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[Treatment] Treating UARS with CPAP and bilevel
RE: UARS and APAP
(11-06-2019, 01:48 PM)jaswilliams Wrote:
(11-06-2019, 06:50 AM)slowriter Wrote: As a rule, I don't get OA events. I got two reported last night. 

I was assuming, though, that these would  be accompanied by FL activity? What makes this an OA vs CA (as I would have assumed)?

It is classed as an OA as the FOT pulses of your machine decided that there was no clear unobstructed path to your lung so the reason to stop breathing was due to an obstruction

Ah, right. Thanks!
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RE: UARS and APAP
See the disturbance before the event, and the larger recovery breath following.  CA typically, not always, ramps from low to high.  A rolling could cause an obstruction resulting in the OA report.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
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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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RE: UARS and APAP
Since I mentioned an oximeter a bit ago, which I finally received, here's one night. 

Does seem my spo2 is a couple points lower during sleep than while awake during day.

I don't really know what to make of it. Anything interesting here?

   
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RE: UARS and APAP
Is the reading consistent, and not just a loose sensor?

If the reading is accurate I would image that here and now you will feel more rested, and have stronger cognitive skills, be happier and more fun to be around if you can get the nightly O2 up.  Given that you have decades of time ahead of you if you can get the O2 up on an ongoing basis lower your risks of early stroke and and so forth.    



////    To the Charts.

Your Tidal Volume looks good both the Flow Limits and Pressure charts show you are not battling obstructions.  No problems to solve there. 

So if you can you would want to drive your Respiration Rate up 3 breaths per minute.  

Initial Ideas from our bag of tricks:  
  • I don't see the Resp Rate chart.   If there are low points use 2-3 min Flow Rate charts to find out why and see if you can tune to make them go away.
     
  • Lower total pressure (IPAP) ... ideally without any impacts that dirty up the many great looking measures/charts.  
  • From your two min Flow Rate, Insp Rate & Exp. Rate Chart.  Any signals or Flow Rate waveform shapes that indicate in-efficiencies that you would seek to tune via the TiControl, Cycle, etc. settings?   
     
  • If you cant get Resp Rate to climb then either you tweak Rise Time, Ti Min, etc to increase Insp volume (height and or length of time) or add supplemental continuous O2.    Increasing Insp volume likely will up the tidal volume but if 14 bpm Resp Rate is your new max then you can try to trade off a boost of Tidal Volumes up toward 8mL/Kg PBW to gain more oxygenation.      
 WillSleep

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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RE: UARS and APAP
Oxygen levels are normally a couple of points lower at night, nothing to worry about.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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RE: UARS and APAP
(11-14-2019, 10:50 AM)WillSleep Wrote: So if you can you would want to drive your Respiration Rate up 3 breaths per minute.

My RR is in the normal range. 

Are you saying this, then, simply because it may be a way to raise spo2?

I need to take a closer look, but I don't recall seeing much variability in my RR numbers across different machines and pressure settings, or even using EERS.
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RE: UARS and APAP
(11-14-2019, 03:02 PM)slowriter Wrote:
(11-14-2019, 10:50 AM)WillSleep Wrote: So if you can you would want to drive your Respiration Rate up 3 breaths per minute.

My RR is in the normal range. 

Are you saying this, then, simply because it may be a way to raise spo2?

I need to take a closer look, but I don't recall seeing much variability in my RR numbers across different machines and pressure settings, or even using EERS.


"My RR is in the normal range.  Are you saying this, then, simply because it may be a way to raise spo2?"

Yes.  Reducing total IPAP, Rise Time, Ti Min, Sensitivity, Cycle, RR, & Tidal Volume  are the "somewhat indirect" and then "more indirect" dials you have to turn in order to increase SpO2, as long as the change does not bring negative impacts greater than the benefit. 

Given you are not fighting obstructions, flow limitations, or CAs the most direct dial you can turn is adding continuous O2. 

