07-24-2023, 07:34 AM
RE: Still fatigued after year of treatment
Thanks for your sleep reports. They are pretty self explanatory, zero centrales, and fairly moderate obstructives. Nothing to remarkable so far as I can tell.
A brief summary of your submitted graphs so far.
First graph of 3rd June, zero obstructives, just one hypopnea. (Pressures 9/14)
Second graphs of 20th July again exactly the same results (Pressures 11.6/11.6.)
No real change so far.
I would suggest a slightly different approach, and would like to deal with the pressures seperately,
Focussing firstly on the minimum pressures, it may be interesting to start reducing here initially, to acertain how low you can go, before the hypopneas start to increase. The objective being to get a good base line.
Your first graph, with a minimum of 9, was adequately doing the job, but maybe go down to 8, or perhaps 6 or 7 to see what happens. Just enough to do the job.
After this minimum baseline has been identified, next I would attack the maximum pressure in the same way as the minimum, enough to keep the obstructives, and hypopneas in check.
If the gap between the maximum and minimum is not too wide, hopefully this will bring down the centrals. Defining "not to wide" is found hopefully by this trial and error method.
Usually flow limitations provoke these maximum pressures, not necessarily in reaction to control obstructives and hypopnea events, which are already being dealt successfully.
(As a note, it would be helpful to improve visibility of your flow limitation graph by adjusting the y axis scale maximum to something like 0.2. we could maybe be able to see individual points of limitation peaks pushing up pressures, however it isn't always that obvious.)
EPR, I would be guessing on this one, it is important, most likely leave at 2 as now, but one step at a time.
(A further comment, it may be best to make one change at a time, and wait a few days so you can see the impact. If two or more are made, difficult to trace back which one is meanfully impacting therapy.
3rd June
A brief summary of your submitted graphs so far.
First graph of 3rd June, zero obstructives, just one hypopnea. (Pressures 9/14)
Second graphs of 20th July again exactly the same results (Pressures 11.6/11.6.)
No real change so far.
I would suggest a slightly different approach, and would like to deal with the pressures seperately,
Focussing firstly on the minimum pressures, it may be interesting to start reducing here initially, to acertain how low you can go, before the hypopneas start to increase. The objective being to get a good base line.
Your first graph, with a minimum of 9, was adequately doing the job, but maybe go down to 8, or perhaps 6 or 7 to see what happens. Just enough to do the job.
After this minimum baseline has been identified, next I would attack the maximum pressure in the same way as the minimum, enough to keep the obstructives, and hypopneas in check.
If the gap between the maximum and minimum is not too wide, hopefully this will bring down the centrals. Defining "not to wide" is found hopefully by this trial and error method.
Usually flow limitations provoke these maximum pressures, not necessarily in reaction to control obstructives and hypopnea events, which are already being dealt successfully.
(As a note, it would be helpful to improve visibility of your flow limitation graph by adjusting the y axis scale maximum to something like 0.2. we could maybe be able to see individual points of limitation peaks pushing up pressures, however it isn't always that obvious.)
EPR, I would be guessing on this one, it is important, most likely leave at 2 as now, but one step at a time.
(A further comment, it may be best to make one change at a time, and wait a few days so you can see the impact. If two or more are made, difficult to trace back which one is meanfully impacting therapy.
3rd June
