gettingbetter - Therapy Thread

[gettingbetter]

Thanks again, Crimson Nape!  You and the board members are so incredibly patient and helpful as I learn different aspects of this journey!!!

Eventually I hope to be able to use the Vauto mode so I can access the flagging system for flow limitations (even though we still need to review the flow rate graph due to FLs being underreported).

It probably makes the most sense for me to go back to S-mode in the short-term, at least until I'm solidly tolerating higher pressures without aerophagia.  Surprisingly, EPAP of 5 on the Aircurve 10 has cleared all OAs in my first few days of trialing.  I think I need to start pushing the PS up gradually to address the FLs.  In my few nights of trial 3.0 (even 3.4) just isn't enough to clear the FLs.

[SevereApnea]

@gettingbetter:

"Last night I had the following Vauto settings (tight range to start because of aerophagia):  
Max IPAP 8.4, min EPAP 4, PS 3

So the machine was able to roam between
Min IPAP 4, Max IPAP 7
Max EPAP 5.4, Max IPAP 8.4"

(My apologies: Smart Alec mode: ON

So the machine was able to roam between
Min EPAP 4, Max IPAP 7
Max EPAP 5.4, Max IPAP 8.4

Smart Alec mode: OFF)

this EPAP IPAP business can do my head in and wreak having with my spell checker!

[SevereApnea]

@gettingbetter

an earlier question you posed piqued my interest:

"Is it even remotely possible that if someone has UARS, they get aerophagia from too low of a pressure to address flow limitations?"

here is one link, see point 2. 

Link1

and here is another, 

Link2

both anecdotal.

I would welcome more comments from others here on the board with more experience please.

[SevereApnea]

@gettingbetter, sorry me again.

Your Vauto machine readouts for Vt and MV are median/50% values.
These are values for one night only.

We have some limited data from your charts in your thread, I have summarised this as attached.
This is limited data, some sessions only, mixed machines. But at least the Set Pressures are similar.
I suggest you keep track of your data to see what works for you: your PCP doesn't have the time or incentive to do that.

[attachment=35634]

What strikes me is that your Achieved Median EPAP is rather on the low side by adult standards: 4 to 5 cmH20.
Does this match what you are seeing in all your daily charts?

Your best FL of 0.05 was 17Aug2021 with EPR 3.
As Gideon said in post #24 to get the benefits of EPR your set pressures need to be higher.

I understand your concern about raising pressures because of aerophagia.
Sometimes this PAP therapy gives counter-intuitive results. 

We do know untreated OSA is associated with GERD. Do you think you are undertreated or adequately treated?

With a narrow defined range of pressures your body has to do the work of adjusting your Minute Ventilation by modifying your Vt (tidal volume) and RR (resp rate).
Perhaps the increased work or breathing might increase your negative intrathoracic pressure and therefore your negative oesophageal pressure more than you would want?

Also, do have a look at our Insp Time, Vt and MV on your charts and look at them critically. If you are spending some of the night at higher Insp Time near 3 s why would you want to limit that?

Would anyone like to comment on the effects of undertreatment?

Would anyone suggest opening up the pressures here for a while?

The floor is open...

[gettingbetter]

SevereApnea:  

Thank you for the correction on my major typo!!!

[gettingbetter]

SevereApnea:  

Thanks so much for the time you've taken to help me!  It is greatly appreciated. 

Quick question:  How are you calculating the inspiration time?  60 seconds divided by RR?

[SevereApnea]

You could do it that way, I like things much easier. OSCAR to the rescue.

I just select the Insp Time, Min Vent and Tidal Volume bottom right of the Oscar chart.
I find it kind of helps me see where I was during the night.

You can also just read it off the Statistics on the panel on the left.

[attachment=35638]

Once you get your Flow Limitations and aerophagia under control you can start playing with the other pieces of the jigsaw puzzle.

All the best.

[gettingbetter]

@SevereApnea:  It's me again!  . Thanks again for all of your help!!!  I never realized what a journey this would be.


*The charts in my thread (and that you've highlighted) are representative of my daily results with the AS10 and Vauto (and S-mode).

*I never know if I should be looking at the MED values or the 95% values.  And it's difficult for me to look at RR/MV/Tv/inspire time values critically, when I don't know what "normal" MV/Tv/RR/Inspire time values are for 5'4", 125 lb female.

*I see now you're referring to the Insp time on the Oscar charts.  Some of the Insp times on the AS10 may be a little "off" due to cardio ballistic artifact.  I think The Aircurve seems to have a more accurate Insp time reading.  But I think you're saying that staying at a timax of 3.0 is fine.

*If I'm understanding you correctly, you highly suspect I'm significantly undertreated at my current EPAP/PS/overall pressure settings/flow limitations level, and that my body is likely working harder to breathe at these low settings...and it's a possibility that under treatment could induce the aerophagia and GERD.    And adequate treatment could help tame the GERD and aerophagia, improve flow limitations, and overall help me sleep and feel better.  I think you are spot on.  I've definitely been "scared" to unleash the vauto to do its thing for fear of aerophagia. 

*One thing I have noticed the past few days is that my GERD seems to have improved even with just a little increase in pressure.


So, here's the irony.  Last night I "suited up" with the Aircurve gear.  I fiddled with my phone about 20 mins after laying down, not realizing the phone cord was wrapped around the power supply cord to the Aircurve 10.  Well, the power supply cord disconnected and I was breathing through the mask ALL NIGHT LONG with no power to The Aircurve.  Thank goodness for anti-asphyxiation valves!

I woke up this morning feeling dreadful, didn't sleep well, and GERD was increased significantly.  So, I'm optimistic that increased pressure could help a lot.

Interestingly, I wore my pulse oximeter last night (chart attached).  I slept on my side the whole night.  I did not desat below 89%.  During my sleep study, I went below 88% for 100 mins while sleeping on my back.  This is good evidence for positional apnea (supine sleeping is bad for me).

There is so much to learn on this journey!!!

[Crimson Nape]

May I propose a name change for your thread? Something like, "gettingbetter - Therapy Thread"

[gettingbetter]

Crimson Nape:

Sure!  How do I change the name of my thread?  I've just been using my original thread so I kept all of my information in one place.