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03-15-2024, 02:37 PM (This post was last modified: 03-15-2024, 02:39 PM by marcinpiskala.)
RE: Marcin's Therapy Thread
[attachment=61228][attachment=61228]
Hi, I've added 3 pictures (12Jan, 1March, 4March). 4th picture was not added as threre is a limit. I will add in the next post. I hope now it looks better
6th March
How was the range of 4.4 - 5.4 selected? That is a narrow and low range and not one normally seen.
Flow limitations are higher than desirable. Can you post a screenshot that includes the flow limitations graph? I'd like to see if flow limitations are clustered like other measures are.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
therapy started in August 2023. The doctor said that cmH2O (min 4.0, max 5.0) will be apropriate (PAP-Auto for Her). In November the doctor increased cmH2O (min 4.4, max 5.4) . I think EPR is on. Oskar shows EPR 3 cmH2O.
Thank you in advance for your help. I can send also pdf files showing more information
regards
Marcin
While I am happy to explain what the various OSCAR measures represent, I prefer not to give advice on settings for other people, especially when the values have been established by a doctor.
The lowest pressure a ResMed machine will deliver is 4.0 cmH2O. EPR adjusts the exhalation pressure by the amount specified (3 cmH2O in this case). If you start with a pressure of 4.4, and apply EPR=3, the exhalation pressure will be 4.0; and not 4.4 - 3.0 = 1.4 because the machine will never provide a pressure of less than 4.0. With EPR=3, exhalation pressure will be 4.0 until the Pressure setting exceeds 7.0. For this reason, one would rarely set the pressure to any less than (4.0+EPR).
I will try to direct another advice giver to your thread.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
Thank you very much for explanation. It is very helpful. I am still learining the therapy of my mum. I would be also very grateful for the analysis of the 4 days I sent images. I hope you find somebody who could help. Have a nice weekend! Marcin
Hi marcinpiskala!
Could you please provide some background history on your mom? Things like her age, health and problems, is she active or bedridden, and medicine she takes.
Also, each member is provided a certain size of memory for images. If you reach your limit, you can go into your profile and delete the oldest ones in, "Attachments", to open that space back up.
- Red
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.
Marcin, I have some suggestions for your mom. First off, the 120 second apnea looks real enough to me, there is a strong inhale and breath hold at the beginning and very strong recovery breathing at the end showing the oxygen deficit being restored. Most of your mom's OA events are clustered with a quiet rest of the night, and that is the signature of positional apnea. This is explained in our Positional Apnea article in the Optimizing Therapy wiki https://www.apneaboard.com/wiki/index.ph...onal_Apnea You may be able to address your mom's positional apnea by assessing her sleeping arrangement and avoiding tall firm pillows, multiple pillows or a reclined sleeping position that encourages chin tucking. As you can see, when the chin tucks or some other positional mechanism occurs, pressure cannot re-open the airway, so those types of apnea typically terminate with an arousal and movement to enable breathing. Prevention is key. In some cases we move to a soft cervical collar, but we start with simpler intervention. https://www.apneaboard.com/wiki/index.ph...cal_Collar
The pressures being used are quite low, and with EPR at 3, the exhale pressure never goes above 4.0 cm. You need to understand that it is the exhale or EPAP pressure that prevents obstruction, so it is essential that the minimum pressure be set at 4.0 (the minimum pressure of the machine) plus the EPR setting of 1, 2 or 3. So with EPR 3, the minimum pressure must be set at 7.0 providing a 7.0/4.0 bilevel pressure (inhale/exhale). Moving down EPR 2 requires a minimum of 6.0 and EPR 1 a minimum of 5.0. Clearly we need to raise her minimum pressure to make EPR available. The current pressure are very inadequate and flow limitations are very high. I'm going to suggest a minimum pressure of 6.0, maximum pressure 8.0 and EPR 2. I suspect the autoset algorithm will take her near the top of this range due to her flow limits, but we should see an improvement in her therapy. While this pressure range is very low, you may want to set a ramp starting from a minimum pressure of 4.0 on Auto Ramp mode to allow her to settle into sleep before therapy pressures begin. There is no other way...pressures must be higher to effectively treat your mom, and you must assess her sleeping position(s) for positional issues.
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.
hello, answering to your questions: my mum is 70 years old, she is very active, no other serious health problems. Year ago she was diagnosed for bronhial asthma (beginning stage). She takes inhaled steroid once a day. Additionally 1/2 of tablet of beta-blocker. Currently problems with sleeping at night 4-5 hours on average.
regards,
Marcin
thank you very very much for your help! I have read it many times as I would like to understand it better and help my mum.
Unfortunately the doctor does not want to listen and talk, always busy. It is very difficult to cooperate with him. We choose him as he is recommended by many doctors in Poland as expert in treating apneas by CPAP.
I have read what positional apnea means. I have also read about Soft Cervical Collar. Polisomography confirmed that most of my mum's apneas happened during sleeping on the back, not on the side.
Could you help me to understand the following : What would happen in your opinion if we switch off EPR (EPR=0)?
You also said "flow limitations are very high"? What do you mean by "very high"? Should I look at the Flow chart (scale from -75 to +75) or Flow Restrictions chart (0-1)?? What values are acceptable, healthy for the above charts? What values should we expect?
MANY THANKS FOR YOUR EFFORT AND FOR CLEAR AND HELPFUL ADVICES!
Regards,
Marcin
