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Why don't these flow rate curves count as flow-limited?
#31
RE: Why don't these flow rate curves count as flow-limited?
Impressive!  

Too bad that many of us end of buying the VAuto out of pocket.  It's almost next to impossible to get insurance coverage for a BiLevel if AHI is <5 on an AutoSet.  

Docs and insurance companies don't focus on how you feel, certainly not Flow Limitations, only AHI.  Sad

Good luck!  Hope these good results continue for you.
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#32
RE: Why don't these flow rate curves count as flow-limited?
(07-08-2021, 07:38 AM)Crimson Nape Wrote: Nice!  Now, the BIG question... How do you feel?

Um -- well I feel like I spent the night trying to figure out why my mask was leaking but being too dopey to notice that the cervical collar had popped the left magnet off my F30! Oh-jeez (we need a "facepalm with an octopus" emoji)

And while I can't tell the difference between EPR of 1, 2 or 3, a PS of 4 definitely felt different from EPR. I'm guessing that the other settings might have had a part of that, too? (I left them alone because I didn't have time to research what to do with them -- only got 5 hours of sleep as it is).

...I came into work this morning and asked one of my new colleagues: "so you said that your mom's cpap is white. Which one of these?" and showed him googled pictures of a dreamstation, Air10ForHer, vauto. He pointed to the dreamstation and I told him -- call your mom! her cpap machine has been recalled! But tell her that I have a spare!

...it's always something!
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#33
RE: Why don't these flow rate curves count as flow-limited?
Correct me if I am wrong but that is your highest average minute ventilation in quite a while as well.

All you needed was the higher pressure support, 4 seems to already have made a noticeable difference so I would leave it as is for a bit and then can slowly try a little bit higher if still looking for more improvement (smaller jumps like say 4.5, 4.7, 5) or still seeing some signs of flow limitation.

I believe they are pretty much the same but the timing of pressure supply might be slightly different and with the vauto you do have the ability to adjust it (trigger sensitivity, cycle sensitivity the main ones, ti min and ti max affect as well but not important in your case).

Can learn about these timing settings at the end of the titration protocol document. Most people like normal to very high trigger and normal to very low cycle but varies by person.

https://document.resmed.com/en-us/docume...er_eng.pdf
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#34
RE: Why don't these flow rate curves count as flow-limited?
Actually minute vent, respiratory rate, tidal volume all looked pretty typical for me.

But a 95% flow limit of zero?!? That's just astonishing for me.

Back in March when I set the EPR to 3 on the Air10, the striking thing that I saw is what I call "marching llamas" where the end of each exhale trails off to a pause between breaths. I know exactly what's happening because I'm doing it while I'm still awake. The sensation really is that I don't feel like I need to breathe again right away after I finish a breath so I just wait a bit after each breath.

So that seems pretty clear that the pressure support is clearing CO2 very efficiently, as the llama's "backs" get longer and flatter. And I can see how that can lead directly to centrals, in that when the flat part from the llama's butt to neck has that same shape but more bumps and is longer -- once it's more than 10 seconds, then it's a central. I can see how treatment could cause centrals, because I do see the occasional dachshund marching along with my llamas.

But now without flow limits and all those spiky m-shaped inspiratory curve tops, my llamas no longer have ears -- they don't look so much like llamas anymore, LOL.

I also kind of wonder if I still have extra respiratory capacity from when I was fat. I mean back then I had basically the same lungs and was breathing for like an entire extra person! Maybe that is part of the relatively minor desats during chin tucking? In the midst of a short but hot mess of positional apnea, where over an hour I'll spend 25 minutes not breathing, but still only go down very briefly below 90%. It would seem plausible that just plain old spare capacity would explain that.
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#35
RE: Why don't these flow rate curves count as flow-limited?
I'm late to the party on this, but stopped by to say, I told you so. Smile
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#36
RE: Why don't these flow rate curves count as flow-limited?
(07-09-2021, 08:32 AM)Sleeprider Wrote: I'm late to the party on this, but stopped by to say, I told you so. Smile

  **smooches** [Image: wink.gif]
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#37
RE: Why don't these flow rate curves count as flow-limited?
now don't make it so exciting. Hopefully last night was undisturbed - can you feel the now gone flowlimitations?
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#38
RE: Why don't these flow rate curves count as flow-limited?
4.75 MV seemed a bit higher than at least the last few months, it will be interesting to see if it consistently stays higher.

