pressure plateau

[milboltnut]

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My pressure readings from last night were from 7.5 minimum....(raised to 8 tonight after 3 days)

ramp up to 9,11,10 down to 8...ever since I gradually increased my minimum pressure and events have been decreasing and stabilizing, AHI 10 and below. Where I started at 5 minimum events fluctuated sporadically.

As I gradually increase the minimum pressure every few days or so.. it appears the the maximum pressure hasn't climbed above 12.

Eventually will I plateau to level out pressure wise and possibly decrease events?

[Sleeprider]

I'd be interested in seeing other days and a chart that does not cut-off the events of interest (CA, H OA). That chart is nearly useless to analyze your response to pressure, and the majority of your events are CA an H, so we can't necessarily conclude that pressure is the right answer. That is true of obstructive apnea, but not mixed events. Did your sleep study indicate anything other than obstructive apnea?

[Big Guy]

I first thought the thread read pleasure plateau.

Then I reread it. Thought that maybe.......well, I'll just let that one go unanswered. 

[milboltnut]

Sleeprider pid='349865' dateline='1589164578']     I'd be interested in seeing other days and a chart that does not cut-off the events of interest (CA, H OA). That chart is nearly useless to analyze your response to pressure, and the majority of your events are CA an H, so we can't necessarily conclude that pressure is the right answer.  That is true of obstructive apnea, but not mixed events.   Did your sleep study indicate anything other than obstructive apnea?

5-9-20 and 5-10-20

[Sleeprider]

These charts are much more useful. We can see you probably need a higher minimum pressure, and I want to be sure you are using a lower AFlex setting of 1 or 2 in an attempt to reduce CA. You seem to have mixed or complex apnea with a pretty significant central apnea component, and there is some clustering of obstructive events. I think a minimum pressure of 8.5 is appropriate, and Flex at 1.

[milboltnut]

I was wondering a bout the flex which is presently at 3 A- flex. As far as my minimum pressure it's at 8 last night. I had it at 7.5 for the last three days.. I have been raising it .5 cm every few days, I started at 4 cm in march 13th, I was told it causes CA's.........so I gradually been raising it, and maintaining events 10 or below. Congestion has kicking my butt. On Sudafed as of today.

So a lower flex does what with inhale pressure? My flex of 3 does what as of now, in regards with CA's? I'm trying to understand the concept here.....if you could keep it simple I'd greatly appreciate it.

[Sleeprider]

Unlike Resmed EPR, the Philips Flex setting has a lot more to do with timing than actual pressure relief. Flex reduces pressure ahead of expiration and continues to about midway through, then moves back to CPAP pressure ahead of inspiration. Philips C-Flex, A-Flex and Bi-Flex are all forms of "Proportional Positive Airway Pressure" where the amount of pressure relief is proportional to the patient expiratory flow. https://patents.google.com/patent/US8789527B2/en? This means that the amount of pressure relief is up to 2-cm H2O but varies in proportion to flow, so for any individual or breath, we can't accurately predict the amount of flow relief nor its duration.

Flex is way too complicated and doesn't work well for everyone, including you. It can in some cases cause a lot more problems, and a setting of 3 can cause more sync problems than lower settings. Pressure relief in general can make CA events more numerous. My suggestion is that you turn your Flex setting down. This has worked for a lot of people, however, your results are potentially bad enough that a different therapy is needed to manage CA. By contrast, Resmed EPR is very straight forward and identical to their bilevel pressure support delivery. The pressure reduction follows respiration and is 1 to 3 cm according to the settings, rather than best-guess proportional to flow. It is a lot easier to identify whether a problem is related to pressure support than to isolate the problems of Flex.

[milboltnut]

Unlike Resmed EPR, the Philips Flex setting has a lot more to do with timing than actual pressure relief.  Flex reduces pressure ahead of expiration and continues to about midway through, then moves back to CPAP pressure ahead of inspiration.  Philips C-Flex, A-Flex and Bi-Flex are all forms of "Proportional Positive Airway Pressure" where the amount of pressure relief is proportional to the patient expiratory flow. https://patents.google.com/patent/US8789527B2/en?  This means that the amount of pressure relief is up to 2-cm H2O but varies in proportion to flow, so for any individual or breath, we can't accurately predict the amount of flow relief nor its duration.  

Flex is way too complicated and doesn't work well for everyone, including you.  It can in some cases cause a lot more problems, and a setting of 3 can cause more sync problems than lower settings.  Pressure relief in general can make CA events more numerous.  My suggestion is that you turn your Flex setting down. This has worked for a lot of people, however, your results are potentially bad enough that a different therapy is needed to manage CA.  By contrast, Resmed EPR is very straight forward and identical to their bilevel pressure support delivery. The pressure reduction follows respiration and is 1 to 3 cm according to the settings, rather than best-guess proportional to flow.  It is a lot easier to identify whether a problem is related to pressure support than to isolate the problems of Flex.

turn your Flex setting down

you mean down, by higher number? I have it at 3 right now. Should I go into my comfort settings and reduce it lower? My pulmonary Dr. told me I might need a different machine.

[Sleeprider]

Lower numbers mean less Flex. Use 1, or 2 at the most.

[milboltnut]

Lower numbers mean less Flex.  Use 1, or 2 at the most.

Ok, thank you.... FYI... cpap talk forum isn't as layed back as this site. Really ignorant people over there. I see you have dogslobber here. He was the ONLY one form there who actually gave me helpful advice.. other than getting the OSCAR software.

They love to correct you and say it's the wrong information. Petty stuff. Opinions and not really having the answers to everybodies  problems doesn't call for calling someone out. Petty. Not much help and they thought they were spoon feeding otherwise?? No avail when not know how to read OSCAR graphs? The site that they providing was vauge sometimes.....

I see here it's more respectful here.  

badgering someone over a heated hose.... being prepared with one was my only point. And the moderator was the bigot to drive it home and try and make you look bad?