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[Treatment] Cant seem to adjust pressures
#21
Hello again.
I am not sure that I am thinking about my numbers and my changes correctly. Or if I am I don't feel like I am getting any good results.

I made a change on 9/28 and left it for 5 nights. Although my AHI numbers are 2.51 or less I was still not feeling rested and dragging thru my days.

I made a slight change to my pressure support only on 10/3 and only tried it for one night before I made another slight change to my min EPAP, Max IPAP and my PS.

Sadly I still feel lousy, exhausted and frustrated. I know this isn't a quick fix but I need a couple of good nights!

I attached a spreadsheet of my numbers and the changes when they occurred.

Please note that the two nights that look to be great I was awake but lying quietly with my machine on hoping for sleep for several hours during the night.

If sleepyhead pictures are more help please let me know which ones and I will be more than happy to provide whatever is needed

[attachment=1773]

Looking at my numbers it seems as if I could reduce my min EPAP even more as my Median EPAP is as low as my minimum but is that prudent since my flow limitation numbers are always high?

Thanks in advance.
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#22
(10-08-2015, 07:48 AM)Cookie Wrote: Looking at my numbers it seems as if I could reduce my min EPAP even more as my Median EPAP is as low as my minimum but is that prudent since my flow limitation numbers are always high?

Hi Cookie,

I suggest you try gradually raising together both the Min EPAP and Max IPAP, until the events which are counted in the RDI are lower.

The sum of the (Clear Airway apneas per hour + OBstructive apneas per hour + Unknown-type Apneas per hour + Hypopneas per hour + RERAs per hour) is called the RDI (Respiratory Disturbance Index = AHI + RERA per hour) and is a commonly used "figure of merit" as a measure of how disturbance-free our sleep is.

Historically, although Flow Limitation is also obstructive in nature, it has been perhaps overlooked and not counted as a disturbance; it is merely considered a characteristic of partial obstruction of the airway during inhalation and a sign that IPAP is too low. Although not counted in the RDI, Auto CPAP machines like yours pay attention to FL and use it in their pressure raising algorithms.

Although your median EPAP stays low, this is likely because the EPAP is often being limited by your need for PS. Your need for a moderately high amount of PS is driving IPAP up to its limit, and when IPAP is maxed out EPAP cannot be raised higher, because your machine will only raise EPAP if it can also raise IPAP along with it, so that PS is not changed.

A higher Max IPAP may be all you need, but I suggest raising the Min EPAP along with the Max IPAP so that the EPAP will be more constant, a little closer to fixed-pressure CPAP therapy.

I think PRS1 machines tend to be a little too slow in raising EPAP, and I suspect that a higher Min EPAP may be helpful in your case, so that when obstructive events suddenly come along (because you enter REM sleep stage or because you roll onto your back) and EPAP needs to be raised, the EPAP will be closer to where it needs to be raised to.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#23
Thanks Vaughn for the informative reply.

I have adjusted my min EPAP to 7.5 and max IPAP to 14 for tonight. I don't always adjust to changes easily and didn't want to make a change on a work night.

I also increased my PS to 2-6. I believe this is correct if the difference between my EPAP and IPAP is 6.5. I am not sure I completely understand the function of PS so if I am not thinking about this correctly let me know.

I had read your reply with the note about swallowing air and this was a bit of a problem when the doc had changed me from BIPAP to a CPAP fixed pressure of 12. So far it has not been a problem with the BIPAP even though the pressure is higher when needed.

I will give these changes a try and hope for good results. Thank you for all of the information and time you have devoted to informative replies that help me understand my therapy better.
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#24
(10-10-2015, 07:27 AM)Cookie Wrote: I also increased my PS to 2-6. I believe this is correct if the difference between my EPAP and IPAP is 6.5. I am not sure I completely understand the function of PS so if I am not thinking about this correctly let me know.

Hi Cookie,

I think your new settings (Min EPAP 7.5, Min Pressure Support 2, Max Pressure Support 6, Max IPAP 14) are reasonable.

Increasing the Max IPAP and Max Pressure Support as you have done will likely allow your machine to (very slowly, within several minutes or even more slowly) raise PS as high as needed to avoid or reduce Flow Limitation, while also likely allowing the EPAP to be raised as much as needed to prevent other obstructive events. For example, if PS has already been automatically raised to 4, EPAP could be automatically raised as high as 10, if needed.

Pressure Support is the increase in pressure during inhalation. Pressure Support makes it easier for us to breathe. It does for us some of the work of breathing.

In my case I am susceptible to central apneas, and when a central apnea begins my ASV machine will immediately (within a few seconds) switch to a backup breathing rate and will immediately (within a few seconds) raise PS from my minimum up to perhaps 10, in order to do for me 100% of the work of inhaling.

When breathing on my own, my EPAP needs to be around 15 to avoid obstructive apneas and my Min PS may be around 5, resulting in my IPAP normally being around 20. This means PS is normally doing for me about half the work of breathing, which I like. This high Min PS setting makes it more likely that I may experience "CO2 wash out" which means my blood CO2 may become too low and therefore I may lose the drive to breathe, leading to more central apneas. But, since my ASV machine treats central apneas by automatically switching to a backup respiration rate of around 15 breaths per minute and (very quickly, within seconds) automatically raising PS enough to maintain nearly my normal amount of breathing airflow, central apneas are prevented and are not a problem for me.

In your case, you tend to have lots of Flow Limitation, which means the suction needed during inhalation to pull air into your lungs is causing your airway to narrow during inhalation, partially impeding inhalation. So, during inhalation you need the pressure to be increased, which Pressure Support does for you, reducing the effort needed during inhalation, treating Upper Airway Resistance Syndrome (UARS) and avoiding Respiration Effort Related Arousal (RERA).

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#25
Hello again.

I have made a few subtle changes. On 10/10 Min EPAP 7.5 Max IPAP 14 PS 2-6. Then on 10/26 I reduced Min EPAP to 7, increased Max IPAP to 14.5 and PS to 2-7. Since I don't always respond quickly to changes despite not feeling /sleeping better I have resisted the temptation to keep making changes.

The last two nights I have seen an increase in AHI, and for the last two nights my partner has told me that when I am sleeping I am making a choking sound while inhaling.

Since my last change was to increase my MAX IPAP does this mean I have reached the point that I am causing obstructions or do I still need to increase it since I have reached my max pressure both nights?

I have attached the spreadsheet of data but if specific SH charts would be more helpful I would be happy to attach. Please note that nights that my AHI is dramatically low I was not sleeping, just laying quietly trying to go to sleep.

Looking for advice for the next change as I don't feel that I am making any improvements.

Thanks for all help and advice.


Attached Files
.xlsx   sleep data 9-28 thru 10-30.xlsx (Size: 14.87 KB / Downloads: 23)
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