   
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#39
RE: Why don't these flow rate curves count as flow-limited?
(07-06-2021, 08:22 PM)TBMx Wrote: But: we replace evidence based knowledge / medicine with anecdotal 'knowledge'.

Happens to best of us  Too-funny  - You all know the SERVE-HF Study! You could have asked every doctor in that topic out there - everyone would have told you: ASV is the best for central apnea syndrom and CSR with heart failure.
Well ... the study ended with: NO! (and that study was done after the even bigger CPAP-study showed no advantage for those)
evidence vs. anecdotal!

The study sparked my interest a while back again - an ASV is by definition the best device there is out there. Breath by breath normalisation - what more can you get? So basically that device is the definition of overtreatment.
In that study where ONLY(!!!) people with an LVEF <= 45% - it ended early because they where dying earlier than the control group - it ended denying those an ASV treatment. Shocker!

Now that does simply not say anything about other people or patients ... but it makes me think! Why would people with a serious heart condition not profit from a nearly complete elimation of their central apneas? Does that mean, that somehow those apneas have a protective function?
Are heart conditions not one of the reasons we strap on a mask each night?

TBM. Wow. Such a detailed and insightful post (probably too much for most to read through though!). I always enjoy reading your well thought out viewpoints and (sceptical) scientfic approach.

I had not read the SERVE-HF study report ( https://www.nejm.org/doi/full/10.1056/nejmoa1506459 ). I expect that ResMed, who supported the study, were mortified with the results. Who would have thought that people well treated with ASV would feel better (at least for the first 3 years) but have lower fitness (based on 6 minute walk distance) and higher cardiovascular mortality!

Saying "it ended early" is rather misleading. The study stopped when the "protocol-specified goal of 651" end-points was reached (this end point was never changed and they added people to the study in order to reach this in a reasonable timeframe). As ASV seems to have accelerated these end-points it ended earlier than it would have if ASV actually helped, but they didn't pull the plug on the study as they would have if there were very clear benefits or harm on one side.

@cathyf. Great that you got the desired result from the VAuto. Hope that you get benefits from it.

In my view, EPR is less "exhalation relief" and more "inhalation support" given that it is triggered by inhale and has a pressure curve that will tend to reduce the flatness of the inspiration. Given that ResMed's Flow Limitation metric is a measure of inspiration flatness, EPR will naturally reduce this metric. For example, compare my early night supine breathing patterns with and without EPR:
         
I this it's clear in these graphs that the mask pressure profile is mirrored in the inspiration flow hence the FL metric is reduced.

I'm not convinced that FL is the ultimate metric, although it's clear it has significant value for many people.
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#40
RE: Why don't these flow rate curves count as flow-limited?
So last night was a lot more ambiguous.

[Image: attachment.php?aid=33634]
(Screen Shot 2021-07-10 at 12.13.07 AM.png)

Had some more centrals than before. And a pretty weird-looking non-event event. Here's a closeup:
[Image: attachment.php?aid=33635]
(Screen Shot 2021-07-09 at 11.55.57 PM.png)

The vauto sure makes those extended areas of very flat breaths a lot more interesting!

And in the {things that make you go "hmmmm"} category,
[Image: attachment.php?aid=33636]
(Screen Shot 2021-07-10 at 12.13.07 AM.png)

A WHOLE LOT of "marching llamas". A lot of which have ears -- yet the vauto doesn't flag them as flow limits. I'm now suspicious that the vauto is using the same algorithm for flow limits as the Air10?

Here's my identification.tgt from the vauto:
#IMF 0001
#VIR 0065
#RIR 0064
#PVR 0065
#PVD 001A
#CID CX036-009-013-026-101-100-101
#RID 000D
#VID 0009
#SRN 23191671673
#SID SX567-0401
#PNA AirCurve_10_VAuto
#PCD 37051
#PCB (90)R370-7518(91)T1(21)93125908
#MID 0024
#FGT 24_M36_V9
#BID SX577-0200


And from the Air10:
#IMF 0001
#VIR 0064
#RIR 0064
#PVR 0064
#PVD 0014
#CID CX036-001-013-020-100-100-100
#RID 000D
#VID 0001
#SRN 22141371252
#SID SX567-0205
#PNA AirSense_10_AutoSet
#PCD 37028
#PCB (90)R370-7341(91)1(21)48211478
#MID 0024
#FGT 24_M36_V1
#BID SX577-0200

I'm thinking the Air10 is version one of something important, while the vauto is version nine?


Any thoughts?


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