Curious question about PS

[zzzZorro]

Been sitting on my hands waiting on a whisper II shipment to check out EERs but in the meantime I tinker with my settings.

Can anyone reasonably estimate the changes that should occur in OSCAR charts if the PS is raised from 2 to 3 and leaving pressure settings as-is?  Currently using ResMed AirCurve10 VATO set 24/16 PS-2.  Getting "sub-one" AHIs (without a collar) with those settings and can deal with the pressures but don't think actual rest is all that good..
Thanks

   

[zzzZorro]

ANSWERED Plugged in 24/16 PS-3 last night to see for myself.  NO cervical Collar. Noticed immediately the air flow that had previously felt warm, (seemingly) short on oxygen and restricted became much better.  Air flow was now without those annoyances.  Felt cooler, fresher and unrestricted. At least that is how it felt to me.  The chart is posted below should anyone also be curious.

   

Note: The last two hours or so was deleted as I WAS AWAKE and that characteristically causes a B-load of SWJ for me.

[Jay51]

In the 2nd chart, your flow limitations are 0.35 95th percentile.  That is a very, very high number.  Even though your AHI is very low.  

You have PS set at 3.  Maybe try 4 and see if that helps decrease flow limitations more.  If VAuto can give PS more then 4, then try that as well. 

Your pressure is pretty high (not a problem if you can handle it).  Possibly by raising PS more, your max pressure may come down a little bit.

That one bad stretch in your 2nd chart could have a positional apnea element to it.  Here is some reading on it and tips:

• 5.3Positional Apnea
  

[zzzZorro]

Thanks for the reply Jay.  I have never learned how to properly interpret Flow Limitations on an Oscar chart. Obviously zero is good but when FL Med is 0.00 and 95% is 0.17 or whatever what should I be looking at? What would be an acceptable FL to shoot for?

Thanks for the positional link but I am a physically committed back sleeper and have no choice.  I will read it over though and FYI I use a Velpeau Neck Brace occasionally when checking out new settings.  The higher pressures do NOT require the brace to get the sub-one AHIs.

Sleeprider was working with me to try to get the pressures down and the FL improved with 20/10 PS-4 a while back but suggested I try EERs.  Waiting on a Whisper II Swivel <supposedly being shipped by one of our suppliers ?>... Till then I am experimenting.

I will dial in the 24/16 PS-4 tonight and see what happens.  I do have a 25/15 PS-4 from a couple weeks ago I will post here FYI.  I expect they are going to look about the same.  The FL is improved here.

   

[Jay51]

Thank you for that.  It looks like you have already tried the PS 4 experiment.  

Does wearing the collar make a big difference in your flow limitations?  

Probably at least single digit flow limitations might be acceptable (less than at least 0.09).   Probably around 0.05 or even lower would be considered good.  But a person can usually tell by the quality of their sleep if flow limitations are too high and causing some problems.  I copied and pasted the chart from our wiki:

Flow Limitation Statistics Interpretation
In general, Any flow limitation showing up in the median statistic is a significant problem.
95% Flow Limitation
Interpretation
> 0.2
Needs more pressure or pressure support
< 0.15
Marginal
0.1
Good
< 0.05
Excellent and rarely associated with other therapy problems
The maximum statistics are not as significant.

Hopefully the EERs experiment works for you.

[zzzZorro]

Jay; The link you posted has a lot of things I needed as a refresher and/or what I did not know.  Also the Flow Limitations specs are just what I was looking for. Thanks again for all that.

Last night I dialed in 24/16 PS-4  Trigger was bumped from High to Very High.  Amazingly it looks like a great improvement to me. 95% FL dropped to 0.12 and AHIs are 0.30   Breathing quality was parallel to last night (Good).  This chart is below..

Also I just now received the Whisper Swivel II exhalation port. I can now assemble the EER set-up for my F-30 mask. I plan on testing it tonight with the current settings.

The second attachment is of 12 second O/A at 0517 hrs.  If my understanding of EERs is correct this waveform in indicative of such treatment being warranted?

Many Thanks


         

[Jay51]

I'm glad the experiment went well last night.  Your close up chart looks like at least minor periodic breathing IMO (a kind of waxing waning, crescendo decrescendo pattern to it).

If you have the EERs equipment and want to give it a try, please post a few OSCAR charts of this particular set up.

[zzzZorro]

Will do.  Starting with 6" of tubing.

I wrapped the swivel vent and the 6" tubing with several wraps of poly fill sheet after reading about the rain-out and air noise warnings by GuyScharf so maybe that will prevent those issues..

[zzzZorro]

Jay 51;  Failed to answer question "Does wearing the collar make a big difference in your flow limitations? "  No at higher pressures and Yes with lower pressures.

EERS: (My personal take) As noted above I duplicated GuyScharf's directions for adapting the ResMed F-30 for EERS.  I used dacron sheeting -used in pillow stuffing- to both insulate the tubing from rain-out and to silence the Whisper II Swivel Valve. [shown below] The tubing snuggie was slid up to cover the whole works.

I did a brief 'proof' and it seemed to be functioning OK.  Come time to go to bed I found the breathing to be restrictive and concerning so I figured the dacron was causing the problem so it was rolled back to not cover the valve vent area.  That didn't seem to help so I decided to 'tuff' it out anyway.  I attempted to go to sleep but the vent air from the Swivel Valve was extremely loud, akin to being under a waterfall.  Totally intolerable for me.  So, the EERS rig was removed and the standard F-30 attachment was replaced.  Wonderful quiet was restored and I slept through the night.  My guess is that the EERS is probably something that would benefit me but it seems the potential small improvement does not justify the constant noise disruption to sleep?

Probably the 'extra' loud air vent noise was increased by the higher pressures I use so it may not be so with everyone.  The chart from last night is below.  The first three segments are dinking with the EERS setup, Then the fourth is sleeping with the ResMed F-30 with original settings from night before, and the last is awake (absent the usual SWJ).  The FL is a little higher but I would guess anxiety from fooling around with it before treatment may explain that.  Planning on leaving everything as it is now and shelving the EERS experiment for now.  Hopefully the FL will improve as I adapt.  If not maybe bumping the PS from 4.0 to 4.2 or so is the key.

Hoping this information will help someone else with similar concerns..

           

[Jay51]

Sounds like a good plan.  Maybe someone with experience with EER's may be able to pinpoint your specific problem and possibly give a viable solution.