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ataylor830 therapy
#11
RE: ataylor830 therapy
Standby to have your mind blown. We have not found an effective way to increase tidal volume with bilevel pressure support, BUT we have consistently seen higher tidal volume and minute vent with EERS.
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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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#12
RE: ataylor830 therapy
(that's very interesting about the tidal volume. I was wondering with more exercise, etc, if I could do anything to increase my TV naturally. I feel it's awfully low for someone of my size).

Quick update on the introduction of EPR: here's link to last night's daily view: https://imgur.com/gallery/yoN0sXO

I have now been on Min pressure 12.6 for over 2 weeks but I introduced EPR=1 only 7 days ago to try to clear up some flow limitations. As you can see from the image (link above) I still have clusters of flow limitations, although it's hard to tell if they have gotten "better". Here's what I do know:

- my o2 seems to fall below the 90 mark less frequently (but still dips to 89 or 88 for a second or two)
- my average o2 has fallen a bit, it used to hover between 95.5 and 96 and now has been closer to 94
- my o2 variance seems to be higher with EPR of 1. It fluctuates more

So I'm not sure if having a lower average but fewer dips is better or not. The waxing and waning during REM (during the clusters of FLs) is still there, but potentially less extreme (it's hard to tell).

I have also noticed a FEW OAs in the past 7 days, which was very uncommon when I had EPR turned off totally.

I may increase to EPR=2 to see what happens.

My question: Is the hypothesis that the introduction and slow increase of EPR could reduce the flow limitations, thereby helping the waxing and waning? (because the waxing and waning (well, the waning) seems to be the cause of my o2 dips). I guess what I'm asking is are we trying to treat both the FLs and the waxing and waning with EPR? I want to make sure I know what to be on the lookout for.
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#13
RE: ataylor830 therapy
Your chart is an image of excellent therapy. Flow limit is low, so not a problem, but there is nothing to prevent you from increasing EPR. Remember it is the same as bilevel pressure support, and can help with flow limitation and tidal volume. With regard to respiratory volume, minute vent is a better metric because it is a function of tidal volume and respiration rate. The resolution of your graphs is not high enough for me to establish a relationship between SpO2 and the other parameters you are associating with lower SpO2. To my eye, your median oxygen saturation is 94% which is good, and rarely drops below 92%. There is almost no sustained desaturation.
Sleeprider
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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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#14
RE: ataylor830 therapy
The main goal for increasing EPR is to reduce flow limitations. They may (or may not) be preventing you from sleeping as well as you can.

I'm not sure whether this will address the waxing and waning. It could, if sounder sleep meant fewer episodes of arousal-type breathing starting the pattern off. If you could report back on your observations, I'd learn something!

You're smart to keep track of trends, but I think your O2 still sounds fine; likewise the small scattering of OAs.

Do try EPR of 2. If this results in a marked uptick in OAs, try raising your minimum a little.

About tidal volume: earlier you mentioned that you are obese. Obesity can result in lower tidal volume, with a higher respiration rate to maintain minute ventilation. If that is part of what's going on with you, it appears to me to be a mild version of the phenomenon. You might want to discuss this with your doctor to get more information.

Keep us posted, would you?
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#15
RE: ataylor830 therapy
Thank you both for your thoughtful answers. I agree I'm being a bit "greedy" because these charts are so ideal and it's what everyone is shooting for. I've just been pouring over these data for so long and these questions linger.

Dormeo - yep, I'm obese and I wondered if that's what was causing the lower tidal volume. Obviously if my o2 stays satisfactory, the low tidal volume must not be too much of a problem, but I'm interested to see if I can shed some weight and see that number increase. Only time will tell.

I forgot to change EPR to 2. With the setting still at 1 last night I had one dip below 90 to 89 and average o2 for the night was 94.7... but the trend of more drastic o2 variation continues with the "% of time in SpO2 Drop" being 72% (it was often single digits before I introduced EPR).

I'm going to update EPR to 2 right now. I truly appreciate the time and effort you all spend on here helping folks you've never met. Drs and DMEs just don't spend the time necessary to help us get efficient therapy. I'll be donating!

I hope everyone has a happy, healthy and safe new year.
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#16
RE: ataylor830 therapy
All the best for 2021! Keep us posted, would you?
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#17
RE: ataylor830 therapy
Just a quick follow up in case anyone is interested. I've had a few pretty great nights on Min pressure 12.6 and EPR of 2. In general, my o2 dips seem to be less frequent (with lowest o2 of 91 one night!!!).

The waxing and waning still occurs, but not as drastically. And while the introduction of EPR has helped the FLs, there are still some that occur in clusters during what I assume is REM. But the FLs that occur are fewer and it actually makes it easier to see/associate the waning periods with FLs.. mauybe I'm not able to get a full breath due to FL, which combined with such a low TV in the first place, maybe enough co2 isn't getting displaced, causing it to build up and then I go back to the bigger breaths? And then the pattern begins again. (I'm still learning as far as this goes, thanks to Dormeo and Sleeprider for helping with the waxing/waning).
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#18
RE: ataylor830 therapy
Good to hear you are more comfortable and effective with the EPR. Respiration consists of both volume and rate, and those will fluctuate, and often offset each other. Minute vent is the function of tidal volume and respiration rate and is usually a better indicator of what is going on.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Organize your OSCAR Charts
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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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#19
RE: ataylor830 therapy
Many thanks for the update, and I'm glad things are going better. You might want to experiment with raising EPR to 3.

About your analysis: I think flow limited breathing would tend to allow more CO2 to build up. Then it would be followed by deeper recovery-type breaths, which would wash out CO2, which would reduce the drive to breathe, etc.

Keep us posted, would you?
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#20
RE: ataylor830 therapy
Another update... I stand corrected (at least based on one single night, which I know is anecdotal) on my theory that the FLs were causing the waning moments shown in the flow rate. I know this image may be hard to see (open it in its own tab and zoom in). https://imgur.com/gallery/cFe4lvy

The image shows a period of waxing and waning, causing spo2 to dip to 88 for ~10-15 seconds at a time, but there are NO flow limitations. The rest of the night, spo2 was well above 90 and the waxing and waning not nearly as severe. AND YES! I'm ecstatic with an AHI of 0! (I guess the waning was never more than 10 seconds at a time and that's why no hypopnea was recorded?)

So you were both absolutely right that introduction of EPR helped flow limits. And looks like FL isn't contributing to the waxing/waning.

Next, I think I'm going to bump up the min pressure to maybe 13 and EPR to 3. I wanted to see if the increase in pressure may help even out the waxing and waning. Do either of you see any issues with this increase in min pressure (as long as it doesn't start causing CAs?). I will set EPR to 3 to see if I can reduce FLs even further (as I do still see clusters throughout the night, but they are greatly reduced with EPR 2).
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