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Frustrated with recommendations by doctor
RE: Frustrated with recommendations by doctor
UA and H appear to be obstructive, but a closer 2-minute zoom would help to see it. There may be some positional aspect to the clusters. No CA in evidence. I think a lot of stuff may be happening with that 30 minute ramp time, and it would be better if you could shorten it or turn it off.
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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RE: Frustrated with recommendations by doctor
I think more max PS would be useful, that would reduce the hypopnoeas and UA’s a max PS of 11 is pretty low.
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RE: Frustrated with recommendations by doctor
(08-16-2019, 12:36 PM)Sleeprider Wrote: UA and H appear to be obstructive, but a closer 2-minute zoom would help to see it.  There may be some positional aspect to the clusters.  No CA in evidence.  I think a lot of stuff may be happening with that 30 minute ramp time, and it would  be better if you could shorten it or turn it off.

Thanks, Sleeprider.  I turned off the ramp, and I also upped the max PS, as JASWilliams suggested (just turned up several notches.  

My AHI was the lowest last night that it has ever been, which was kind of cool to see.  I'm attaching a few screen shots to that you can see some of the UAs and hypopnea clusters in more detail ...

The night, overall:
[attachment=14631]

First UA of the night. Looks like a CA to me (?):
[attachment=14632]

Another UA:
[attachment=14633]

Leading up to an hypopnea:
[attachment=14634]

A cluster:
[attachment=14637]
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RE: Frustrated with recommendations by doctor
First a suggestion,  swap the positions of the mask pressure chart and the leak rate,  This put the Mask Pressure right under the Flow Rate chart and you can better see that ASV increasing pressure as it should, but failing to actually trigger a breath.  That goes along with what someone was mentioning earlier, more pressure, try giving the ASV more PS to work with.  Everything seems close to the max so see how high you can set the max PS.

two other things, I see a fair amount of expiratory mouth breathing,  It don't think you need to worry about it, at least noit yet, but be aware of it.  If you are cycling air out your mouth during inhale, that could be a problem.

Your numbers are good enough to leave alone, so don't be too disappointed if we cannot improve them.

Finally, your ASV is doing everything it can to initiate that breath and all I see is a very very small "inhale" that maybe, if where on a mom-ASV machine would indicate a breath initiation, but here could be a little push of air from the increase in mask pressure.  (thus the suggestion to max the max PS) This makes me think that it may be Mixed Apnea as I see characteristics of both.

Try taping your lips for a night or two, for now just to see if it makes a difference,  This is because if you are cycling inhale air out your mouth, that could compromise the function of the ASV.
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RE: Frustrated with recommendations by doctor
Bonjour, Bonjour Wink

I've moved the charts around as you suggested:
[attachment=14639]

I'll try taping my lips tonight. Though I'm a little mystified as to how I could be breathing out whilst breathing in, esp. as I wear a full face mask. Wouldn't the machine pressure prevent that?

And just so I'm clear, are you suggesting I increase PS max to as high as it can go? If so I'll try that too. I'm not there yet, I don't think.

A bientôt,
Allan
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RE: Frustrated with recommendations by doctor
(08-19-2019, 10:05 AM)allanri Wrote: Bonjour, Bonjour Wink

I've moved the charts around as you suggested:


I'll try taping my lips tonight.  Though I'm a little mystified as to how I could be breathing out whilst breathing in, esp. as I wear a full face mask. Wouldn't the machine pressure prevent that?

And just so I'm clear, are you suggesting I increase PS max to as high as it can go?  If so I'll try that too.  I'm not there yet, I don't think.

A bientôt,
Allan

I bet you won't believe it, but I've actually heard that before, many, many times.

An ASV will only use what it needs, and 15 as max is the default recommended/starting value.  So I definitely see a need to raise it, my thought was do it once and see if it makes a difference, slower is ok too, but I'd start with a 2cmw increase in that case.

If you look at the detailed example that you posted, you will see many inhales with much less exhale, the volumes under the curves should be similar area and by eyeball you have many cases where the exhale is much smaller than the inhale.  I did not note the FFM when I wrote this BUT this is a closed system and what goes in has to come out and the question becomes where did it go.  If you had excessive flatulence all night that could be 1 explanation.
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RE: Frustrated with recommendations by doctor
I though I'd check back in. I'm in agreement with Bonjour in all conclusions. I think some of the UA events were clearly obstructive. Although the UA flag occurs at the first inspiration following the apnea, we can see all of the breaths the ASV is trying to deliver preceding that breath do not cause any result at all. Obstruction could be positional, but may be a collapsed airway suggesting a need for higher EPAP.

http://www.apneaboard.com/forums/attachm...?aid=14632

On the other hand, the hypopnea shown here was central. As the mask pressure rises, we see a respiratory response, but diminished flow. This suggests a need for more pressure support. Hypopnea can also result from incomplete obstruction and positional issues, so that is an area we need to consider.

http://www.apneaboard.com/forums/attachm...?aid=14637
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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RE: Frustrated with recommendations by doctor
So I did change the Max PS last night. I cranked it up to the highest level, and turned off ramp. But I quickly found it was a little TOO much for me; my lungs felt like they were being inflated like a very resistant balloon. So I backed it off, but I wasn't wearing my glasses, so I backed it off too much ... to 16cmw Sad So I need to try it again tonight. I'll aim for 18-19 cm or so.
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RE: Frustrated with recommendations by doctor
Sigh. So I feel like I'm back to where I was just under a year ago. With the Ps Max upped to 18, I couldn't get to sleep with the mask on. It just kept waking me up. The only way I can sleep with the pressure this high is to take a sleeping pill, which I hate doing. Any tips how to get used to having your lungs inflated like a carnival balloon?
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RE: Frustrated with recommendations by doctor
Have you tried the "blow-back" technique to settle the machine down?
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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