"I need to take a closer look, but I don't recall seeing much variability in my RR numbers across different machines and pressure settings, or even using EERS." 

.. during EERS we saw machine reporting of a crazy increase in Tidal Volume.  This increase in TV may not have been real but I have to bring it up as another unconfirmed possible dial.  That TV increase if real was too big but then EERS capacities and location/distance might be tunable.   


/////////////////

On an indirectly related topic .. EERS.  

One concept that has been on my mind regarding is the validation of a fully deployed EERS for heart patients, the introduction of continuous O2 in the tube at the mouth past the EERS swivel where the intended airflow/pressure loss vents through the swivel.  Adding O2 past the vent for intended leak seeks a lower dilution impact on the oxygen bled into the xPAP tube line hopefully enabling more attainable lower and quieter L/min flow requirements from the concentrator. http://www.apneaboard.com/wiki/index.php..._with_CPAP

I had hoped to update on the etCO2 monitoring solution I intend for Cycle / autoPEEP testing, to add an important ongoing EERS safety layer and for testing and optimizing EERS configurations with common masks.   I thought I a path had sorted with a low enough cost solution that others might be able to use as well but I am hitting roadblocks.  Will update when I know more.  

WillSleep

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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RE: UARS and APAP
(11-14-2019, 03:02 PM)slowriter Wrote:
(11-14-2019, 10:50 AM)WillSleep Wrote: So if you can you would want to drive your Respiration Rate up 3 breaths per minute.

My RR is in the normal range. 

Are you saying this, then, simply because it may be a way to raise spo2?

I need to take a closer look, but I don't recall seeing much variability in my RR numbers across different machines and pressure settings, or even using EERS.

Not totally correct. There does appear to be some positive correlation between PS and RR. At PS 6, my RR is a bit higher; ranging from just over 14 to 15.8.
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RE: UARS and APAP
(11-14-2019, 03:36 PM)WillSleep Wrote:
(11-14-2019, 03:02 PM)slowriter Wrote:
(11-14-2019, 10:50 AM)WillSleep Wrote: So if you can you would want to drive your Respiration Rate up 3 breaths per minute.

My RR is in the normal range. 

Are you saying this, then, simply because it may be a way to raise spo2?

I need to take a closer look, but I don't recall seeing much variability in my RR numbers across different machines and pressure settings, or even using EERS.


"My RR is in the normal range.  Are you saying this, then, simply because it may be a way to raise spo2?"

Yes.  Reducing total IPAP, Rise Time, Ti Min, Sensitivity, Cycle, RR, & Tidal Volume  are the "somewhat indirect" and then "more indirect" dials you have to turn in order to increase SpO2, as long as the change does not bring negative impacts greater than the benefit. 

Given you are not fighting obstructions, flow limitations, or CAs the most direct dial you can turn is adding continuous O2. 

"I need to take a closer look, but I don't recall seeing much variability in my RR numbers across different machines and pressure settings, or even using EERS." 

.. during EERS we saw machine reporting of a crazy increase in Tidal Volume.  This increase in TV may not have been real but I have to bring it up as another unconfirmed possible dial.  That TV increase if real was too big but then EERS capacities and location/distance might be tunable.   

Yes, I'm thinking about that.
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RE: UARS and APAP
Because I now have the oximeter and I was curious, I did last night with the same settings, but with the EERS-adapted mask.

Of note:
  • as with first time I tried, significant (20%) increase in median TV, but significant decline in 95% and max TV
  • MV is higher also; a bit higher than "normal"
  • from start until 3:30, looks to be roughly 2% improvement in median spo2 (from 93 to 95)
  • there's then a drop in spo2 after that; not sure why; including this, though, median spo2 is still higher than night before
  • no significant change in RR
  • AHI a bit higher, but that's mostly four hypopneas from end of night
edit: I can't seem to include earlier attachment here and have it display properly, so leaving it out. It's just a few posts above if curious

   
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