durxll - Therapy Thread

[durxll]

Looking back at the last couple of pages, we can see bilevel therapy is much better for AHI and resolving flow limitation and RERA than the Autoset. Your charts don't include the settings information which makes it harder to interpret the results because we don't have a complete picture.  You have tried PS between 3 and 5 cm, with fixed pressures of 11/8 (in CPAP mode) and 12/7 in S or Vauto mode.   There are no severe issues here and AHI is relatively low in both cases, but there is a pretty wide spread of the conditions tested.  You are setting up your device in a way that you can't really leverage the power of Vauto to self-adjust pressure.  I'm gong to suggest some settings to try, and let's see where that takes us. I'd like to see a chart based on these settings, then we can evaluate and make adjustments.

Mode Vauto
EPAP min: 6.0
Max Pressure: 12.0
PS: 4.0

Damn it sorry. I didn't want you to possibly read my above post and then have me edit it and have you miss an important detail so I have to do one more quote post instead of editing. 

So what I wanted to add is that it seems like when I go up to inhale pressure I don't get any of the lung issues. I don't get any aching or anything. It seems to be only when I go up on it my exhale pressure that I need about a week to get used to it.

[Sleeprider]

I missed that you are affected in that way by higher pressure. Are you certain you cannot tolerate more than 8 cm IPAP? In Vauto mode having some room to move would be very helpful for efficacy, but just to get the PS 4, you must be at least EPAP min 4.0, max pressure 8 with PS 4.0. If you can bump that maximum pressure to 10, that gives you a bit more opportunity to resolve flow issues. If you feel this higher pressure triggers aerophagia, then it is pretty easy to back off. Usually the lower exhale pressure makes the higher pressure support tolerable.

[durxll]

I missed that you are affected in that way by higher pressure.  Are you certain you cannot tolerate more than 8 cm IPAP?  In Vauto mode having some room to move would be very helpful for efficacy, but just to get the PS 4, you must be at least EPAP min 4.0, max pressure 8 with PS 4.0.  If you can bump that maximum pressure to 10, that gives you a bit more opportunity to resolve flow issues.  If you feel this higher pressure triggers aerophagia, then it is pretty easy to back off. Usually the lower exhale pressure makes the higher pressure support tolerable.

I can go as high as I want on the ipap or at least I've gone up to a 12 and was fine. it's the epap that gives me the issues and I can go up on it I just have to go up a week at a time each increase. So I'm currently at seven Max epap so I can't set the machine up so that I go straight to a nine or even part of the night at 9. I would have to do a pressure that was a Max epap of eight for about a week then I could go to a 9.

I looked into the pressures though that you're recommending and from what I understand it wouldn't go higher than an eight epap right? It would be at either a 6-10 or a 7-11 or an 8-12 right? If so I can try that I may have a little bit of chest tightness here and there and a little bit of labored breathing I would call it for about a week and then it goes away over the course of a week. At that time after week I could then adjust it to where I could go up to an epap of 9 then I likely would have the same issues for about a week then I could go to a 10 theoretically although I have never gone to a 10.

[Sleeprider]

That is correct. With PS 4, your EPAP will always be 4 cm less than the maximum pressure setting. I was trying to keep the settings within your proven experience.

[durxll]

That is correct.  With PS 4, your EPAP will always be 4 cm less than the maximum pressure setting.  I was trying to keep the settings within your proven experience.

Okay I will switch to this soon and then post some Oscar stuff. Thanks for the help