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Struggling finding the right settings for flow limitations
#1
Struggling finding the right settings for flow limitations
Dear All,

I had a “Resmed Airsense 10” for 3 years, but did not recover.
Recently we’ve found out that I do have a lot of flow limitations and the remaining AHI of about 6 consists of central apneas. 
Therefor I received a BiPap (Resmed Aircurve 10) about 5 weeks ago.
It was configured with this settings:

Modus: vauto
Max ipap: 12
Min epap: 4
PS: 4
Ti max: 0.6
Ti min: 0.5
Trigger: Med
Cycle: Med

Breathing is easier, but i still had a AHI between 4 and 5 (mainly central).
Also i still do have a lot of flow limitations.
I told my careprovider after a week, but due to circumstances nothing happened so far, so I started trying things myself.
I did read that raising the “Trigger” value could help lowering the central apneas, so I raised it from “Medium” to “High”. 
This had the result that the my AHI is now between 1 and 3.
Still all central apneas.

The flow limitations picture.

   

When zooming in.

   

I also found out that “inspiration time” was always the same.
It's 0.6 seconds everytime.

It looks like it is always between the Ti Min and Max values and that it cuts off my inhalation because it’s falling back into EPAP modus to soon.
I think it should look like this.

   

I raised Ti Max to 2.5 and this resulted in an inhalation time that fluctuates more and has an average of 1.6 seconds.
It also feels like it blows more air into my nose.
Also there are more periods with round flow curves.
Still there are flow limitations, but less than before.

The change to Ti Max seems to have some effect on the flow limitations, however the AHI with central apneas goes up to around 10. 
Also these apneas last longer. One time I even hit 87 seconds. (normally 10-20)
Experimenting with the Trigger, Cyle, Ti Min/Max and PS does not help me to lower the central apneas.
I now ended with the default settings and the “Trigger” on “High”, which seems to work best for now.
Does anybody have an idea why the central apneas go up when I raise the Ti Max ?

Thanks for reading.
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#2
RE: Struggling finding the right settings for flow limitations
Hello snakewrestler,

I know the data geeks here would probably like to see the complete chart.  

Follow the directions in this link to guide you.  
http://www.apneaboard.com/wiki/index.php...ganization

I don't know about the T1 Max setting causing CA's.  However, the pressure support setting, if too high could cause CA's to increase.  At the same time, you need Pressure Support/EPR to help with Flow Limitations.  

Also, if you had a sleep study, let us know if it showed central apnea.  You can also post a copy here, redacted of any personal information.

Post a graph or two from OSCAR here in this thread, and someone will be able to help.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
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Optimizing therapy
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Struggling finding the right settings for flow limitations
Hi OpalRose,

Thanks for your swift reply.
I've followed your instructions and inserted the screenshot.
Unfortunately i can't upload my sleep study due to an error: "The type of file that you attached is not allowed. Please remove the attachment or choose a different type".
I see other people also attached pdf files, so don't understand whats going wrong. (It's only 800kb)
During the study i mainly had hypopneas.
I also had another sleep study with my CPAP and that one showed central apneas as well.

Have a wonderful day

[attachment=47104]
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#4
RE: Struggling finding the right settings for flow limitations
This chart is exactly what we need. Flow limitation is high but so is the CA event occurrence. Lets move EPAP min to 5.0, PS 3.6 and Max IPAP 12.0 Change trigger sensitivity from medium to high. This should help to reduce the CA events, and we will keep an eye on the flow limits.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Struggling finding the right settings for flow limitations
snakewrestler,
If you're having trouble uploading your sleep study, it could be the type or size.
Here's a guide to help.

http://www.apneaboard.com/wiki/index.php...pnea_Board
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Struggling finding the right settings for flow limitations
Thanks Sleeprider.
I will try these settings first.

Best regards
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#7
RE: Struggling finding the right settings for flow limitations
Thanks OpalRose for this information.
I noticed other people uploaded even bigger PDF files and i think my file did met the criteria.
Will leave it for now and first try Sleeprider's recomendation.

Best regards
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#8
RE: Struggling finding the right settings for flow limitations
snakewrestler,

Once you transition from the " New Members" group into the "Members" group you should be able to post files other than images (like PDF's). Looks like you are almost there...

http://www.apneaboard.com/forums/Thread-...-explained
Jeff8356
Apnea Board Moderator
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MacBook Air (2017, Intel) | macOS Monterey (12.6.3) | OSCAR v1.4.0 | VM = Win10 (19043.1446) |
How to Links:
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Struggling finding the right settings for flow limitations
(01-17-2023, 01:56 PM)Jeff8356 Wrote: snakewrestler,

Once you transition from the " New Members" group into the "Members" group you should be able to post files other than images (like PDF's).  Looks like you are almost there...

http://www.apneaboard.com/forums/Thread-...-explained

Ah, thanks for making this clear Jeff.
Seems that I have to learn a lot :-)
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#10
RE: Struggling finding the right settings for flow limitations
Thanks for starting this post!
I have a lot to learn too. It's helpful.
DaveL
compliant for 35 years /// Still learning!

ResMed N20; ResMed P30i modified headgear; F&P Evora Full FFM



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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