David Clark - Therapy Thread

[pholynyk]

Not so great if you want to buy it from Ama....ca - it's close to $50 Canadian...

[David Clark]

If you want to try getting after the flow limitations, increase IPAP by 1-2 cm and increase PS from 5 to 6.  You are already using a relatively high pressure support, and you should consider this move to be somewhat experimental to see if it makes a difference.  We want to evaluate for effectiveness and comfort, and may decide to reduce PS to a more comfortable level.  I don't know the source of your FL but it may be anywhere in the upper airway from nasal to near the soft palate or pharyngeal. Some people get lower flow limits with direct pressure to the nose using nasal pillows, but tolerance for nasal therapy is an individual thing.

I made those adjustments last night and the flow limit did go down.

[Sleeprider]

You're not triggering any CA events, so if this is more comfortable, then let's hang out with these settings for a while.

[David Clark]

Since making a few adjustments it's looking like the flow limit numbers are better and the CA's I was having seem to be going away, except for last night. The OA's seem to be increasing though and the AHI is getting higher. I guess I'm at a "let it ride" point and see where it goes unless anyone sees a tweak or two you think I should make.

[David Clark]

Since making a few adjustments it's looking like the flow limit numbers are better and the CA's I was having seem to be going away. The OA's seem to be increasing though and the AHI is getting higher. I guess I'm at a "let it ride" point and see where it goes unless anyone sees a tweak or two you think I should make.

A few more....

[Sleeprider]

For OA events the solution is increased EPAP. Take it to 5.0, and move up gradually until the OA events titrate out. We have discussed chin-tucking and positional apnea in the past, so be sure none of that is possible.

[David Clark]

Last night. Best AHI number I've had since I started. 

[David Clark]

The last two nights. How are things looking?

[David Clark]

I feel like I slept pretty good last night. I'm thinking about increasing the EPAP a little to get rid of the OA's. There's still some almost asleep centrals. What do you think?

[Gideon]

How do you feel? You are at a point where it is much more about comfort than your numbers. While increasing EPAP is the thing to do based on the numbers, why do you want to try this ignoring the numbers?