morgana's - Therapy Thread

[Sleeprider]

Give EPR a try at current pressure and we can take a look at the results. I think you will see a significant difference in comfort using EPR. The wiki on Flow Limitations shows how EPR can help to improve therapy. https://www.apneaboard.com/wiki/index.ph...limitation

The positional apnea suggestion was due to clusters of obstructive events. The Positional Apnea wiki may help to understand this. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[morgana]

Thanks, I'll give it a go and report back the outcome.

[morgana]

   

I tried new settings last night. EPR 3 F/T. Pressure stays at 9-11. 
AHI remains the same but H have reduced and CA increased. FL looks lower to me but I'm not sure if it's enough. 
Can you let me know what you think please? Thanks

[morgana]

Second night using EPR 3 F/T, pressure 9-11. 

I am unsure how interpret the results.

Should I be concerned about the increase in CA?

I feel like I am getting less disturbances during the night but I am groggy when I wake up still feeling very tired during the day.

Is there anything else I could be doing?

I would appreciate any advice.


   

[Sleeprider]

Even with EPR 3, your flow limits are impressive at 0.17, but are reduced from 0.37 from your chart on 11/27. Tidal volume improved from 380 to 400 showing EPR helps you take a bigger breath, and your AHI has improved by nearly 50%, dropping from 8.1 to 4.4-4.5. Your CAI is approximately unchanged, so most of the improvement comes from EPR helping with obstructive hypopnea events. I'm pretty sure your central events are actually obstructive, but would need to see a zoomed image that shows no more than 3 to 5 minutes of event data. Resmed will interpret an obstructive apnea that has some air movement as central, and a deeper analysis is needed in your case. All events are at higher pressure, so I'd like to reduce pressure further to 8.0 minimum, 9.0 maximum with EPR 3. If you would please provide a zoomed image of the event clusters from Dec 4 08:40 to 08:44, and Dec 3 from 05:10 to 05:14, we will try to see what is going on.

[morgana]

Thanks Sleeprider, I'll reduce the pressures tonight and see what happens.

One question about the times for the zoomed images you asked for.

I'm assuming that Dec 3 05:10 to 05:14 is the same as 5:10am to 5:14am? I've attached an image for this one.

If I've got this right, I'm unsure what Dec 08:40 to 08:44 refers to?

   

[Sleeprider]

It's surprising a hypopnea was not flagged at 05:12. The CA at 05:14 appears to be a real CA event, following a hyperventilation event, with respiration restarting very gradually. There is a lot of flow limitation in the larger breaths, so this may be a complex apnea. If we can resolve the obstructive component and still see a central apnea component, the next step is bilevel or ASV, but I don't want to get ahead of myself.

[morgana]

That sounds a bit scary.


I'm sending another screenshot from the 4th to see what you think. Plus a screenshot from last night. The AHI was lower but I was awake for hours after about 0130, so that would reduce AHI wouldn't it?.

Should I still reduce my pressures?

   

   

[morgana]

I reduced pressures to 8-9 EPR 3F/T as suggested on night of the 6th Dec. 
AHI 2.47
CA 2.10
OA 0.12
H 0.25
RE 0.12
FL 0.11

I have attached a screenshot from last night which was even better. To my eyes, and to how I am feeling, things are so much better than they were. I'd appreciate your thoughts on how things look. 


   

[cexer]

even after waking up from a central, i just couldn't take a deep breath,
but instead had to work my way up. you, too ?
in my case it mysteriously needed subzero nights for it to be like that.

in the beginning i has a headache from my full face mask, too.
is this ongoing in your case ?

early on i used a finger clip oximeter capable of recording data.
maybe this would bring you some insights, too. some are compatible with oscar.

for instance your central where you gradually start breathing afterwards
is like 2 minutes long. this could have well thrown you in the 70's of %SpO2,
eg. depending on your body mass. how did you feel after the night ?

in general, you could collect say a week worth of data and then see.

why is another machine scary ? the bilevel is the one with the short "high trigger sensitivity"-push
and the asv is very comfortable, almost like natural breathing and it's very popular, here.
(i'm of course not that convinced, cause it did not help with my hypopnea and the centrals did not vanish either,
so i hope i somehow get an ivaps which might feel somewhat rough.)
also take a look at the 10 series or would you prefer the 11's ?

or is it cause of the expensiveness in australia ?


i asked sleeprider for a source for how the flexible target
of an asv is set (it's by minute ventilation)
and he gave me some info for referring and sharing.
maybe this is of some help for you, too:

Start with the wiki. https://www.apneaboard.com/wiki/index.ph...tion_(ASV)
Here is the Resmed version https://www.resmed.com/en-us/healthcare-...ve-10-asv/
And some more: https://document.resmed.com/documents/pr...ow_eng.pdf

This should be copied to a thread so others get the information.