Old Steve - Therapy Adventure

[KeepSmiling]

Steve,

Somewhere on the board there was info on how low flow limitations (FL) be, I could not find it. Sorry.

Unofficially, I would say up pressure until they stop, without increasing central events. If FL causes issues then that is to many.

[pholynyk]

Usually, flow limitations are controlled by increasing Pressure Support (or EPR) rather than Pressure. That may increase the CA, so it can be a balancing act.

[Old Steve]

I have had the EPR set at three, I have varied the pressure from 10cm up to 10.2cm and then back down to 9.8cm.  Pretty good AHI on all, the Fl's range from 0.7 to 0.11. Is there anything more I can do to lower the FL's or is this about a good as it gets without a different machine?




   


     


   

[KeepSmiling]

Steve,

Usual titration method for CPAP
(not including centralapnra)


EPR comfort setting –
Set to patient comfort (1, 2 or 3)

Increase CPAP ≥1 cm H2O every ≥5 mins for
obstructive apneas, hypopneas, RERAs and at
least 3 min of loud or unambiguous snoring

Up minimum pressure to 12 cm.

[Expat31]

@ Old Steve

Hi, haven't checked onyour progress for some time..

Firstly your charts are excellent. Well calibrated, and I don't think you can do much bettter.

You seem somewhat concerned about FLs with "the Fl's range from 0.7 to 0.11.", in fact if you look again at yout charts, the values are from .07 to 0.11!

I would suggest that you focus on the up to 95% values, which are actuallygreat. The  up to 99.5% values include the "marginal" events.

I haven't tried to calculate the duration values (in secs.) of these marginal events, but guess in the scheme of things they are irrelevant and create a false debate.

I would relax on this subject. I can't remember the correct wording for this phrase, but it is something like this:-
                           "Don't try to fix something that ain't broke!"

You have done extremely well in such a short time. I have quite a similar profile to you, in that short of sleep hours in spite of a well calibrated CPAP. My average is only about 6 hours at best. 

This I put down to being retired for quite a few years and being without the mental stimulation of the working life; and the pain from side sleeping due to some residual chronic pain from an operation several years ago.

Also as one ages, the natural production of melatonin reduces, and can impact length of sleep. But that is another debate with  all sort of issues that I have researched, but that opens "Pandora's box" which would lead to a dead end. I will close this paragraph firmly shut.

Just a couple of points on the set-up of your graphs. It may be helpful to trim the ranges of some of
the "y values" to get a better detailed view, eg. Flow limitations max say 

Flow limitations max 0.30 instead of 1.0.
Flow rate. 100 max, instead of 120.

This is of course just cosmetic stuff, but worth looking at to fine tune things.

[Old Steve]

Expat31,

I adjusted my OSCAR flow limit and flow rate as you suggested.

Last night I raised my pressure to 12cm and 3 EPR,  Wasn't any better than the 10cm and 3 EPR, so I am going to leave my settings there for a time and see how it goes.

Thanks again for all your help.

Old Steve

[KeepSmiling]

Hi Steve,

I found the page I was looking for.

http://www.apneaboard.com/wiki/index.php...ng_therapy

I would like to see the OSCAR. The last two OSCARS have similar 95% pressures. If you set pressure around might be good for you if the pressure change, flow limitation is disturbing you.

Not machine related but just important for me on my quest for deeper sleep is trying to follow good sleep hygiene.

I am working on medication timing. Unfortunately, consistent bedtime is a work in progress. Covering my eyes was a big surprise at the difference it made. I spent my second night with a weighted blanket, so far so good, I will give it more time before saying it was a success.

[Old Steve]

KeepSmiling,

Thanks for sending the info...

Old Steve

[Old Steve]

For the last several weeks I have occasionally been having an odd looking flow rate shape, the shape usually lasts for only 15 to 20 minutes.  Looking at a flow shape chart it appears to be expiratory mouth breathing with normal inspiratory flow morphology.   Is this what it is?    It doesn't seem to cause any problem with my AHI.  Just curious.




   

[Sleeprider]

We often see this pattern, and the popular opinion is that it might be expiratory mouth breathing. Another view is that it represents a 0.5 cm pressure bounce as reflected in the mask pressure wave.  It might be interesting to see if this is reduced with an EPR of 2 rather than your current EPR of 3.  My guess is that you're not aware of this while sleeping as it is a very small bounce on exhale pressure and exhale is completed at a normal rate and flow. I don't know if this is really worth chasing as it's not really an event or therapy interference.