Flow Limitations?

[SeePak]

10cm constant,  EPR=0

If you really need to try EPR
11cm  EPR1

Here's my interpretation, for what its worth....

If the flow narrowing is indication of airway narrowing, beyond all the possible reasons for this, it is the hope of pressure to splint the airway open.

The pressure range you are using is allowing the exhale pressure to drop to 8 or 9 depending on which scenario you have posted.

That is enough to allow the airway(s) to narrow over time, so.....

Adjust pressure so it stays at a point that will keep/splint airway open.

10cm may do that and reduce the OA events that are a result of too low a pressure as above.

The problem with the EPR, in my theory, is even when you get the exhale pressure to 10cm while using EPR, the EXCESS inhale pressure can/may actually contribute to CLOSING the airway !
I am not a scientist, sleep doctor, sleep clinician, I am simply reading the information that these people all provide.
There is easily enough evidence out there combined with practice, that would sanction these settings i suggest.

So, 

I suggest 10cm as a constant pressure. No EPR
See how the flowrate chart responds.
See how the OA events respond, and it should give enough evidence to make small further changes.

But, most of all, See How You Feel !?

[gr3gg0]

Hi All,

Posting the last two days using 9-10 range EPR off, didn't see SeePak's last post until now re constant 10 EPR off.

Regardless, first night was pretty ugly with almost constant coning all night.  Last night was better but still not great.  As shown APAP constantly raising pressure with EPR off to deal with the FLs it looks like.  AHI's are as usual looking good but still not feeling rested.

The flow chart is from the second night during some of the "grassy" areas.

To SeePak's point, I have also seen on a Lefty video an interview with a sleep doctor about how EPR/Bi-Level can cause to instability of the airway as the decrease in pressure during exhale might contribute to closing/shrinking the airway.  I recall him mentioning looking at it more like memory foam than a balloon which would just spring back open during increase in IPAP pressure, hence EPAP pressure played a larger role than most think.  I believe he was discussing KPAP which used a completely difference algorithm.

While i realize my Sarcoidosis and lung issues play a role (have multiple nodules w/ some fibrosis, but my last PF test was completely normal, no obstructions/restrictions), my normal breathing looks "rounded" and there are times during the night where breathing looks good so I'll continue to try to find the sweet spot with my ResMed.  Everyone's input has been invaluable.

Any further feedback is much appreciated!

Thank you.

[Jay51]

I have had several conversations with my Pulmonologist.  I currently have a ventilator and have used several of them in the past few years.  

In regards to your sarcoidosis and other lung issues, higher PS (pressure support) seems like it possibly might benefit your condition.  If you feel the situation is happening like you describe (your airway might be collapsing on exhale due to pressure decreasing) then simply raise epap more so this won't occur.  

PS of 7 or more is recommended for COPD.  My last pressures that worked well for me were 10 epap and 20 ipap.  The higher PS causes more oxygen intake (and may even help stretch the lungs out a little bit).  BUT, you don't want pressure too high to where it causes chest/lung pain the following morning.  I found this out the hard way in the beginning. 

The higher PS also has another positive for someone with lung issues:  when the ps drops a lot (during exhale) it helps suction more co2 out of the lungs.  

These are advanced techniques for lung issues only.

Have you already discussed this with your Pulmonologist?

[SeePak]

Hey Jay, i was thinking same thing, more pressure, but....

Take it up slowly, constant and see how flowrate reacts.

I am wondering if the inflammation is sudden and then disappears over time, intermittent?
I am not a doctor, nor understand this sarcoidosis, just wondering from the charts if a higher Exhale pressure alone will eventually overcome the times when inflammation is happening.
Also wondering if a lumps form and go away on their own so not seen by the tests?