THE ROAD TO SUCCESS...almost there, help fine tuning please!

[SevereApnea]

@sheepless

Hmm, I hadn't even thought of that. (shows you just how little I actually know) 

Why would that be? If I look at my CPAP nights the FLs are clearly showing in the numbers and the charts. 
And ResScan doesn't show any FL either for my S-mode nights so that means the data is not there on the card.

Thanks for the comment (even though it kinda depresses me!) You are quite right of course, my AHIs are up a bit when using the S-mode even though my nights seem better, with less side effects. 

When looking through the Flow Rate charts there are clearly still FL present.
[attachment=31578][attachment=31579]

Hmm, I thought I was getting somewhere: two steps forward and one step backwards.

But now it looks like one step forwards and two steps backward? or at least just treading water!

I will have to rethink all of this: I may try going back to Vauto set up to mimic S-mode settings of EPAP 5.6 IPAP of 9.2 and see what happens.

I do like the Feel of the S-mode, spontaneous breathing feels so much better. I wonder how I can mimic this in the Vauto settings.

Looking at the Mask Pressure graph it does at least look like that the full range of pressures of 5.6 - 9.2 is being reached for most of the night.

So, the million dollar question is, if the Vauto is so good at eliminating FLs why would it not report / record them in the S-mode? I can't find anything in the clinical guide about this.

thanks for the reply, and more food for thought.

[sheepless]

my understanding is that resmed depends largely on flow limitation to adjust ranging pressure. while useful info to you, apparently not to integral to resmed operating with fixed pressure. afaik, fl is reported only in auto adjusting settings.

as you suggested, setting vauto mode to mimic fixed pressure (capping ipap) may be similar enough & give you fl info.

[SevereApnea]

I thought I knew a thing or two about this therapy, but when it comes it how it affects venous return, I haven't got a clue. I think you can disregard that your sleep tech said the Vauto breathes for you. I'm sure you are wondering if the portion of the work done by  your PAP equipment reduces venous return, and so you're experimenting with removing that factor by using CPAP and various configurations of VPAP.  Per my disclaimer above, I don't buy it and think any effect is negligible.  I think your PAP therapy is totally unrelated to your perceived poor venous return, and you need to look elsewhere with your regular physician and quit making your sleep tech come up with wrong answers.  We are not equipped to advise or discuss circulatory problems here, and this needs to go to your physician, not a forum.  I honestly think you are barking up the wrong tree to associate this issue with your otherwise excellent PAP therapy.

@ Sleeprider, Many thanks, advice noted and taken.
Saw the vein specialist this week. Only one or two minor incompetent perforators, not worth treatment at this stage. He too does not know of any association of CPAP and vein problems.

However, it is interesting that he does see variable competence of the valves communicating between the deep and superficial systems (sometimes they work, sometimes they don't). He himself has found this is his own veins after long haul flights, and those of some of his patients even during the same day. I have good days and bad days and think this is happening to me too. Reason? No idea.

@sheepless, 

I have set the Vauto to the same pressures as on S-mode, so I can monitor the flow limitations. What I find, from my own experience is that things go well for 3 or 4 nights and then they go pear-shaped, certainly with respect to my side effects. Looking at my data my best nights are those when I start the night with an anxiolytic, some mediation/tapping before masking up, and keeping the minute ventilation and tidal volume under control. The Vauto allows me to do this by using the trigger and cycle settings. I have been experimenting with changing these to somehow mimic my normal breathing pattern. 

For me the TS needs to be higher than the CS. 
If I reverse this (ie Trigger Low and Cycle High) it feels terrible. 
When I use TS High CS low, or TS High and CS Medium, or TS Medium and CS Low things feel better. 
If I use TS Very High with CS Low I get much longer Insp times and somewhat higher Tidal volumes which is uncomfortable.

I am finding that I am very sensitive to EPAP, and IPAP and PS. The last few nights I have been on Vauto 6 - 10 (PS 2) with much fewer side effects in the morning or during the day.
Early days yet, but I am close, and think the middle ground is somewhere I need to be: moderate EPAP, moderate IPAP and moderate PS. I suspect the benefit of the Vauto will be the ability to fine tune things with the TS and CS settings.

CPAP 9 (EPR) keeps AHI under control, and as I mentioned before does display the Flow Limitations, whereas the S-mode does not. But always starts to feel bad after a few days.


I am now (after more than a year) focusing on how I feel and what effects that. I am looking at the number less and less and that alone is progress!

[Sleeprider]

Appreciate the follow-up on this and am relieved the specialists essentially agrees on the lack of association of CPAP and venous return. We're always learning here.