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Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
#71
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
The million dollar question

How do you feel? Please answer critically.
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#72
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Auto appears to target 10 BPM which is probably fine.

It appears that the machine is using high PS for some reason. I don't get exactly why it is doing this but my understanding is PR machines target tidal volume which was 480 compared to your usual sub 400, it is like the machine got stuck on a target higher than what your spontaneous breathing usually is so then it tried ventilating you to maintain this high level.

I would try a lower min PS (3 or maybe even 2.5) to try and avoid machine from targeting a high TV. If that doesn't work you are probably better off going back to handcuffing PS max to avoid this issue.
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#73
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(08-21-2021, 05:09 PM)Gideon Wrote: The million dollar question

How do you feel?  Please answer critically.

Past 8 months: changing settings, they're all more or less the same unless they're much worse. 

Asv day 1 (11 AHI) I awoke feeling so much better - no brain fog, could hold conversation and leave the bed within a second or two, clear head. More motivated. Then extremely tired by early afternoon and found things more difficult than usual days with my machine so far. 

Over the day, even if I'm up late or skipping sleeping, I feel better in certain ways. I think I was close to waking for a while, or waking a lot without knowing, before doing so. Giving the illusion of treatment working, giving me a little motivation, then hit with the deprivation by the afternoon. 


Asv day 2 (1.8ahi) felt like most days with my machine. Day 3 (ahi 33) I felt slightly more motivated and clearer headed and so on most of the day, but I really really struggled upon waking and it took a while. 

I slept 9.5 hours last night after a bout of undersleeping, so I'd need to try this for longer. But the machine breathed for me majority of the time, not good I imagine? Plus there was definitely flow issues and I felt as foggy this morning as I tend to with high flow issues. Really struggled to wake up. 

Basically setting changes either do nothing or make me feel worse. But sometimes days with lots of centrals make me feel better early on but more tired more quickly, likely due to being quite close to awake for a while before actually waking up. 

I also assume an AHI of 11 or 36, even if I feel better early in the day, wouldn't be good for my brain or heart health like apnea normally isn't, so I don't think my feelings trump the data in this specific case. 

(08-21-2021, 05:32 PM)Geer1 Wrote: Auto appears to target 10 BPM which is probably fine.

It appears that the machine is using high PS for some reason. I don't get exactly why it is doing this but my understanding is PR machines target tidal volume which was 480 compared to your usual sub 400, it is like the machine got stuck on a target higher than what your spontaneous breathing usually is so then it tried ventilating you to maintain this high level.

I would try a lower min PS (3 or maybe even 2.5) to try and avoid machine from targeting a high TV. If that doesn't work you are probably better off going back to handcuffing PS max to avoid this issue.

I'm not sure I understand - a PS of 3 doesn't treat my UARS. I thought an ASV was supposed to be used specifically in situations like this, where PS increases led to centrals? 

If I were to lower my maxPS what should I lower it to? 12 again?
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#74
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
I'm not sure I understand - a PS of 3 doesn't treat my UARS. I thought an ASV was supposed to be used specifically in situations like this, where PS increases led to centrals?

If I were to lower my maxPS what should I lower it to? 12 again?
***********"**********************"********
That is what I was trying to do, get your PS high enough to treat your UARS and the target of my How do you feel question.

Continue this for a whole week. Sorry but I want to find out if you adapt to the ASV. It should sufficiently resolved your UARS though with all the pressure changes from the ASV it would be hard to tell.

If this doesn't work revert back to essentially EPAP 7 and PS 3-3.5 with a few centrals to grow tolerance for PS.
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#75
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Thank you very much, I just meant with Geer1 saying to lower PS I don't understand where we'd go from there given UARS. I think I've been keeping up with your thoughts on my treatment though, thanks for explaining it all!

When you say continue, do you mean to just do what i did last night, with the auto bpm, and hope I don't need so many timed breaths over time? With no changes to PSmin or max?
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#76
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Yes with no changes, and I know it will be rough, the goal is to see if you adapt to the ASV.

As I said, the ASV is driving the PS high enough that it should be managing your UARS.
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#77
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Okay! If i can't wake up for over an hour in an unpredictable manner tomorrow I'll have to try adapting again to asv on thursday night so I make it to work on time. But I give tomorrow a go!

If timed breaths don't reduce, is it bad for me to rely on the machine for that many breaths?
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#78
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
For you we are trying to get enough PS to treat UARS.
To treat your centrals I would put you on PS of 3.0 or less possibly, with an EPAP of around 7 and tweak that for comfort. This could be accomplished with a ResMed AutoSet.

The ASV is resolving essentially ALL of you generated centrals by now doing what it was designed to do and in the process generating sufficient PS to resolve your UARS.

On either path I expect your centrals will diminish over the next 2 to 3 months. That is what the medical community says it takes. Without you having chosen an ASV machine we would not even be trying this.

A 3rd option is to travel out of state and get an appointment at on of Dr
Barry Krakow' s clinic's to get examined, diagnosed, setup, and followed up for UARS. Why there? Simply because they specialize in UARS treatment
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#79
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
I think I understand. So we either set PS to a small number, then slowly manually titrate upwards and treat UARS over a few months, hopefully not letting centrals build too much.

Alternatively we can just handle centrals, and while the PS is high enough for a timed breath, it's also high enough to stop UARS. Or does an ASV just handle UARS anyway, even if a central isn't imminent?
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#80
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Without centrals ASV settings would likely need to be modified for UARS
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