Good Result, but could it be better?

[wesozzzz]

Hi
Thanks to the SAB advice my AHI has come down from 47 to between 3 and <1 per night.
The soft collar chin support did the trick.


I am posting up some charts from Oscar which may trigger some helpful fine tuning of my settings.
I note that my 95% pressure (15.6cm.) is not far away from my max setting of 16cm and pressures often reach 15.8 which may be maxing out. Would there be some more potential support by increasing the max pressure or maybe some other settings could be adjusted to bring the max needed pressure down?


Also my inspiration flow rates are low, extended and lumpy.


I have Idiopathic Pulmonary Fibrosis (IPF) and I have lost 40% of my lung capacity. IPF also results in my lungs being stiff.
I have some nasal restriction and tend to mouth breathe.
The conclusion of my Sleep Test ,”Severe, predominantly obstructive sleep apnea associated with profound oxygen desaturation and sleep fragmentation”


I am having some indications of arythmia which is a common outcome from lung disease and sleep apnea along with my low o2 levels I need to try to get the best results I can.


I have attached some Oscar charts for a typical night.

[attachment=13337][attachment=13338][attachment=13339]


Also here I had a rough night . I had a head cold with added nasal congestion, but a low AHI:
[attachment=13337][attachment=13337]

Keep breathing
wesozzzz

[DeepBreathing]

G'day wesozzz, and welcome to Apnea Board.

Your lung disease makes me reluctant to say too much as I'm no doctor. However... Your machine is obviously treating your apnea well, but you may need extra breathing support. I see you have a fairly long ramp time and that you have the EPR set to "ramp only". My guess is that breathing would be easier with a reduced ramp time and EPR set permanently on (and perhaps increase it to 3). This way your machine will act more like a bilevel and help get more air into and out of your lungs. The next step would be to consider a "proper" bilevel machine such as the Resmed Lumis 150 or an ASV such as the Resmed CS Pacewave:

https://www.resmed.com/au/en/healthcare-...ap-st.html
https://www.resmed.com/au/en/healthcare-...ewave.html

These may be some options to discuss with your pulmonogist.

[Sleeprider]

Wesoz, I'm impressed with your AHI results at 6 to 16 pressure in Autoset mode, which are more than acceptable, and appreciate the details about your pulmonary function.  Also, your close up chart is very well done and shows the flow limitation I'd like to target with some setting changes to your machine.   First, let's note that  your median pressure is currently 13 to 14 cm, so the minimum pressure is not something you experience very long.  Secondly, we can see in the detailed chart below, and your summary statistics that you have relatively high flow limitation.  This flow limitation is what drives your pressure higher.  I'm going to propose that we increase your minimum pressure to 9.0 and add exhale pressure relief (EPR), which on the Resmed Autoset acts like bilevel pressure support.   You should be able to add the EPR, Full Time at a setting of 3 in your comfort settings.  This will result in the following settings:

Mode: Autoset Standard
Maximum Pressure 16.0
Minimum Pressure 9.0
EPR ON Full-Time
EPR setting: 3

Your pressure will start out at 9.0/6.0 (IPAP/EPAP) which will greatly support your inspiratory breathing effort. I'm certain this will be more comfortable and allow you inhale time to be shorter, while resolving the very flow-limited appearance shown in the graph below, where inspiration starts off fine, but flow quickly drops  showing a labored breathing effort. This will also give you more time for exhale.  Your results are very good, and as noted by Deepbreathing, a person with impaired pulmonary function usually does better with a bilevel machine. Fortunately, you have one (limited to 3-cm of pressure support), and all you need to do is turn on the EPR full time at 3 to take advantage of it. 

[wesozzzz]

Thank you DeepBreather

I will try your suggestions.

last night I had raised my max pressure to 16.6 cm the 95% pressure was 16.54 , max was the 16.6 so the auto was often at its limit.

Is there any problem likely if I cautiously edge up the max pressure?

cheers

wesozzzz

[Sleeprider]

Wesozzz, the most important recommendation by both Deepbreathing and myself is EPR full time,and turn off ramp or turn it to auto. Edging up maximum pressure is fine because the autoset will only move pressure as high as it needs to go. You can set the max to 20 and it would still be right. Fix the EPR and Ramp.

[DeepBreathing]

I don't see any problem increasing the maximum - generally speaking the machine will go as high as necessary, and no higher. I say generally because there can be circumstances where the pressure just increases to the limit.

However I think it's more important right now to get the EPR working for you, so the advice SleepRider gave is very germane to your situation.

As an aside, do you have (or has your doctor suggested) supplementary oxygen? Also have you discussed a bilevel machine or non-invasive ventilator?

[Gideon]

Agree with the proposed changes.

Because of your reduced lung capacity I'll suggest one of the recording oximeters compatible with OSCAR. Oxygen levels are important and in your case worth monitoring even if only to provide talking points with your doctor.

[ajack]

You really need the leaks fixed. Also see the mask pressure. It may look better zoomed in, but it's almost a straight line and not showing the 3cm EPR difference and may be because of leak. As well as raising the max, you also need to raise the min pressure, 12 or 13 may be a place to start. To increase o2, your raise min pressure to clear most events before they start and refer to your doctor

[DeepBreathing]

The charts provided indicate excellent leak control except for two episodes on Saturday night. Thursday night, for example shows 0.0% time over the red line.

The mask pressure isn't showing a 3cm EPR difference because EPR is currently set to "ramp only" and therefore is not working during the rest of the night. This is nothing to do with leaks.

It's not a bad idea to increase minimum pressure by 3cm when going to full-time EPR, in order to maintain the same exhale pressure when the machine is operating at minimum pressure. However I think it's good practice to change only one parameter at a time. Fix the EPR first then see about whether or not the minimum pressure needs to be changed.

[ajack]

Thanks for the EPR correction, I missed that. As flagged, there are areas of large leak though.