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02-11-2023, 11:44 AM (This post was last modified: 02-11-2023, 11:45 AM by SleepingFish.)
RE: Call this good, or keep going?
(02-11-2023, 11:31 AM)Crimson Nape Wrote: Please provide a more complete screenshot of your Daily screen. Make sure your View is set to "Standard" and then use the F12 or Fn+F12(for a Mac) to take the screenshot. The detailed data on the left really helps is reviewing your parameters and making recommendations.
- Red
This is my f12 screenshot.
I might need to scroll down and take more if you want it all, on Linux so F12 isn't quite the same.
(02-11-2023, 11:33 AM)mesenteria Wrote: Raising your pressures, either one, runs the risk of introducing treatment-induced central apnea. There's a reason why people are prescribed certain pressures, even if we often have to fiddle a bit with the prescription to get it 'just right'.
I was prescribed APAP 6-16 with no titrition study and only a home sleep study, and my insurance company (blue cross blue shield) has denied a titrition study as not medically necessary.
Sooo.. I give my rX 0 weight and will continue to work on this on my own
(02-11-2023, 11:37 AM)Sleeprider Wrote: Increasing pressure will further stent the airway and may reduce flow limitations. With conventional CPAP, obstructive hypopnea and flow limitation is indeed treated with a higher pressure. I'm not sure it will increase expiration time, but the ratio should look a lot better. You can see this in the decision-tree in the Resmed CPAP Titration Protocol below. Generally we seek to achieve a normal I:E ratio of 1:1 (inspiration is the same as expiration), to 1:3 (inspiration is 1/3 the time of expiration). When see inverse ratio, we know that is the result of effort or straining to get the breath.
What you need to recognize is that with the Resmed Autoset, you actually have a bilevel machine with pressure support limited at 3-cm. I can show you flow charts with mask pressure that prove the pressure delivery between the Autoset and Aircurve bilevel is identical or very similar. Now with a bilevle titration protocol, notice that once OA events are addressed, it is IPAP, or PS that is increased to treat hypopnea, RERA/flow limitation and snoring. So if we think about using your Autoset as a bilevel, we can optimize your titration better, by using EPR to our advantage rather than just pressure. So we maintain the EPAP at 8.0 and add IPAP by increasing the set pressure by the same amount that we add EPR. This maintains EPAP 8.0 and with EPR 1 we have 9/8, EPR 2 is 10/8 and EPR 3 11/8 in bilevel terms. Are we on the same page with this rationale?
I love the flowchart, thanks for taking the time to explain more.
I am more willing to try EPR than I am to try APAP.
So taking your advice, I will start with
9cm / EPR 1 for 3ish days.
If my inspiration time is still longer than my exp time, I will increase to 10cm / EPR 2.
If still, then we can try 11cm / EPR 3.
The 8cm starting point is pretty random, so it's possible that if I end up finding say 10cm / EPR 2 is great.. I can actually do 9cm EPR 2 (bi-level of 7/9 essentially)... but it sounds like I should tweak this EPR FIRST, and then I can look at my final pressure tweak.
Sounds good to me. If CA events return in any significance, then you have to back off on EPR and just use the pressure. Either way, these are the basic tools we have to work with to optimize your therapy.
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 am not an expert on OSA, but I have been using a CPAC for over 22 years. For many years after I started using a CPAP all I had was a set pressure. I was at 12cm all the time and sure I could handle the pressure easy enough, although, I never really felt rested. When I got my Resmed AirSense 10 about a year ago my sleep quality improved dramatically. This was due to the knowlegable folks on this site that helped me interpert my OSCAR charts and having the ability to fine tune with the EPR.
My AHI now averages around 0.5, my flow limit is normally 1-4 (95%) and 8-13 (99.5%).
(02-11-2023, 12:21 PM)Old Steve Wrote: I am not an expert on OSA, but I have been using a CPAC for over 22 years. For many years after I started using a CPAP all I had was a set pressure. I was at 12cm all the time and sure I could handle the pressure easy enough, although, I never really felt rested. When I got my Resmed AirSense 10 about a year ago my sleep quality improved dramatically. This was due to the knowlegable folks on this site that helped me interpert my OSCAR charts and having the ability to fine tune with the EPR.
My AHI now averages around 0.5, my flow limit is normally 1-4 (95%) and 8-13 (99.5%).
What did you end up on? 15cm and EPR 3? Or something else?
My best results now are at 10cm and 3 EPR. I have tried other setting as low as 8.2 and 2 EPR, and my results were pretty good, but the 10cm and 3 EPR is what works best for me.
The main thing is how good you feel, not the settings you use.
(02-11-2023, 12:00 PM)Sleeprider Wrote: Sounds good to me. If CA events return in any significance, then you have to back off on EPR and just use the pressure. Either way, these are the basic tools we have to work with to optimize your therapy.
Okay day 1 of EPR1.
AHI went down
Flow limit is the same
Expir is the same
inspir time is down .3 seconds
I think we will continue on this slow path of adapting to the EPR. Your flow limit was slightly lower (0.19 vs 0.21), and with the improvement in AHI we are moving in the right direction, assuming you are reasonably comfortable. Just hang onto these settings, and when you're ready we will try increasing EPR to 2.
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.
(02-12-2023, 10:17 AM)Sleeprider Wrote: I think we will continue on this slow path of adapting to the EPR. Your flow limit was slightly lower (0.19 vs 0.21), and with the improvement in AHI we are moving in the right direction, assuming you are reasonably comfortable. Just hang onto these settings, and when you're ready we will try increasing EPR to 2.
So I have moved from 8/8 no EPR, to 11/11 with EPR 3. As far as I an tell, my results are the same or slightly worse than when I started.
What gives? What do I do next, now that my EPR is maxed?
