Is that a rough guideline for the way things can pan out? Would expecting some sort of conclusion on the effectiveness of my machine by this time next year be a reasonable expectation?

Also, I'm not sure I did try having a variable PS for treating CA, I never even realised I could treat CA with that. I've had high max PS before, but that was with a big variation in min to max EPAP as well, and without my collar.
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#35
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Your machine is designed to treat CA.

Settings would start at something like this
Mode: AutoASV (This will maintain a "constant" Tidal Volume by manipulating the below settings)
Min EPAP = 6 ( or better pressure )
Min PS = 5 (targeting the UARS) normally would be = 3
Max PS = 15 (targeting the CA events) you need enough to 'force' a breath, it will only go up as high as it needs.
Max IPAP = 25 (Machine Max)

Note: You recently had a significant issue with PS = 4, how do you think you will handle a PS of 10+?
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#36
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(07-29-2021, 03:44 PM)Gideon Wrote: Your machine is designed to treat CA.  

Settings would start at something like this
Mode: AutoASV (This will maintain a "constant" Tidal Volume by manipulating the below settings)
Min EPAP = 6 ( or better pressure )
Min PS = 5 (targeting the UARS)  normally would be = 3
Max PS = 15 (targeting the CA events) you need enough to 'force' a breath, it will only go up as high as it needs.
Max IPAP = 25 (Machine Max)

Note: You recently had a significant issue with PS = 4, how do you think you will handle a PS of 10+?

I see, thanks for the explanation! So I'm guessing if I can't adapt to higher PS, I just won't be able to handle PS 10+? It might be that treating the CA that way causes more CAs, causing a loop?

If not then I imagine it's a case of therapy being good enough, or needing surgery for any more progress?
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#37
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
If Central Apnea is your issue, and in part it must be, due to having Respironics SV Auto, surgery doesn't work with CA that I'm aware of. Surgeries have relatively low success rates for Obstructive events as is.
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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#38
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(07-29-2021, 03:44 PM)Gideon Wrote: Your machine is designed to treat CA.  

Settings would start at something like this
Mode: AutoASV (This will maintain a "constant" Tidal Volume by manipulating the below settings)
Min EPAP = 6 ( or better pressure )
Min PS = 5 (targeting the UARS)  normally would be = 3
Max PS = 15 (targeting the CA events) you need enough to 'force' a breath, it will only go up as high as it needs.
Max IPAP = 25 (Machine Max)

Note: You recently had a significant issue with PS = 4, how do you think you will handle a PS of 10+?

I tried EPAP 5.0 and from a subjective symptomatic point of view, today has been a bit better! Not outside the realm of a one-off, or placebo, but still! 

CA decreased a bit, but I realise we still need a trend. Data looks good. Have a single OA - if not mislabelled then maybe EPAP 5.5 is best?

I've attached the daily, as well as the OA event, and an example of flow rate still being a bit off. 

What's the next move? 

(07-30-2021, 01:16 AM)SarcasticDave94 Wrote: If Central Apnea is your issue, and in part it must be, due to having Respironics SV Auto, surgery doesn't work with CA that I'm aware of. Surgeries have relatively low success rates for Obstructive events as is.

Thanks Dave. I chose this machine myself rather than being assigned it from a study - but I see your point.

I didn't mean to suggest surgery would help my treatment emerging CA events. I meant that surgery would help my UARS, and that might allow me to stop using the machine or at least lower the PS needed to treat remaining UARS, to lower the amount of treatment emerging CA events while still treating UARS. I'm not bothered about OA as is, I've never really had any problems with handling that. 

If I can't treat both the flow rate issues and the treatment emerging CA events, and surgery isn't likely to do much, are there any other options or am I just stuck with my UARS?


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#39
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
I don't have much info on UARS treatment. Others likely do have something. I'll gladly let them fill you in.
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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#40
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
I don't mean to bump/spam before getting feedback but it has been a few days and I figured it's best to upload information as it comes rather than dumping it at once later. I've attached two nights ago, and will respond to this with last night's data. 

Not knowing what to do after trying EPAP 5 as requested, I upped to 5.5 to counter the obstructive event I had. The first of the two nights are attached, with an earlier and later flow rate image just to keep records of the flow issues. The next reply will have last night's full day chart and two flow limit focused images. There was a single obstructive but I believe it was after I woke up, nothing to worry about.


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