Flow limitations and other questions

[sleepless badger]

Hi Sleeprider:
I may have confused the issue by replying incorrectly to my post to bump it up.  Post #24 is accurate, post #25 is not.  Feel free to remove the inaccurate post.  Post #26 is my question again - but I forgot to include the screenshots (they are correct in post #24).   Sorry, foggy brain.


For tonight, I will go back to EPAP at 9.0, IPAP at 16, PS at 4.0.
I have changed Ti min to 0.8.
Trigger to "high" vs " medium" - to make it more sensitive.  Other parameters at defaults.   Mask - back to the P10.

I hope that is what you had in mind.
Thank you!
Sleepless badger

[Sleeprider]

Remind me what your settings were on the Autoset. I will go back and look at older results, but I'd like to get your expiration down a bit, without compromising tidal volume. I think the lower EPAP pressure is a good start. I'd actually like to drop your EPAP to the critical minimum for OA events, then if CA is acceptable, start increasing pressure support and perhaps reducing TiMax. That's the current plan. If you have questions let me know.

[sleepless badger]

Hi Sleeprider:
My last settings on APAP before the switch to the Vauto were:
Minimum: .12.4
Maximum:  16.0
EPR of 2.

At those settings, my inspiration time was around 2.3 or so and expiration time at 2.5 with tidal volume running between 320-380.

I will set the Vauto as described in the previous post for tonight and report tomorrow.

Thanks much!
Sleepless badger

[sleepless badger]

Good Morning:

Here is a screenshot of last night using the new settings:  EPAP; 9, IPAP max 16, PS - 4  Trigger: High  Ti min 0.8

[attachment=10558]
The majority of CA were when I was awake - I seem to have to swallow often when first going to sleep which the machine perceives as breath holding.  The CA in the middle of the night at about 2:45 appears to be real.  The OA at 5:50 or so is when I had a cramp in my calf - so again I don't think it is real. 

My respiratory rate is marginally better as is tidal volume, but that just might be nightly variation.   On the whole, I felt like I sleep well enough - two X getting up to walk my legs is about par for the course lately.

Reading on the blood pressure medication I take : metoprolol - it is a beta-blocker so slows heart rate and may slow respiratory rate.  So that might be one reason the respiratory rate is low.   I am otherwise a fairly healthy person.

When I look back at data from the Auto APAP, I can see that my respiratory rate ran around 18-22 - much of it driven by flow limitations.  I had O2 testing done during that period and when flow limitations were high, my heart rate increased rather significantly (and I assume respiratory rate would follow).    When I started using EPR of 2, the respiratory rate when down to 11-13 range.

Thanks for your assistance!  It is much appreciated.
Sleepless badger

[Sleeprider]

Things moved in the right direction. If this is good enough for you, it's fine by me. Let us know if it doesn't resolve your concerns from earlier in this thread.

[sleepless badger]

Hi Sleeprider:

I would like to hold at these settings to see if last night is a trend or not.  Do you think there is value in trying to decrease EPAP a bit or increasing pressure support or Ti Max??

When I look at 2 minute segments of the night, my breath shapes vary considerably.  I can have nice easy breathing like the following:
[attachment=10559]

And then more ragged breathing like this which I think sometimes corresponds to a mini arousal and seems to be associated with deeper sleep - tissues are more relaxed and flow restricted.
[attachment=10560]

Is this just typical?  Or is this something I should continue to pursue by adjusting the machine parameters?

I know that my personal sleep issues are more involved than apnea alone (restless legs etc).  However I would like to be able to reduce the small arousals I seem to experience so that I can experience longer chunks of solid sleep.


I had started to look at a different nasal pillow mask due to the discussion on this board regarding the P10.  I will continue to monitor that discussion.  I know you and many others use the P10.  Any concern about continued use in light of this information?

Thank you again for all of your help!
Sleepless badger