Vauto, PLM, FL & Mixed Apnea

[mper6794]

Ok,
-your charts look rather similar to last night. I see some some FL/RERA become clearer, individualizing relative to PLMS-driven arousals.
-There are still room to improve FL/RERA's, firstly by increasing PS (graph suggest large room for this).
_both leaks and CA's are under control. RR: 8.4 not detrimental; you already faced higher.
-Then, my suggestion is keep on moving with the same concept: stable EPAPmin: 7.6 for while, keep increasing slowly PS: 5.4. IPAPmax: 13.0
_3;17...looks mouth breathing.

good luck

[WillSleep]

Mper

1. EPAP Min on Chart 3 looks good.

2.  I saw what you wrote about manually counting RERA + Near RERA each day.  

I was wondering if you have looked at Custom Flagging and if you thought maybe that could get close enough that neither you nor Sheepless would need to count ~RERAs each day manually. 

WillSleep


File > Preferences > CPAP
   

[JoeyWallaby]

I didn't know you could do that with OSCAR, cool!

[Gideon]

That calc will not touch RERAs because it doesn't address arousals it

[mper6794]

Hi, Will and all

thanks for the inputs.....
Yes, willsleep, a follow your suggestion and add EPAPmin....take advantage, and also added FL max to start see the progress....looks interesting!

thanks

[SarcasticDave94]

sheepless,

Forgive my folly in asking, but in light of the grand total of 237 posts with this and the older split thread, can you remind me why you were once on an ASV?

And if the ASV acquisition went through insurance, we both know how hard it was to obtain it, even with medical necessity evidence which probably was due to CA. How is your CA count BTW?

Since we both know the ASV is the best at CA treatment, is abandoning the CA treatment worth this current direction?

[Gideon]

Mper, where are you going? Are you just ignoring what looks like widespread CSR without the centrals. But definitely the waxing and waning in the flow rate indicating an unstable pCO2 in the blood. By all traditional evaluations this is tending to look dangerous.

You have failed to present your methods in a manor that many of the senior contributing users here can understand. And I'll add that in general we have no problem looking at and for new and nontraditional methods.

The OP has chosen to follow one person who says it works for them and not the collective wisdom of the many. That puts a ton of responsibility on you mper.

[sheepless]

Dave, I'll post another short history in this thread in a bit. I was never a clear candidate for asv by the numbers so I picked up a used one after continuing to feel lousy on apap. asv is better on paper and while I feel better with asv, I just don't feel well rested yet; hence, trying out the vauto based on non-mainstream methods that show some promise. we'll see.

bonjour, I appreciate your concern. however, the responsibility is mine, not mper's. I have not ignored the collective wisdom of the forum. in fact, the forum hasn't had much to say at all about it - just 2 posts I can remember so far mildly challenging methodology. but that's beside the point. I'm aware of the differences between the tried and true and mper's direction.

I won't do anything I'm not comfortable with. I've chosen to experiment with the vauto because nearly 3 years on apap and asv haven't gotten me to a point that I can function normally. better but not good enough. it's a short term excursion in search of further relief. I don't see any harm or danger in trying vauto for a while. there's reason to think it might help - overall, I feel better than with apap and asv. pressures are lower, leaks are lower, ps isn't swinging unsuccessfully against plm induced flow limitations. while I may be a candidate for heart problems, I have no reason to think I have any. my sense is that if I have a heart attack, it's likely to be because I'm prone to it, not simply because I'm on the vauto.

fragmentation remains, because, I believe, plm is the root of most of my ongoing problems. indeed, controlling plm one day might change a lot with respect to machine settings and efficacy, regardless of machine modality.

I am fully aware of and watching the periodic breathing. I had some of the csr like pattern in apap; asv evens it out. but does that mean it resolves the underlying issue or merely masks it? actually, I'm not sure it isn't just more plm that looks different because I'm taking ripinirol for it and/or the different machine algorithms express it differently. I tend to doubt that ripinirol has that effect though because I still see some of the same plm pattern I saw in asv and apap in addition to the csr like pattern. even so, while remaining a bit skeptical, I'm starting to question whether I ever had a ca problem, despite my initial diagnosis of ca, wondering if they may be an artifact of plm as well. this experiment may shed some light on that.

otoh, it might be that much of what I continue to see in vauto charts really is a tendency toward central weakening and pausing of breathing. this is something I hope to clarify with this trial.

I don't think it'll take more than a couple weeks to complete this self titration. then I think WillSleep's suggestions for weighing the pros and cons of vauto vs asv will serve me well.

please give me and mper and anyone else that wants to experiment the space to do that. let's keep an open mind. join the conversation with comments, criticisms, requests for explanations, whatever. let's find out if mper is onto something here or not. innovation is a good thing and somebody has to try things out to demonstrate success or failure. I'm willingly doing this, aware and accepting of any risk (which I perceive as very low anyway). it could be life changing for me if it works. we should know that in fairly short order. if it doesn't work, it could be the methodology or it could be because I really do have problems requiring asv. I'm willing to gamble on no harm done. success is better but failure is okay too. no matter how it turns out, we'll learn something.

