Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

megabill - Apnea Therapy
#11
RE: [split]megabill - Apnea Therapy
I did some experimenting.  Hopefully these will be more suitable


Attached Files Thumbnail(s)
           
Post Reply Post Reply
#12
RE: [split]megabill - Apnea Therapy
the snips justposted are from Thur niight.  here is the overall daily


Attached Files Thumbnail(s)
   
Post Reply Post Reply
#13
RE: [split]megabill - Apnea Therapy
Last night I increased IPAP 1cm from 12.0 to 13.0 and this reduced AHI to under half the previous night's result.  Of course, this resulted in mask leak ..1 problem at a time. I will work on mask fitting today and also have a new mask to try (Phillips dreamwear. Like most masks of this type, the nose slits never seem to be large enough and are not in the right place).  I suspect the go-to will still be the Resmed airtouch f20.   New data posts with this reply.


Attached Files Thumbnail(s)
           
Post Reply Post Reply
#14
RE: [split]megabill - Apnea Therapy
The patterns of your apnea look obstructive to me.  We see increased flattening of the inspiration flow wave and reduction of its flow volume leading into most apnea and hypopnea. Your respiration is very normal until these clusters of obstruction show up and the obstruction becomes increasingly acute, and shows snores and obstruction  until you clear.  I think this graph shows it best.  At 02:28:30 we see normal breathing that becomes flow limited by obstruction leading to a hypopnea. Normal breathing again at 02:29:30 becomes flow limited, then transitions to recovery breathing with a higher rate and volume, and some expiratory flow limits confirming the "frog in your throat" feeling, and may be an arousal. At 02:31:00  you are in an obstructive apnea but respiratory effort or pressure support is visible.  This patter repeats with recovery breathing, flow limitation, hypopnea, recovery breathing, flow limitation, hypopnea.  The oscillations look like central apnea, but the breathing looks like obstruction throughout.

If my interpretation above is correct, you are showing strong signs of Positional Apnea, and may respond positively to an increase in pressure to stent your airway, and/or a soft cervical collar.  I think we need to increase EPAP pressure to 9.0, IPAP to 13.6 and see if that improves this obstruction.  If we continue to see clusters of apnea and hypopnea, you will need to find a way to keep your chin from dropping into your chest. This is probably related to your sleep position since you cannot sleep flat. Any device, pillows or collar that supports your jaw and keeps the airway straight should help.  

[Image: attachment.php?aid=48099]
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.
Post Reply Post Reply
#15
RE: [split]megabill - Apnea Therapy
I ordered a collar.  Because there was no size chart I ordered a large and a medium.  One shows up today and the other tomorrow.
I made the suggested pressure changes and here are two data snips taken from different times.

I really appreciate the help and advice!


Attached Files Thumbnail(s)
       
Post Reply Post Reply
#16
RE: [split]megabill - Apnea Therapy
The same problem is present there, but with even worse results, so while this is obstruction, the addition 1-cm pressure made no difference.. I hope the collar will make a big difference for you. It's fine to have a relatively loose fit where you can fit several fingers between the collar and your neck, the important issue is to avoid kinking the airway.
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.
Post Reply Post Reply
#17
RE: [split]megabill - Apnea Therapy
Thanks for the analysis.

I've read that IPAP - EPAP is the baseline support pressure to keep the airway open.  Might there be any benefit to lowering EPAP a bit?  

There are so many variables in this device it's difficult to get a handle on them.  For example, what effect do trigger settings have?  They were originally set to very low, and I changed both to low.  It made treatment more comfortable but not sure about other effects.
Post Reply Post Reply
#18
RE: [split]megabill - Apnea Therapy
Let's take a look at the clinical titration protocol for the ST...in fact I'm also going to include the S titration protocol because I don't think you need the ST.  Normally, without any previous data, we would start with EPAP 4.0, IPAP 8.0 and we are not going to worry about the backup rate because I think you are a spontaneous breather and could be using S-mode, or even better a Vauto with a different machine.  For obstructive apnea for any bilevel, we increase the  EPAP and for hypopnea the IPAP.  We use EPAP to hold the airway stable and stent it against obstruction, and we use IPAP or pressure support (the difference between IPAP and EPAP) to increase ventilation and treat flow limitation and hypopnea.  The problem is that with positional apnea, we can throw the full pressure of the VPAP against the obstruction and still not get satisfactory results, however higher pressure might pry open the obstruction to lower the apnea events.

If you would like to start with a fresh titration and back off pressure to 10.0/6.0 (IPAP/EPAP), I have no problems with that, but until you wear the soft cervical collar, I think your obstructive apnea and hypopnea are going to be a problem.

[Image: attachment.php?aid=8455]

[Image: attachment.php?aid=4118]
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.
Post Reply Post Reply
#19
RE: [split]megabill - Apnea Therapy
I'm not sure who picked the ST, the doc or the lab.  Each lab was operated by a hospital so getting a hospital bed should have been easy. The tech running BOTH labs was a dork.  Because of his not following up on the fact that I needed an articulating bed, he barely had me asleep for any more than 3-4 hours.  I do not see any way  he could adhere to titration protocols within that short time frame.  Adding that the broken recliners both resulted in fragmented sleep  heightens the impossibility factor!  And the titration he ran the first time was CPAP not BIPAP in contravention of the test order.
Post Reply Post Reply
#20
RE: [split]megabill - Apnea Therapy
Let's wait until I have a collar that fits properly.    And even though this machine does have 's' mode, let's proceed one variable at a time.  The flakiness of mask leak detection does seem to support the jaw dropping.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  WW4B Therapy thread WW4B 49 4,061 Yesterday, 04:31 PM
Last Post: WW4B
  Therapy Help - Possible UARS - REM jkossis 8 156 Yesterday, 02:09 PM
Last Post: Sleeprider
  [CPAP] Therapy help rekaviv 9 253 Yesterday, 11:22 AM
Last Post: rekaviv
  IanD - Therapy Thread IanD 28 2,264 03-26-2024, 08:18 PM
Last Post: IanD
  MrIvanDrago - CPAP|Bi-PAP Therapy Journey MrIvanDrago 67 3,342 03-26-2024, 01:22 PM
Last Post: MrIvanDrago
  Invisalign to help sleep apnea and dental extractions as a cause of sleep apnea SingleH 10 609 03-24-2024, 07:00 PM
Last Post: stevew168
  Marcin's Therapy Thread marcinpiskala 20 957 03-23-2024, 04:38 PM
Last Post: Sleeprider


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.