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It's still a possibility to cause positional apnea if your neck is bent towards the side. Chin tuck isn't necessarily required for this to happen as I understand it. On 3/7, there's lots of flow limits compared to 3/6, a 95% of .20 and Max of .46.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
The difference between 3/6 and 3/7 are the pressure settings. I was sleeping in exactly the same position as far as I know on both evenings -- at least the same bed position, pillow, etc. Can that flow restriction be a result of the lower pressures? If so, I guess I need higher pressures.
I think you may have answered your own question. EPAP min of 15 and PS 5 is a solid performance! If you see any clusters of OA with that setting, then I think you need to look at positional issues. You could just use a fixed pressure of 20/15 and if that works for you, it works for me. Did this resolve air ingestion?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
As long as I maintain the position reasonably well, I seem to be OK as far as apnea with the 14- 19 range, or perhaps a little safer with 15-20. However, I still get bad gas at that pressure. So that leaves me pretty much where I started.
Then let's reduce pressure until OA becomes a problem. I don't know where the cutoff will occur, but lets set your machine on fixed pressure (VPAP-S) and set the EPAP at 12.0 and IPAP at 17.0 and see what that give you. We can continue titrating downward for comfort if we don't trigger excessive apnea. Be sure the Easybreathe comfort option is on.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I actually tried a setting of 12-20 cm with PS 5 last evening. See attached. It looks like I made it through most of the night except for one period in the middle where the flow restriction caused it to ramp up to almost 19 for a short time. I can try this again, or lower a bit. Is it better to fix the pressure so it will not ramp up? Also, it is not clear to me how you decide on the PS, 4, 5, or more?
I did have strong gas last evening. It kept me very uncomfortable because it took a long time to clear, even into mid-day. However, there may have been less overall gas this time than some recent days when I passed a lot more during the night and morning. It is my impression that I may get more gas when I have more incidents. Perhaps I am gasping for air and that causes more gas. It is not clear to me how to balance higher pressure that will prevent events relative to lower that might have gasping -- as to which causes the least gas.
Thanks again for your help. I see the sleep doctor tomorrow. I will mention the gas to see what he says. At this point, I need to see him at least once a year to get a prescription for medicare to pay for my supplies (the machine is paid off). I am not sure if there is anyone any better in my area, so I may just continue with him to keep my coverage. He is one of only two sleep doctors connected with the large local hospital that did my sleep studies. That is how I ended up with him after my a family doctor referred me to the hospital for the original sleep study.
For your situation I'd be inclined to artificially cap Max pressure by lowering from 20 to something like 17-18 somewhere about there. That reduces it by about 2 at least. It may be enough to reduce air that's swallowed but not impact therapy too much. Yours only went to max of 18.76 last chart.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I tried last evening keeping the minimum pressure at 12 cm but reducing the maximum to 18. I attached the screenshot. I recorded no incidents. However, one can see that, at one point during my second sleep period, the flow limiting started ramping up. The machine responded by raising the pressure to 18, but that was not enough to deal with the flow limit. It kept rising to a very high level, but then it suddenly dropped to zero. Perhaps this suggests that my flow limit is triggered by some positional change, perhaps a rotation movement, and it corrected after a while. Curious. I may try lowering the minimum pressure to 11 tonight.
At these settings, I still had some gas issues, but it may have been less than I have been having. When I saw the doctor today, he was sympathetic to the gas problems. He had no options other than to try lowering the pressures to a point where there is a good tradeoff between less gas with lower pressure but high enough to have reasonable incidents as has been suggested here.
It looks like I could still do better on dealing with the position sensitivity. I know of no other obvious things to try, but perhaps I will go back and experiment with some of the other collars and pillows I tried earlier.
The chart looks great, it's just getting you comfortable. Not worried about the bit of flow limits at this stage.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
