RE: Expiratory flow limitations?
Note: the impact of EERS will be reduced by your high pressures and high PS which will result in greater flushing of the added hose. I suspect it may be to the point of making the EERS fairly ineffective.
I do think you need to look for a non-pap solution to your issues.
RE: Expiratory flow limitations?
(08-15-2023, 02:13 PM)Gideon Wrote: Note: the impact of EERS will be reduced by your high pressures and high PS which will result in greater flushing of the added hose. I suspect it may be to the point of making the EERS fairly ineffective.
I do think you need to look for a non-pap solution to your issues.
Are my current PAP settings (MIN EPAP = 15, MAX EPAP = 25, and PS = 6) freakish? Based on my past trial and error, I can probably lower my MIN EPAP to 13 and my PS to 5.6, but going lower than that causes me to feel like I am not getting enough air.
I am somewhat re-assured by Barry Krakow:
https://www.apneaboard.com/wiki/index.ph..._and_BiPAP
https://fastasleep.substack.com/p/premie...t/comments
From the first post, I quote:
" Should you be able to produce the same results with CFLEX, APAP, etc? Presumably so, except for one “large” difference. You cannot generate the same gradient or gap between IPAP and EPAP with any of the other devices. And, in our clinical and research experience, we are using gaps of 4 to 12 cm of water in our patients. My personal bilevel settings are 21/12.5 for a gap of 8.5.
In our prescriptions for bilevel, I would venture that the average gap is in the 5 to 6 range with tremendous variation, including some with a gap of only 2 or 3. Those with a lower gap requirement would likely do as well on FLEX or APAP, but to repeat, the large majority of our patients have a gap of 4 or greater."
From the second post, I quote:
" As I've reported in many forums as well as research papers, once you get very close to your optimal settings, you can change EPAP or PS on a device by as little as 0.2 or 0.4 units and notice huge differences in the way you feel the next morning."
Therefore, it seems plenty of UARs patients have similar settings to mine.
RE: Expiratory flow limitations?
You are starting to look to alternative causes for your arousal issues, and I think that may be an important step. I’m not a fan of Trazadone, but I would not rule it or as part of the solution. I think Gideon and I have a common objective to move you away from the PAP therapy as the solution for remaining issues. There appears to be a lot of possibilities.
RE: Expiratory flow limitations?
(08-15-2023, 05:45 PM)Sleeprider Wrote: You are starting to look to alternative causes for your arousal issues, and I think that may be an important step. I’m not a fan of Trazadone, but I would not rule it or as part of the solution. I think Gideon and I have a common objective to move you away from the PAP therapy as the solution for remaining issues. There appears to be a lot of possibilities.
I will start to more actively pursue non-PAP solutions. This discussion has been very helpful. Due to this discussion, I am more convinced that my poor sleep is not due to my current PAP settings.
I have two lingering questions about my PAP therapy that I am hoping people here will comment on:
- Are my current PAP settings (MIN EPAP = 15, MAX EPAP = 25, and PS = 6) highly abnormal and indicative of some lung or neuromuscular disease? Based on my trial and error over the last year, I can probably lower my MIN EPAP to 13 and my PS to 5.6, but going lower than that causes me to feel like I am not getting enough air. Based on comments by Barry Krakow, I do not think these settings are too unusual (at least with people with UARs). See my previous post above.
- I am a 45 year old 5'10'' male. When I set my PS to 6 or higher, my median tidal volume (TV) and minute ventilation (MV) range between 400 - 600 mL and 5 - 7 mL/min respectively depending on other settings. My understanding is these values are normal for a man of my height. When I set my PS to 0, my median TV and MV range between 250 - 350 mL and 4 - 5 mL/min respectively. My understanding is that these values are very low for a man of my height. Could this explain my need for higher PS? These numbers are for the last year when I started to sleep poorly and felt I needed to experiment with my PS. Unfortunately, I do not have any PAP data from more than one year ago when I was sleeping well and had my PS always set to 3.
RE: Expiratory flow limitations?
1. Change your min EPAP to 11 and you match my settings so no. At this time you do not show signs of UARS, thus the thought about trying, only trying, lower pressure. My Original and only Dr. originated Rx is 19 Fixed CPAP.
2. I don't think either Sleeprider or myself ever implied that you didn't need it, but high PS is not that common so we both ask why? I didn't because I saw your reason. neither of us want to undo good therapy. Without seeing your data I am hesitant at drawing any conclusions of the way it was before.
RE: Expiratory flow limitations?
Similar to Gideon, my comment on PS was in response to your concern for possible hypocapnea. If you indeed have that problem, then lower PS can resolve it, however your current settings result in 0.00 AHI. Experimentation with alternatives that make you more comfortable or sleep better needs to be the priority. I think your conclusion that further progress probably lies outside of PAP therapy is correct.
RE: Expiratory flow limitations?
Hi Michael, did you make any progress with your arousals? I have a similar problem. I am currently battling my arousals with a PS of 2.4 in order to reduce flow limits. That worked for a short while, but now I‘m back to a very fractured sleep again. My breathing also feels somewhat less natural, unnecessarily deep. I am suspecting my nose. Therefore I will try some nasal sprays. Cheers!
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