Wcsleep - Therapy Thread

[Wcsleep]

           


Thank you. Here are more charts without the pie graphs.

[Wcsleep]

   
here is a chart in the order suggested....

[Wcsleep]

So am I still not posting my charts correctly? I’m not sure what I’m doing wrong that I’m not getting responses to my requests for help...
There seems to be so much knowledge and information here...

[jaswilliams]

here is a chart in the order suggested....

I think you need to raise the max pressure higher than 10 as at times the machine wants to go higher but cannot this will reduce the hypopnoeas

[Sleeprider]

Wcsleep, thanks for posting charts.  They appear fine to me and tell us that at a narrow pressure range of 9 to 10 cm your obstructive events are well controlled.  There are some CA events that might respond to a lower A-Flex setting.  I you are using a setting of 3, try using 1 or 2 for Flex.


Many users of the Philips Dreamstation seem to have Flow Limitations, and you have more than your share.  This is an obstructive narrowing of the upper respiratory tract that results in a restriction of inspiratory flow.  This often is associated with hypopnea and respiratory event related arousals (RERA), that in your case does not seem very severe.  Revising the Flex setting may help, but with Philips machines, a higher minimum pressure is usually needed to reduce the FL events.  Notice that increases in auto pressure are correlated with these flow limits, you just have to give the machine a head start.  Flow limitations are interesting because they seem to be better controlled when inhale pressure is higher than exhale pressure as we see in BiPAP or even the Resmed Airsense 10 with EPR (exhale pressure relief).  The Philips has Flex, but it does not work like bilevel.   I think it would be beneficial to titrate your minimum pressure higher until flow limitations are reduced.  You can do this with a pressure range or set minimum and maximum pressure the same.  Since you are currently at a minimum pressure of 9.0, I think a minimum of 10.0 and maximum of 12.0 looks good.  Again, if Flex is at 3, reduce that to 1 or 2.

[Wcsleep]

Ok thank you. I will implement these suggestions and get back to you with the results.

[Wcsleep]

Sleeprider pid='309154' dateline='1567196646'] I think it would be beneficial to titrate your minimum pressure higher until flow limitations are reduced.  You can do this with a pressure range or set minimum and maximum pressure the same.  Since you are currently at a minimum pressure of 9.0, I think a minimum of 10.0 and maximum of 12.0 looks good.  Again, if Flex is at 3, reduce that to 1 or 2

I reduced Flex to 1 and increased the minimum pressure.  Last night was a very unrestful l night; I don't know why.  Can you look at my chart and let me know what is going on? I don't really understand why I am having so many Flow Limitations. Are they what is waking me up? Any why more CAs than OAs which was my original diagnosis.  If I raise the upper pressure, do I risk more CAs?

[Sleeprider]

You have high flow limitations and this probably leads to sleep disruption that results in the CA events. I don't think you have a predominately central or complex apnea problem. I would really like to see you on a Resmed machine where bilevel pressure can help, but the only tool we have for obstructive events is pressure. I think your idea of increasing the minimum pressure makes a lot of sense.

[Wcsleep]

I will look into a Resmed machine then. Will you please explain to me (or direct me to sources of explanation) what bilevel pressure is and how that would help my flow limitations. I need to understand it well so that I can make my case to my doc and insurance and anyone else. If need be I will consider paying out of pocket; I need my sleep issues to resolve. But I do not really understand what I need and how a Resmed CPAP will provide it.
Thanks so much for your time.

[hearsay73]

Hi Wcsleep,

A simple explanation of a Bilevel machine is that it is a CPAP machine that has two pressures instead of one. An expiratory (exhalation) pressure called EPAP  and  an inspiratory (inhalation) pressure called IPAP. For more info check out our wiki on BIPAP: Wiki BIPAP.

The one mostly recommended here is the one by Resmed but the one made by Respironics is also suitable. I have the Respironics dreamstation Auto Bipap and it had been working great for me especially with all the help I've gotten here.

EDIT: oh, I forgot to mention that Resmed and Respironics have different proprietary algorithms on how it approaches obstructive events. I've read somewhere (I forgot where) that Resmed machines appear to be more aggressive thus it would be more helpful in reducing flow limitations while Respironics seem to be more gentle thus it would be more helpful for those who are prone to frequent awakenings, such as having UARS for example.