[CPAP] Newby trying to understand what i am seeing

[WoodyV12]

Thanks Macka
Here is Mk11 chart, doesn't look a scary as before 


   


-  plus the one from PrismaTS


   

Cheers
Jen

[Macka]

Thats better, the focus is now directed at those reras, flow limitations and your obstruction levels. You can't go too wrong with the f20 once you have it fitted well, so that is great. 90% of the battle is finding a leak free mask. As others mentioned you will do well to investigate chin tucking and get the pressure up a bit and apply softpap 3 (if you have it on your machine?)

Two things which also make a big difference in comfort and when going up in pressure is a 22mm hose and a Vcom. The 22mm hose makes night and day difference IMO. What do you have on your machine?

[WoodyV12]

I suspect that the chin tucking and some of the obstructions may come from lying on my back. 

There are only 3 settings for Soft PAP
Off = no pressure relief
1= mild to moderate relief (Lowenstein recommended for most patients)
2= moderate to high(consider if 1 not tolerated well)

Tube is standard 15mm.
Will look into 22mm tube
What is Vcom?

Cheers 
Jen

[Sleeprider]

Jen, you have persistent flow limitations and RERA. Could you post some zoomed shots that show 2 to 3 minute segments so we can see what the flow rate wave looks like? It sure doesn't look restful if you actually have that going on all night.

I have never used a VCOM device, (GetVcom), and to me it defies everything we try to do with increasing pressure support during inspiration to reduce flow limitation by adding pressure support to supplement spontaneous inspiratory effort. More mechanical assistance has proven to consistently reduce flow limitations and upper airway resistance. The Vcom device actually claims that it "lowers inspiratory pressure and peak inspiratory flow rate but has minimal to no effect on EPAP". This is counter-intuitive to me. I have used EPR to provide some level of inspiratory pressure support, but often encouraged members with persistent upper airway resistance and flow limits to move to bilevel to get more pressure support than a CPAP affords. To install a device that suppresses the positive effects of PS seems like it would only damage therapy efficacy. So far, no one has shown me Oscar charts, with and without V-Com that persuade me otherwise, and I have in fact encouraged a number of members to remove the V-Com and throw it in the bin.

[WoodyV12]

Thanks Sleeprider

Are these extracts sufficient to illustrate?

Cheers

Jen

   

   

   

[Sleeprider]

Oh wow! You need bilevel! That's ridiculous. You must feel like crap. Let me know how I can help, but CPAP is not going to cut it for you.

[WoodyV12]

Hi Sleepmaker,

Wow! ..thats an eye opener! 
We have appt with Sleep center next week.. going to be interesting.

I'll be back!

Cheers

Jen

[Sleeprider]

I'm sorry to have been so brief, but this flow chart looks like pure torture, and apparently your Prisma agrees. Read out wiki article on flow limitation, and our examples there don't even come close to being as bad as your charts indicate. The reason you need bilevel therapy is, pressure alone will not resolve the inspiratory resistance that these flow-charts represent. As you know, your AHI is low, but you don't feel rested. That's because you are working all night just to get a breath. It's as though you are trying to breathe through a thin straw. It takes a long time to fill your lungs, which is why your inspiration time is much longer than expiration time. Each breath starts out strong and flow increases until it hits the "flow limit" where it flattens out, because no amount of spontaneous respiratory effort will let more air/second pass. So there is a long flat peak before you relax and this falls off into expiration.

Why bilevel? Because we can still stent the airway and prevent obstruction with the expiratory pressure (EPAP) and then we can recruit pressure support, an increase of pressure during inspiration, to supplement your spontaneous effort with mechanical assistance. This should normalize the respiratory curve allowing a full breath to be obtained in less time with less effort resulting in...better sleep. This will resolve flow limitation, RERA, Hypopnea and will continue to be effective against obstructive sleep disorders. Another member from AU recently bought a Resmed Aircurve 10 Vauto bilevel from a U.S. company CPAPspecials for $1530 AUD including shipping https://www.apneaboard.com/forums/Thread...#pid503654 That is much lower than you can buy the device locally. We are trying to get two new additions to our supplier list, TheCPAPshop and CPAPspecials, both of which offer very good prices. That requires a yes vote from at least 10 Advisory Members. Good luck in your therapy, and if you are able to move to bilevel, I look forward to changing your life.

[Macka]

Thats the best short explanation I have read on bi-level yet sleeprider! Am just moving to one myself as my Prisma20a can't give the pressure support I need. Close, but not enough. Its like they have figured out just how much to limit the setting by to force you into a machine upgrade. With softpap3 you can get pressure support of 4 and with Lowenstein timing of when it is delivered it is effective with only mild flow limitation. I forget it is easier to get a new machine for you US guys and gals. Being self funded (and subject to ridiculous geo pricing) we end up stuck trying to wring the best we can from insufficient machines. Very annoying.

Good luck Jen with the appointment next week. If you need reinforcement for your request for bi-level you can just take a laptop or some printed pdf reports showing those last charts.