Question about flow rate charts and events

[jminminnesota]

After looking at my sleepyhead graphs I am confused as to the difference between OA and CA's when viewing the Flow rate. 

Also I am trying to make the best of the Vpap machine I have until I get a ASV machine.  Last night I switched to a constant pressure of 9. I am thinking I need to increase it as I still had OA's. Any suggestions?

John Miller

[jaswilliams]

After looking at my sleepyhead graphs I am confused as to the difference between OA and CA's when viewing the Flow rate. 

Also I am trying to make the best of the Vpap machine I have until I get a ASV machine.  Last night I switched to a constant pressure of 9. I am thinking I need to increase it as I still had OA's. Any suggestions?

John Miller

We need daily graphs to see what happened with the fixed pressure

[jminminnesota]

I chose the file I must have not clicked add attachment

[sheepless]

I'm interested in answers to your question about how to tell the difference between oa and ca too.

one thing I notice in your chart is that flow limitations are recorded relative to your hypopnea and ca; much fewer and smaller for oa.

while flagged as periodic breathing, it does not look to this layman like the flow in this chart is classic cheyne-stokes breathing. that would be more rounded pattern from small to large to small respirations, punctuated by ca. your pattern has a pb look to it but rather suggests (to me) recovery breathing following an apnea, meaning that higher pressure might resolve both the oa and the pb-appearing flow. I don't remember your history and why you're waiting for an asv but looking at the above charts, if you can tolerate higher pressure without more ca, it might well help resolve some of those hypopnea and oa.

[jminminnesota]

I'm interested in answers to your question about how to tell the difference between oa and ca too.  

one thing I notice in your chart is that flow limitations are recorded relative to your hypopnea and ca; much fewer and smaller for oa.

 Yes I can see that now.

while flagged as periodic breathing, it does not look to this layman like the flow in this chart is classic cheyne-stokes breathing. that would be more rounded pattern from small to large to small respirations, punctuated by ca. your pattern has a pb look to it but rather suggests (to me) recovery breathing following an apnea, meaning that higher pressure might resolve both the oa and the pb-appearing flow. I don't remember your history and why you're waiting for an asv but looking at the above charts, if you can tolerate higher pressure without more ca, it might well help resolve some of those hypopnea and oa.

I attached the SH report from the day before when I was using app of  8.4-13.0

I will increase the cpap pressure tonight to see if that helps.

[sheepless]

jm, you said in your post you're using vpap and your profile says autoset (apap). I have no experience with vpap so if that's what you're using, others will have to help out (and hopefully will anyway).

if ca isn't clearly an issue viz higher pressure, I'd suggest min of 9 or 10 and I'd push max up to 20 to see where it wants to go.

on the other hand, if you've been at this for a year (sign up date 9/2017), your ca's are probably more native than cpap induced, which would explain why you're waiting for an asv, and might suggest higher pressure will result in more ca. IDK. what's been your experience?

if ca is an issue for you, finding a fixed pressure that threads the needle between reducing oa and increasing ca is common. you can experiment with that. that's probably why you tried fixed 9cm. however, that chart looks worse to me. if that's why you're trying fixed 9, maybe try an even lower fixed pressure. ca seems to make some of us feel particularly lousy for some reason so the pressure you choose will likely depend more on how you feel than the numbers.

since 9 fixed didn't look so hot (I'm winging it here) if it was me I'd lower fixed settings and I'd also try leaving the min at 8.4 and start nudging my max up just to see what happens.

it should be evident by now that my knowledge and experience are limited and I'm relating how I'd personally feel my way around the situation if it was me. probably not the most efficient approach given that there are a number of folks here that can coach you from real knowledge and experience to best possible result with whatever machine you have now, so let's ask them to jump in please. in the end, as it seems you already know, you may be better served with a different modality.

[jminminnesota]

The results of me upping the cpap pressure from 9 to 11 lowered the AHI but increased the amount of time spent in apnea. Tonight I will go back to the app and set it to 8.8-12.2. as the first chart in the thread shows the best results when set at app 8.4-13. I am tightening the range as the 95%max was 12.08 and my pressure barely returned to lower than 8.6 throughout the night.
I have posted the 3rd night of my efforts (cpap 11)

Recap
1st night  apap  8.4 - 13  AHI 4.36
2nd night cpap  9.0         AHI 10.0 and increased CSR
3rd night  cpap 11.0       AHI 8.67 and increased CSR

All 3 night I have taped my mouth to control large leak through mouth breathing. I have Resmed S9  VPAP Adapt coming and a Airfit F20 coming that I hope will resolve all problems but until then I have been experimenting to see if I could take care of it without new equipment.

[sheepless]

this chart shows more of the classic periodic breathing pattern, particularly around the ca and maybe because the higher fixed pressure. as long as higher pressure produces pb and ca, your current machine may not be your best bet. an asv would smooth out the pb and resolve the ca's and allow higher pressure to deal with the obstructive stuff.

[jaswilliams]

I have Resmed S9  VPAP Adapt coming and a Airfit F20 coming that I hope will resolve all problems but until then I have been experimenting to see if I could take care of it without new equipment.

When you get the VPAP ADAPT arrives I suggest running auto ASV mode if your machine has it 

Min EPAP 4
Max EPAP 15
Min PS 3
Max PS 15

This matches Resmed recommended titration settings for the AutoASV mode

Jason

[jminminnesota]

Big night ahead! I received my S9 Adapt ASV, Sleep strips by Somnifix, and  New AirFit F20 FFM. Yahoo!

By the way, and I can't mention it enough that waldo1945 steered me in the right direction to purchase a used (330 hrs)  S9 Adapt ASV  for the low price of $150.00

Thank you!