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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
1 of 3 nights was fragmented, 5 bad CA nights, a couple of bad CA nights earlier (the chart), i'd consider dropping the PS to 5. not the bigger drop I'd suggest otherwise. BTW, what was the minor change in settings?
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RE: UARS and APAP
(09-20-2019, 08:09 AM)slowriter Wrote:
(09-20-2019, 08:05 AM)alexp Wrote: There is only one thing I would change, I would switch to fixed pressures instead of the VAuto mode. It may help your body stabilizes and you'll understand better the numbers. There is too much going on with the new PS value and the EPAP pressure varying during the night to figure what's working or not. I don't like Auto mode when trying to fine tunes my settings.

I was wondering about that.

Also, because of the complete absence of FL, maybe drop PS just a hair; 5.8 or 5.6.

Yes I would try that in a couple of days if you don't see any improvements. I believe you are really close to your optimal settings but your body may still getting accustomed to the PS. This could all be temporary and resolve by itself without you doing anything after all.
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RE: UARS and APAP
For now (I may change my mind later, in part depending on how this thread develops), I set the machine to stay on VAuto, but dropped the PS to 5.8, and the max IPAP to 11.8.

So effectively S (fixed) mode.

See what happens.
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RE: UARS and APAP
(09-20-2019, 07:49 AM)slowriter Wrote: [quote pid='312529' dateline='1568982260']
Which came first, the sleep fragmentation discovered by your dreem, which you are interpeting as a wake state or the Centrals which caused a fragmented sleep.....just leaving my experience on centrals, on my 193 days therapy with Oscar, while experiencing consistently a lot on EPAPmin and PS: yet, I may eventually counted some of them wrongly, CA's never was an issue for awakenings/wakeups (even in dramatic case during leaks). Most important boost happened when I went on unbalance low EPAPmin (as low as 4) concomintalntly with the highest PS ever (7.0). Nowadays don't ever taking them into account as an ar/aw/wk. 

....pretty good sleep architecture, with unfragmented REM stages. ...... those two fragmented bits. AHI across the three nights was similar.....I don't know if the one night of REM fragmentation is significant...... I am very aware regard this topic sleep fragmentation on literature and people's mind. However, surprisingly, my experience showed me, semi-quantitatively for HYF index (see graphs attached), that fragmentations (ar/aw/wk) is only significative if such events take long duration, and back to sleep as soon as possible.

Good luck


[/quote]
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RE: UARS and APAP
(09-20-2019, 08:17 AM)slowriter Wrote: For now (I may change my mind later, in part depending on how this thread develops), I set the machine to stay on VAuto, but dropped the PS to 5.8, and the max IPAP to 11.8.

So effectively S (fixed) mode.

See what happens.

By the way, one variable that seems correlated to having a good night of sleep in my case is my median tidal volume and minute ventilation . 
Tidal volume represents the volume of air you are inhaling on average during a breath and the minute ventilation represents the volume you are inhaling on average in one minute (therefore min vent = tidal volume * respiratory rate). Actually, it's not the average but the median but you get the idea.

My main problem has always been chronic flow limitations sometimes leading to hypopneas so it makes sense that my tidal volume has always been a bit low. When I first started CPAP on a fixed pressure set to 8, my median tidal volume was around 360 and my minute ventilation was always around 5.5. Now that I have switched to a bilevel, I hit 420 or 440  most of the nights and my minute ventilation is above 6. If for some reason, I go under 400 for a couple of nights like when my nose is congested because of allergies, I don't feel so good. 

Since you have the same chronic flow limitation problem, might be worth it to keep an eye on these stats.
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RE: UARS and APAP
...in time, on my graphs, air flow reductions - AFR _  does not include OA or Centrals (vary rare things in my case). Eventually coul be included accidentally some Hypopnea. AFR includes things such as flagged FL, less than 10s events on reduction, very subtle short events of reduction which were audio-recorded, an so on,.... HOWEVER ALL AFR's have response on TV reductions, which lead to arousal/aw/wk.
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RE: UARS and APAP
(09-20-2019, 08:42 AM)alexp Wrote:
(09-20-2019, 08:17 AM)slowriter Wrote: For now (I may change my mind later, in part depending on how this thread develops), I set the machine to stay on VAuto, but dropped the PS to 5.8, and the max IPAP to 11.8.

So effectively S (fixed) mode.

See what happens.

By the way, one variable that seems correlated to having a good night of sleep in my case is my median tidal volume and minute ventilation . 
Tidal volume represents the volume of air you are inhaling on average during a breath and the minute ventilation represents the volume you are inhaling on average in one minute (therefore min vent = tidal volume * respiratory rate). Actually, it's not the average but the median but you get the idea.

