Rera and O2 desaturations

[REMless]

I am seeking guidance on optimizing my settings to resolve the 02 desats.  



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[Sleeprider]

I can safely predict that your RDI and oxygen desaturations are the result of flow limitation. These are similar to hypopnea in that you don't get a complete breath, and it is often related to upper airway resistance syndrome (UARS). In spite of the low AHI, you are having trouble getting air, and this is causing arousals and the oxygen desaturation. Based on what we see in the posted chart, it appears you should try higher minimum pressure, and consider reducing the Flex setting on your machine. I would try increasing minimum pressure in 1-cm increments until oxygen results and RERA improve, or you find you don't tolerate the needed pressure to break the flow limitation cycle. The best treatment for this problem is bilevel (BiPAP) therapy with pressure support during inspiration to help overcome the upper airway resistance. These wiki articles are a must-read for you.

http://www.apneaboard.com/wiki/index.php...Limitation
http://www.apneaboard.com/wiki/index.php...ome_(UARS)
http://www.apneaboard.com/wiki/index.php..._and_BiPAP

Keep in mind that in any positive pressure ventilation situation, oxygenation is determined by the EPAP pressure. Yours is lower than you might intend at your current settings, particularly with Flex, and I think higher minimum pressure will resolve most of this problem. It is certainly worth trying before resorting to bilevel.

[REMless]

Thanks for the info -- good articles.  I will make the changes tonight and report back in a few days.  Thanks again for you insight. 

[REMless]

I am posting a follow up.  Should I keep the min pressure the same or should I bump it up .5 cm?

[Michaely6]

Did your oxygen levels improve with the higher EPAP?

[Sleeprider]

REMless, how are you feeling at this point? I think bumping up pressure is the best avenue you have at hand, but if you could be approved for bilevel therapy, I think you'd discover a brave new world of more comfort and efficacy.

[REMless]

I feel better but I am still getting a high ODI.   Increasing my pressure  did have a subtle improvement though.
 
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 I have taken your advice and acquired a bi-level device.  I will start on it this weekend.
Thanks for your advice.

[Sleeprider]

 I have taken your advice and acquired a bi-level device.  I will start on it this weekend.
Thanks for your advice.

Wow! Stand by for some amazing results.  What did you get?

[REMless]

 I have taken your advice and acquired a bi-level device.  I will start on it this weekend.
Thanks for your advice.

Wow! Stand by for some amazing results.  What did you get?

I bought a low hour Resmed Vauto.

[Gideon]

IMHO VAuto is best of class

Top of this page (CPAP Setup Manuals) send a request email for a ResMed AirCurve 10 VAuto Clinician and User manual, it is a manual response and as such is not instant.
Press the Dial and the Home button simultaneously for 3 seconds (until the Clinicalmenu come up)
Do a Full Factory reset to clear out all current data

Ramp=Off
Mode=VAuto
Min EPAP=7
Max IPAP=18
PS=4

This will start you at EPAP=7 and IPAP= EPAP + PS = 7 + 4 = 11  pretty close to where you are currently at.  I'd also count on an adjustment after your first night.