[Pressure] Reaching maximum IPAP - Time to change settings?

[Frajola81]

About follow-up appointments...    S. Dave gave me some good advice on talking with my sleep dr.     
My    thread?   was titled   "advice appreciated".     That specific advice was #32 in that thread.

Those were great suggestions. Thanks for pointing those out to me. 

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Welcome to the forum!     I wrote that short note last night.    
I just want to tell you that I admire you and all the other people who get started learning these things!      I am new to forum, too,   it is very helpful.

Thanks Martyedb! Yeah, I am also a beginner in my "PAP journey" so I am getting to learn lots and lots all the time that I sit in front of the computer to read the wiki articles or just from other member's posts. This site is very valuable resource.....

[Frajola81]

Maybe try a thinner or a single pillow than what you've been using. I'd disagree with doc here as well. And the collar suggested will help out. There's a good collar called Corflex Ultra Cervical Collar that several members have tried that does well.

I purchased a slightly different collar and am getting used to wearing it. With the full face mask, and now the cervical collar, it is a miracle that I am pushing through to get this therapy right haha.

So far, my snores or flow limitations (what are those by the way??) didn't noticeably decreased. I will wait a couple of more days while adjusting to the collar.

I will see my NP this week. I will bring this up to her but I am not sure if she will have anything up her sleeve to help me out....  and by the way, the daytime sleepiness continues. 

Actually, more in the morning. I am more awake in the afternoons than earlier (taking stimulants of course, but still, it is definitely an improvement).

[SarcasticDave94]

OK that's great that you've got a collar of any brand. I do hope it helps out. Do let us know what your NP has to say. Best wishes things start looking up for you on therapy and sleep.

[staceyburke]

Flow limitations are upper airway apnea.  They are smaller in size but the machine does not time them.  See the bottom of this post I have qualified the different apnea.  The one I did not mention is central or CA (same thing) has no obstruction it is the body just not breathing.  Like holding your breath but it is usually brought on by low C02 so the body does not take a breath.

[Sleeprider]

Let's talk about positional apnea and flow limitation for a minute. http://www.apneaboard.com/wiki/index.php...onal_Apnea In your early charts, we saw a tendency for very high flow limitation to arise out of nowhere, and last for a period of time.  This is often the result of chin tucking. You can probably simulate this by sitting in a chair and relaxing while breathing normally.  Allow your chin to drop to your chest. If you notice increased breathing effort or even a snore, that is  all we are talking about.  The soft cervical collar usually resolves this.   Now with that in mind, look at this chart you posted. Notice that you seem to breathe easily without any flow limits or snoring at first. At 02:15 both flow limits and snores appear, and diminish by 03:00. Your pressure follows that to near the maximum at that time. Then at 04:40 we really see the obstruction or FL increase. You get through this episode with just a few hypopnea and your pressure is maxed out. This is what led us to the original conclusion you may be chin-tucking and that it might improve with a collar.  Added to the use of excess pillows, this theory made quite a bit of sense.  I don't think you have chronic flow limitation. In fact, most of the night you simply have no flow limitation at all, so the only thing we really need to resolve is the positional aspect.

[Frajola81]

Hey guys,

It seems that my therapy is going pretty good. But the fact that the pressure is going up several times and approaching maxIPAP still bothers me... a little only

I am using a soft cervical collar to see if my snores get better but still, it seems that my snores are making the pressure go up. Do you guys have any suggestion here?

Thanks![attachment=28726]

[Frajola81]

@Sleeprider, interesting post. Thanks!

I posted my last chart without reading this so I am sorry for the repetitive issue. It seems that even with the collar, I am having problems. 

Or I am not using the collar properly.....  it feels snug and difficult to tuck the chin in at night but maybe when I am on my side, I somehow am tucking my chin....    

[Sleeprider]

If you want to get after the flow limits and snores, you are going to have to elevate both EPAP min and IPAP max. I also think you might tolerate additional pressure support. I don't usually do multiple changes, but I'll make an exception IF you think your comfort is not what it could be. If you're game, here it is:
Mode: Vauto
EPAP min: 7.0
IPAP max: 16.0
PS: 4.4

[Frajola81]

If you want to get after the flow limits and snores, you are going to have to elevate both EPAP min and IPAP max. I also think you might tolerate additional pressure support.  I don't usually do multiple changes, but I'll make an exception IF you think your comfort is not what it could be.  If you're game, here it is:
Mode: Vauto
EPAP min: 7.0
IPAP max: 16.0
PS: 4.4

I am game

If I am understanding this correctly, this is an effective increase of 2.4cmH20, right?    I will give it a try. 

This increase in EPAP may also decrease the number of "Hypopnea" events that sometimes are flagged, correct?

[SarcasticDave94]

I say yes. Pressure increases like proposed tackles snores, Hypopnea, and Flow Limit all at once as I see it. Basically your current pressure isn't quite strong enough to stop the partial apnea/ hypopnea, and snores and flow limits are signs airway restrictions remain.