My main problem has always been chronic flow limitations sometimes leading to hypopneas so it makes sense that my tidal volume has always been a bit low. When I first started CPAP on a fixed pressure set to 8, my median tidal volume was around 360 and my minute ventilation was always around 5.5. Now that I have switched to a bilevel, I hit 420 or 440  most of the nights and my minute ventilation is above 6. If for some reason, I go under 400 for a couple of nights like when my nose is congested because of allergies, I don't feel so good. 

Since you have the same chronic flow limitation problem, might be worth it to keep an eye on these stats.

So what would the relationship be between those variables and PS? I'm assuming 6.0 may be a touch too high, so if that was the case, would it be apparent in these variables?
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RE: UARS and APAP
(09-20-2019, 08:10 AM)bonjour Wrote: 1 of 3 nights was fragmented, 5 bad CA nights, a couple of bad CA nights earlier (the chart), i'd consider dropping the PS to 5.  not the bigger drop I'd suggest otherwise.  BTW, what was the minor change in settings?

My max IPAP; was 14 for a few days preceding the change, but I raised it per the prescription, so I could demonstrate to the doc that I was making a good faith effort to follow instructions :-)
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RE: UARS and APAP
(09-20-2019, 09:21 AM)slowriter Wrote:
(09-20-2019, 08:10 AM)bonjour Wrote: 1 of 3 nights was fragmented, 5 bad CA nights, a couple of bad CA nights earlier (the chart), i'd consider dropping the PS to 5.  not the bigger drop I'd suggest otherwise.  BTW, what was the minor change in settings?

My max IPAP; was 14 for a few days preceding the change, but I raised it per the prescription, so I could demonstrate to the doc that I was making a good faith effort to follow instructions :-)

But, to avoid confusion, this was on September 9, so doesn't explain the changes in AHI.
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RE: UARS and APAP
(09-20-2019, 09:08 AM)slowriter Wrote:
(09-20-2019, 08:42 AM)alexp Wrote:
(09-20-2019, 08:17 AM)slowriter Wrote: For now (I may change my mind later, in part depending on how this thread develops), I set the machine to stay on VAuto, but dropped the PS to 5.8, and the max IPAP to 11.8.

So effectively S (fixed) mode.

See what happens.

By the way, one variable that seems correlated to having a good night of sleep in my case is my median tidal volume and minute ventilation . 
Tidal volume represents the volume of air you are inhaling on average during a breath and the minute ventilation represents the volume you are inhaling on average in one minute (therefore min vent = tidal volume * respiratory rate). Actually, it's not the average but the median but you get the idea.

My main problem has always been chronic flow limitations sometimes leading to hypopneas so it makes sense that my tidal volume has always been a bit low. When I first started CPAP on a fixed pressure set to 8, my median tidal volume was around 360 and my minute ventilation was always around 5.5. Now that I have switched to a bilevel, I hit 420 or 440  most of the nights and my minute ventilation is above 6. If for some reason, I go under 400 for a couple of nights like when my nose is congested because of allergies, I don't feel so good. 

Since you have the same chronic flow limitation problem, might be worth it to keep an eye on these stats.

So what would the relationship be between those variables and PS? I'm assuming 6.0 may be a touch too high, so if that was the case, would it be apparent in these variables?

No, if it's too high, you'll get centrals but I don't think your mean tidal volume would be higher. Once the flow limitations are gone, your airways are totally clear and air flows easily but pressure can't make your airways bigger after all.

The relationship is that when you have flow limitations, your tidal volume is lower because the obstruction slow down the airflow. Remember that the tidal volume is the volume of air you inhale in one breath. If there is a big obstruction, you won't be able to draw as much air in your lungs as you would if your airways were clear.

Now, when your flow limitations are chronic (lasting most of the night), your median tidal volume will be lower. The median like the average is just a number to describe what was the tidal volume during most of the night. So if your median tidal volume is lower, it probably means you had more flow limitations that night and as we know flow limitations can be bad because they cause RERA and some researchers pretend that chronic flow limitations are not good even if you don't experience an arousal. Since pressure support reduces flow limitations, it should raise the median tidal volume until there is no flow limitation. 

The point I'm making is that the median tidal volume, at least in my case, can be a good indication of the amount of flow limitations I experience in one night so that's the first thing I check in the morning nowadays.

*Note that this is actually a simplification, pressure support not only opens up your airways but speeds up the air flow as well but the end result is the same, no flow limitation, so the same logic applies. 

Hope it makes sense. Hard to explain in a few paragraphs  Smile
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