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ataylor830 therapy
#21
RE: ataylor830 therapy
I will defer to Sleeprider, but I see no reason not to do the experiment you propose. And while I'm at it: your constructive, problem-solving, self-educating approach is terrific!
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#22
RE: ataylor830 therapy
It's okay to increase EPR, but don't increase minimum pressure. With a minimum pressure of 12.6, your pressure is not moving at all, so my guess is that you are already over your most effective therapeutic pressure, and adding EPR may increase the tendency to be near an apneic threshold. I would rather see some pressure change than none in the presence of this oscillating respiration. To clarify, here is my interpretation of your chart. Up to 01:00 your respiration is very even and normal, then your respiratory drive drops just a bit, increasing CO2. You over-react with some larger volume breathing that drives down CO2 and your respiration diminishes with it. This is a feedback cycle that occurs when you approach the apneic threshold. Just assume that CO2, which drives respiration, is the inverse of your SpO2, and you can picture this. I think if you add to the EPR, the flow reduction at 00:12:30 would become a CA event.

My theory is you are at or near the apneic threshold, and the answer is to hold on EPR and decrease minimum pressure to 11. With that said, this is a very brief period of your night and results are just beyond excellent. Don't do a lot at once if you do anything at all.
Sleeprider
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#23
RE: ataylor830 therapy
10-4, I will not do a lot at once. That makes sense. I've been really honing in on getting my minimum pressure up to that 95% number. My 95% pressure for the last 30 days is 12.74 and for the last week is 12.84. However, since setting EPR to 2, I've had a few nights where - you're right - it hasn't budged from 12.6.

And I assure you, the remarkable results I'm getting do not go unappreciated! (I have some perfectionist tendencies, I suppose... plus, I really want to understand and zap this whole waxing and waning thing).

I will try lowering minimum pressure a bit and keeping EPR at 2 and see where we go. As always, thank you both.
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#24
RE: ataylor830 therapy
Sleeprider, I have a question about your comment about being near the apneic threshold. Does that statement consider the specific part of the graph I shared or is that a more general statement related to my minimum pressure being too high and so I'm almost constantly near the apneic threshold?

I'm trying to understand why my breathing is extremely even except during these small sections of what I assume to be REM. Introducing EPR of 2 has lessened the flow limits (ie, there are still clusters of them but they're more sparse during the clusters and values not as high.). However, the waxing and waning is still there, causing o2 variation and dips during these times.

So is it possible I could only be near apneic threshold during REM? I'm wondering what else could causing me to take these shallow breaths during REM, and kick off this cycle.

(update on stats, I've kept EPR at 2 and lowered min pressure to 12.0... it still stays within 1cm all night but moves around a tad more than it was at 12.6).
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#25
RE: ataylor830 therapy
When respiration destabilized, it usually looks like an evenly oscillating respiratory flow rate, often referred to as "periodic breathing". In your case, the flow does not come near apnea, and my comment was based entirely off of seeing this oscillation. It may be absolutely nothing, and we have not seen an update to your charts since this was posted, so we cannot accurately predict your results with more EPR or pressure support. Enough time has passed that it is probably fine to try increasing that, as you have probably adapted to using EPR now.

[Image: yIVHxtN.png]
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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#26
RE: ataylor830 therapy
I'm more than happy to load any and all images that anyone needs! I have just put together a post (https://imgur.com/gallery/c6TdsZZ) with several zoomed in portions from a few nights ago. My AHI was 0 that night (which is ridiculously amazing!) and has been between 0 and .3 for the past week or so.. absolutely fantastic. I know you all have more severe problems to work on so I really appreciate any attention you're giving me. I just have further questions about this weird waxing and waning that happens every 60-90 minutes.

Since it SEEMS to coincide with REM (though I have nothing to prove that), and muscles relax more during REM (at least that's what I've read)... could it be that I'm just not breathing as well as I should during REM for some other reason than apnea/hypopnea/FLs/apneic thresholds??
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#27
RE: ataylor830 therapy
I have also had similar oscillations, and still increased pressure support gradually. The best way to find out if a thing is a thing is to just try it. You're not going to hurt yourself, and can always go back to home base.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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