[Treatment] Still fatigued, history, are these CAs real?

[jaswilliams]

Supplier #2 will likely sort you one with your existing prescription may come set to your Autoset prescription

[SarcasticDave94]

Isn't there a qualifier for BPAP types if you need higher PS or about 15 or higher pressure or can otherwise show intolerance for CPAP?

[Gideon]

The qualifier are the disturbances still being felt by Guy, thus failing CPAP/BiLevel even though there is a good AHI. This is the why for EERS.

[GuyScharf]

As an experiment, I created a test file showing the flow graph for the entire night last night (EERS 12"). It is a video where I took a 5 minute zoom and moved through the entire night. All of the other graphs move with it, so you can see flow limits, snores, etc.  I didn't use the oximeter last night, so SpO2 is not there.

Just view the video in any video viewer, stop where desired, move the current point in the video back and forth, etc.

The video is here. (When I try to play it directly in dropbox, resolution is poor. You may have to download it for it to be clear.)

Unfortunately, this is not a viable method for uploading to the forum as it takes about 500x as much space as a screen shot plus a panel of eight flow charts.  But does it give an idea of the kind of view you might like for reviewing charts?  Maybe we need a way in OSCAR to export a single day, or small number of days, for analysis?

[Sleeprider]

The video is pretty cool. The only thing I got was that periodic breathing or variable tidal volume correlates with higher pressure. Have we tried a fixed pressure, at your current minimum?

[GuyScharf]

Yes, fixed pressure makes little difference. I am planning to switch back to fixed pressure tonight.

I think that periodic breathing correlates more with flow limitations. It often starts after a flow limitation, even a small one. Since ResMed also increases pressure for flow limitations, I suspect that is more a consequence than a cause.

[Gideon]

I like it. The motion calls your eye to areas that may be problematic and thus need more attention, at least to under stand what is going on.

[GuyScharf]

First night with VAuto and PS=4 results are in.  I had pressures set to EPAPmin=6.0, PS=4, IPAPmax=10 (i.e., fixed pressure).  I didn't touch any other therapy settings.  No EERS connected.  (Ignore the screenshot that says 6.2/4/10.2 -- that is the way it was set when I started but I changed it after a few minutes.  Evidence that ResMed reports the settings from the beginning of the night, not the end.)

Sleep was fragmented, but I don't blame this on the VAuto (except maybe the excitement to see how it worked).  I expect a more normal sleep pattern in future nights.  Fragmentation meant Fitbit wasn't helpful.

Flow limits appear reduced.  Waxing and waning continues, but not as often, and often appears to be triggered by flow limits.  The three Hypopneas are all associated with flow limits and two clearly show flat-topped breathing.

SpO2 graph appears to be offset about 30 seconds to the right.  (Now if we just had a way to slide that graph into proper alignment...)

Breathing and exhaling were easy.

There are no OAs, which suggests that maybe I could lower the pressure?

What do you suggest to try next?  Lower pressure?  Adjust other settings?

Thanks!

            

[Gideon]

One change, Set Trigger Sensitivity to high, No EERS.  Let us know if you prefer this or High or Medium (where it should currently be sensitivity.
I'd like you to run a week after this, and set a new baseline.  Then eval if you need to try EERS again.


edit
And yes, you may be able to lower your max pressure, I'd rather see if we can get it to come off of the max pressure naturally as that would mean we have you solved.

[GuyScharf]

And yes, you may be able to lower your max pressure, I'd rather see if we can get it to come off of the max pressure naturally as that would mean we have you solved.

Not sure what you mean by "come off of the max pressure naturally."  I am currently using fixed pressure (IPAPmax = EPAPmin + PS) so there is no variation in pressure.