[mper6794]

Hi, Fred
Nice to hear from you.
Mper, where are you going? Well, just trying to help sheepless on a long ago untreated UARS-plms, by adjusting EPAPmin and PS, tailored for him, aiming at, first, taming remaining FL and eventually H (<10s).... Are you just ignoring what looks like widespread CSR without the centrals.  But definitely the waxing and waning in the flow rate indicating an unstable pCO2 in the blood.   By all traditional evaluations this is tending to look dangerous. ....I am afraid I would not agree with you on this. We all known this would not sound as 2+2= 4 , however we can select among options, based on each experience, literature, and on what we conceive. What i see,on this “waxing and waning” are PLMS-driven peaks of increased RR, intercalated with remaining FL and imperfect H, maybe, anyhow,  flow reductions. In the following up I am going to add some illustrations on this, including EEG diagrams and one video. Please, let me know what you think.
Moreover, I would kindly ask sheepless to add some 2-min windows on those stretches.
I am expecting that when get the maximum of the EPAPmin and PS, we would improve flow reductions of those stretches. What would be the order? FL leading to PLMS, or the other way around? Still not sure yet, however, luckily, improving respiration, PLM would improve as well, as by literature, my case, and my hope.
 
Following up you and Dave: where are the sheepless' true CA's?
 
Others would be wellcome and shed lights on all of this.
 
You have failed to present your methods in a manor that many of the senior contributing users here can understand.  And I'll add that in general we have no problem looking at and for new and nontraditional methods. ...i have a thread (o single one) on this. I Will more than happy to discuss my method there and trying to answer your questions, and others. Still wating for your checkin there. Meanwhile, for those interested, i Will keep testing/applying It and try to help. It looks work.
 
The OP has chosen to follow one person who says it works for them and not the collective wisdom of the many.  That puts a ton of responsibility on you mper.....agree, However It is also a matter of user accept or not what we suggest. This would not be the same for everybody here? Before i post my single thread on this, i scrutinized this blog for some 5 months, and i think  i know what is going here, concerning responsability. While on that, i think i learned a great deal with all you guys and i am very thankfull. Somewhat saving my life at that time.
While scrutinizing, focused on my UARS-plms case, i noticed some room, not only  to help myself, but also eventually others, keep totally focused on this serious impairment. At the time i noticed a strong bias toward OSA in this blog, whereas UARS-Plms kind was left in second plan. Then, i selected the Topic to work and Go deeper.
Many Thanks
 
 PS: in the Jason's video, please, play attention on the thoracic and flow curves while the  person moves....
https://www.youtube.com/watch?v=IEgvw1Z-...x=63&t=64s

[mper6794]

Dave, I'll post another short history in this thread in a bit.  I was never a clear candidate for asv by the numbers so I picked up a used one after continuing to feel lousy on apap.  asv is better on paper and while I feel better with asv, I just don't feel well rested yet; hence, trying out the vauto based on non-mainstream methods that show some promise.  we'll see.    

bonjour, I appreciate your concern.  however, the responsibility is mine, not mper's.  I have not ignored the collective wisdom of the forum.  in fact, the forum hasn't had much to say at all about it - just 2 posts I can remember so far mildly challenging methodology.  but that's beside the point.  I'm aware of the differences between the tried and true and mper's direction.

I won't do anything I'm not comfortable with.  I've chosen to experiment with the vauto because nearly 3 years on apap and asv haven't gotten me to a point that I can function normally.  better but not good enough.  it's a short term excursion in search of further relief.  I don't see any harm or danger in trying vauto for a while.  there's reason to think it might help - overall, I feel better than with apap and asv.  pressures are lower, leaks are lower, ps isn't swinging unsuccessfully against plm induced flow limitations.  while I may be a candidate for heart problems, I have no reason to think I have any.  my sense is that if I have a heart attack, it's likely to be because I'm prone to it, not simply because I'm on the vauto.

fragmentation remains, because, I believe, plm is the root of most of my ongoing problems.  indeed, controlling plm one day might change a lot with respect to machine settings and efficacy, regardless of machine modality.  

I am fully aware of and watching the periodic breathing.  I had some of the csr like pattern in apap; asv evens it out.  but does that mean it resolves the underlying issue or merely masks it?  actually, I'm not sure it isn't just more plm that looks different because I'm taking ripinirol for it and/or the different machine algorithms express it differently.  I tend to doubt that ripinirol has that effect though because I still see some of the same plm pattern I saw in asv and apap in addition to the csr like pattern.   even so, while remaining a bit skeptical, I'm starting to question whether I ever had a ca problem, despite my initial diagnosis of ca, wondering if they may be an artifact of plm as well.  this experiment may shed some light on that.

otoh, it might be that much of what I continue to see in vauto charts really is a tendency toward central weakening and pausing of breathing.  this is something I hope to clarify with this trial.

I don't think it'll take more than a couple weeks to complete this self titration.  then I think WillSleep's suggestions for weighing the pros and cons of vauto vs asv will serve me well.

please give me and mper and anyone else that wants to experiment the space to do that.  let's keep an open mind.  join the conversation with comments, criticisms, requests for explanations, whatever.  let's find out if mper is onto something here or not.  innovation is a good thing and somebody has to try things out to demonstrate success or failure.  I'm willingly doing this, aware and accepting of any risk (which I perceive as very low anyway).  it could be life changing for me if it works.  we should know that in fairly short order.  if it doesn't work, it could be the methodology or it could be because I really do have problems requiring asv.  I'm willing to gamble on no harm done.  success is better but failure is okay too.  no matter how it turns out, we'll learn something.

Thanks, sheepless

Good points!

And, I am a little relieved.

Let us keep working, expect for some other lights. Hoperfuly, we will succeed.


good luck

good luck