06-29-2020, 07:01 PM
Update: flow limitations, I:E ratio, and switch to VAuto
I’m writing to provide an update to this thread from January of 2019:
http://www.apneaboard.com/forums/Thread-...-questions
Per recommendations from Bonjour and Sleeprider, I addressed flow limitations by switching from a ResMed Airsense 10 Autoset to a ResMed Aircurce VAuto (self-funded) in July of 2019. I gradually raised the pressure support, encountering aerophagia and an increase in centrals along the way. Once PS reached 4.8, the 95% values for FLs were consistently 0. Above 4.8, the aerophagia and centrals were a little too much for me to deal with, so I backed down to 4.8, and after about 2-3 months, the centrals settled down.
Given that my AHI has always been good, I suppose the big question is: how do I feel? The answer is: definitely better. I have a chronic pain problem that makes the second half of most nights pretty choppy, so I can’t say I feel tremendously rested during the day. But my mood is better, my sense of energy is better, I rarely want a nap, and my cognition is better.
A few other observations:
* I no longer think the FL problem was the dust-mite allergy. That is still with me, but the FLs aren't.
* I’m also completely reassured about my I:E ratio. The VAuto measures these values differently from the Airsense, and it gets them right, i.e., it is not fooled by cardiogenic oscillations (aka cardioballistic effect). My I:E ratio is around 48-49.
* My TV has gone up from a median of 440 to a median of 460, and MV has increased from a median of 6 to a median of 6.25. Respiration rate is about the same.
* The ResMed algorithms pick up a lot of flow limitation, but not all.
I’m attaching before and after pictures (note a custom Y-axis).
I’m so grateful to Bonjour and Sleeprider for steering me aright, and I hope this update will be helpful to other forum members who struggle with flow limitations.
http://www.apneaboard.com/forums/Thread-...-questions
Per recommendations from Bonjour and Sleeprider, I addressed flow limitations by switching from a ResMed Airsense 10 Autoset to a ResMed Aircurce VAuto (self-funded) in July of 2019. I gradually raised the pressure support, encountering aerophagia and an increase in centrals along the way. Once PS reached 4.8, the 95% values for FLs were consistently 0. Above 4.8, the aerophagia and centrals were a little too much for me to deal with, so I backed down to 4.8, and after about 2-3 months, the centrals settled down.
Given that my AHI has always been good, I suppose the big question is: how do I feel? The answer is: definitely better. I have a chronic pain problem that makes the second half of most nights pretty choppy, so I can’t say I feel tremendously rested during the day. But my mood is better, my sense of energy is better, I rarely want a nap, and my cognition is better.
A few other observations:
* I no longer think the FL problem was the dust-mite allergy. That is still with me, but the FLs aren't.
* I’m also completely reassured about my I:E ratio. The VAuto measures these values differently from the Airsense, and it gets them right, i.e., it is not fooled by cardiogenic oscillations (aka cardioballistic effect). My I:E ratio is around 48-49.
* My TV has gone up from a median of 440 to a median of 460, and MV has increased from a median of 6 to a median of 6.25. Respiration rate is about the same.
* The ResMed algorithms pick up a lot of flow limitation, but not all.
I’m attaching before and after pictures (note a custom Y-axis).
I’m so grateful to Bonjour and Sleeprider for steering me aright, and I hope this update will be helpful to other forum members who struggle with flow limitations.
