lukazi (Therapy Thread)

[OpalRose]

lukazi,
Your charts look good, but even though your numbers are decent, there is still some Flow Limitation.  You can see it on the flow graph by the flatter tops.  
You are already using EPR at 3, so there is no where else to go with that.  Possibly a little higher minimum pressure, but I don't think it would make a difference, plus it could disrupt your sleep even more.

There is also some leaking going on (maybe just enough to wake you now and then).
I don't know what mask you're using, but if you look at the leak graph, the spiky areas are mask movement, and the rest looks to be some mouth breathing.  This could also be just enough to wake you.  

The Clear Airways at the beginning of the night, you are probably awake and trying to get comfortable, maybe holding your breath?  I wouldn't worry to much over the CA's as there aren't that many.

If we were to lower the EPR, it might show fewer CA's, but then you may see more FL. So it's just a balancing act, and you should concentrate more on comfort.  Pay attention to your mask fit.  

Also, could you update your profile with machine, pressures and mask info?  This is the first place folk look to see what you are using.
Thanks!

Here's a link shortcut to take you to your profile.
http://www.apneaboard.com/forums/usercp....on=profile

[lukazi]

lukazi,
Your charts look good, but even though your numbers are decent, there is still some Flow Limitation.  You can see it on the flow graph by the flatter tops.  
You are already using EPR at 3, so there is no where else to go with that.  Possibly a little higher minimum pressure, but I don't think it would make a difference, plus it could disrupt your sleep even more.

There is also some leaking going on (maybe just enough to wake you now and then).
I don't know what mask you're using, but if you look at the leak graph, the spiky areas are mask movement, and the rest looks to be some mouth breathing.  This could also be just enough to wake you.  

The Clear Airways at the beginning of the night, you are probably awake and trying to get comfortable, maybe holding your breath?  I wouldn't worry to much over the CA's as there aren't that many.

If we were to lower the EPR, it might show fewer CA's, but then you may see more FL. So it's just a balancing act, and you should concentrate more on comfort.  Pay attention to your mask fit.  

Also, could you update your profile with machine, pressures and mask info?  This is the first place folk look to see what you are using.
Thanks!

Here's a link shortcut to take you to your profile.
http://www.apneaboard.com/forums/usercp....on=profile

Thanks so much for your invaluable comments!

So there is nothing really I can do about FLs?

I am using Airfit P10 (just updated my profile) and maybe leaks happen when I sleep on my side. Any thoughts how to reduce the leaks?

Overall, would you consider my therapy successful considering all the stats?

[OpalRose]

Yes, your therapy is successful.  

The Flow Limitations probably could be helped more, but that requires using Pressure Support.  Your current machine supplies up to 3cm EPR, whereas the VAuto would allow you to use more Pressure Support to help.  

You could try a little higher minimum pressure.  That may or may not help.  Try raising it to 10.4.  You shouldn't notice the difference and it might just give you the extra air flow to help.  

With the P10 mask or any mask for that matter, try sleeping in your side with you head more at a 45 degree angle, not buried in your pillow.  Or if that's not comfortable, try
to position your head at the end of your pillow so that the mask hangs off the pillow.

[lukazi]

Yes, your therapy is successful.  

The Flow Limitations probably could be helped more, but that requires using Pressure Support.  Your current machine supplies up to 3cm EPR, whereas the VAuto would allow you to use more Pressure Support to help.  

You could try a little higher minimum pressure.  That may or may not help.  Try raising it to 10.4.  You shouldn't notice the difference and it might just give you the extra air flow to help.  

With the P10 mask or any mask for that matter, try sleeping in your side with you head more at a 45 degree angle, not buried in your pillow.  Or if that's not comfortable, try
to position your head at the end of your pillow so that the mask hangs off the pillow.

Hi OpalRose,

Hope you have been well. I adjusted min pressure to 10.4 cm last night. Please see the attached screenshots. Overall AHI was lower than the night before but I had more FLs. What are your thoughts?

Also I was in bed only for 7hrs because it seems that I don't sleep as much anymore, however I still woke up 4 times. Any idea on what else I can try to stop waking up so often?

Thank you!

[lukazi]

Yes, your therapy is successful.  

The Flow Limitations probably could be helped more, but that requires using Pressure Support.  Your current machine supplies up to 3cm EPR, whereas the VAuto would allow you to use more Pressure Support to help.  

You could try a little higher minimum pressure.  That may or may not help.  Try raising it to 10.4.  You shouldn't notice the difference and it might just give you the extra air flow to help.  

With the P10 mask or any mask for that matter, try sleeping in your side with you head more at a 45 degree angle, not buried in your pillow.  Or if that's not comfortable, try
to position your head at the end of your pillow so that the mask hangs off the pillow.

And I just have two more questions if you dont mind. What is the acceptable limit for FLs? I think I read somewhere that if they are less than 0.1 (for 95%), then this is considered ok.

Also, I just received AS10 for her. Should I use for her mode or just the normal mode? My understanding is that in for her mode, pressure doesn't go above 12 unless in case of OAs which means that this could not be good for my FLs (if I understand this correctly).

[OpalRose]

Your FL seem to be within normal range. Since you have the "for her" algorithm, it does no harm to try it. If anything, it may help with the arousals.


An excerpt from the Clinicians Manual:
AutoSet for Her mode is based on key aspects of ResMed’s AutoSet algorithm and delivers therapeutic responses tailored to the characteristics of female OSA patients.
The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:
 Reduced rate of pressure increments designed to help prevent arousals.
 Slower pressure decays.
 Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O

[lukazi]

Your FL seem to be within normal range.  Since you have the "for her" algorithm, it does no harm to try it.  If anything, it may help with the arousals.


An excerpt from the Clinicians Manual:
AutoSet for Her mode is based on key aspects of ResMed’s AutoSet algorithm and delivers therapeutic responses tailored to the characteristics of female OSA patients.
The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:
 Reduced rate of pressure increments designed to help prevent arousals.
 Slower pressure decays.
 Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O

Would you kindly be able to comment my second last post? I tried 10.4 as min pressure last night. I attached the reports from that night a few posts above.

Thank you!

[OpalRose]

There really wasn't much difference in using minimum pressure of 10 to 10.4, so use what is most comfortable.

When and if you use the "for her" setting, repost a chart. And take note if you sleep better.

[lukazi]

There really wasn't much difference in using minimum pressure of 10 to 10.4, so use what is most comfortable.

When and if you use the "for her" setting, repost a chart.  And take note if you sleep better.

Hi OpalRose,

Thanks so much for your ongoing support, appreciate it!

I tried For Her mode last night. Prior to going to bed, I was trying M and L size of AirFit P10 pillows and realized that M size probably fits me better. I also realized that 10cm as a minimum pressure was a bit uncomfortable with M size pillow, I assumed this was because of less leaks maybe (hence tha mask pressure at 9 would be higher that at 10?).

Please see some charts attached from last night. My own observations:
- I had about 6.5hrs of effective sleep (was in bed for 7.5hrs). I feel very good now.
- I still woke up 3 times to go to toilet. This is really frustrating, but don't know what to do here. Do toilet breaks normally reduce with time on CPAP therapy?
- Looking at the charts, I had way less leaks with M size pillows. 
- It seems that I had more FL's? 99.5% value was higher than the previous nights, however 95% value was lower.
- AHI values was higher last night compared to previous nights.

What are your thoguhts? I have attached the zoomed in section of the report just prior to waking up. Any idea why the flow rate seems so irregular?

Thank you!

[lukazi]

@sleeprider would you kindly be able to review my latest results and suggest min pressure? Thank you!