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thoughts to control hypopnea
#11
RE: thoughts to control hypopnea
(06-09-2021, 01:16 PM)doug001 Wrote:
(06-09-2021, 11:05 AM)staceyburke Wrote: Your change of min pressure to 7 is good. It should help get you enough air. 

BUT your main problem is the positional apnea with both O and H events. There is NO pressure changes that can reduce positional apnea. You need to get a collar in my opinion. Again please read the link on collars at the bottom of the post.

staceyburke, yep thanks for the second review the charts do continue to show the clustering of events, there's a lot of good information in the collar link,  i am working towards getting the collar, thinking i will add it once i run the changes of pressure changes. one step at a time.

That’s fine just want to make sure that you know that pressure changes or for that matter - no pap machine can help with positional apnea.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#12
RE: thoughts to control hypopnea
Something else to watch is the green line on your pressure graph (the EPAP).  It's the EPAP that acts like a wedge to keep your airway open and prevent obstructive events.  Your median EPAP last night was around 6.9.  I'd hazard a guess from the data that you'll want to setup your machine to keep your EPAP above 7.0 at all times.

With PR machines, your EPAP is a function of the pressure setting and the flex setting.  By setting the min pressure to 9 or higher you can ensure that the min EPAP would be 7.

That said, no harm in setting your min pressure to 8 and seeing what a min EPAP of 6 does.
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#13
RE: thoughts to control hypopnea
(06-09-2021, 01:59 PM)staceyburke Wrote:
(06-09-2021, 01:16 PM)doug001 Wrote:
(06-09-2021, 11:05 AM)staceyburke Wrote: Your change of min pressure to 7 is good. It should help get you enough air. 

BUT your main problem is the positional apnea with both O and H events. There is NO pressure changes that can reduce positional apnea. You need to get a collar in my opinion. Again please read the link on collars at the bottom of the post.

staceyburke, yep thanks for the second review the charts do continue to show the clustering of events, there's a lot of good information in the collar link,  i am working towards getting the collar, thinking i will add it once i run the changes of pressure changes. one step at a time.

That’s fine just want to make sure that you know that pressure changes or for that matter - no pap machine can help with positional apnea.

ok got it and ordered the collar will have by the weekend and will give it try.
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#14
RE: thoughts to control hypopnea
(06-09-2021, 03:03 PM)notam2 Wrote: Something else to watch is the green line on your pressure graph (the EPAP).  It's the EPAP that acts like a wedge to keep your airway open and prevent obstructive events.  Your median EPAP last night was around 6.9.  I'd hazard a guess from the data that you'll want to setup your machine to keep your EPAP above 7.0 at all times.

With PR machines, your EPAP is a function of the pressure setting and the flex setting.  By setting the min pressure to 9 or higher you can ensure that the min EPAP would be 7.

That said, no harm in setting your min pressure to 8 and seeing what a min EPAP of 6 does.

ok that all makes sense

tonight will set min to 8 and will reduce the max.   

and will see how it goes.

i will not change the flex settings but for reference the current setting is flex=a, 3,  the machine has setting for flex=a, flex=c or flex=off, with secondary option for 1,2 or3. (more to learn ! )

thanks
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#15
RE: thoughts to control hypopnea
ok
increased min pressure to 8
decreased max to 14
used a soft collar (will use over the next few nights to get used to this and adjust the fit, initially i find it to be uncomfortable woke several times thru evening with kink in neck and readjusted and fell back to sleep for total of 6 hours)
total ahi decreased so good and hypopnea are down
attaching 3 oscar shots any thoughts appreciated.


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#16
RE: thoughts to control hypopnea
Looks like your hypopnea index improved from 6 to 3.75.  A lot of your obstructive events are happening when your EPAP is at 6 cmw.  My suggestion is to up the min pressure by 1, and over the next two nights do one night wearing the collar, and one night without the collar.  You want to see if its the pressure helping you, or if its the collar that is helping you.
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#17
RE: thoughts to control hypopnea
Try this edit, change flex from 3 to 2. There's quite a few DreamStation users that report flex 3 is disruptive.

Keep an eye on Obstructive and hypopnea and then CA. You're getting what I'm supposing is treatment emergent CA due to PAP settings increasing CO2 flushing, and the others are likely the positional clustering Stacey was mentioning. These are in opposing ends of the teeter-totter, and actions to combat CA would likely make Obstructive events increase. Watch the numbers when editing and note your well rested feel. You'll have to tune things to have events low enough consistently to maintain rest and comfort.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#18
RE: thoughts to control hypopnea
a curiosity question, is there a way to interpret the oscar charts to best guess if the event reported as Hypopnea is occurring due to obstruction or central ?  or is that not implicit in the charts ?
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#19
RE: thoughts to control hypopnea
I think if the Hypopnea event is zoomed in showing flow rate to about 10 then 3 minutes there's a telltale pattern that may be picked out to help. It's not as accurate as the lab test being wired up but it may be reasonably close.

Part 2 is going off the diagnosic event data at least for me. If one has a high tendency of Central Apnea, Hypopnea may be Central based. Noting how they respond to pressure and specific edits can tell some too.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: thoughts to control hypopnea
Doug - may I suggest reading the board's wiki titled "Optimizing Therapy." It contains a TON of information. I had to read it a half-dozen times to understand it all. There are some parts of the wiki that may not apply to you -- pay attention to the section headings. And then re-read it again.
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