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+--- Thread: poor results [Please Advise] (/Thread-poor-results-Please-Advise)
RE: Last hour readings - Melman - 07-30-2019
(07-30-2019, 10:23 AM)Commodore Wrote: better?
Now we know you have lots of flow limitations but try for this arrangement.
[attachment=13961]
RE: Last hour readings - Commodore - 07-30-2019
thank you for information - hope this is correct. What does flow limit signify?
Is there any 'risk' to adjusting pressures to the levels you suggest? Also, interesting on the ramp advice, does that ramp occur each time I remove the mask? That might explain part of my issue with as I usually wake twice for bathroom. Implies I am essentially not getting therapy for 45 minutes after each mask on/off event?
Thanks for patience with the questions.
RE: Last hour readings - Melman - 07-30-2019
Flow limitations are restrictions in the airway that reduce flow. They can cause arousals even though breathing is not stoped. They are reduced by higher min pressure and by pressure support which is the difference between pressure when you inhale and pressure when you exhale. With EPR at 3 the pressure against which you exhale is 3cm of H20 less than the pressure when you inhale. Pressure support is 3 which is the maximum that can be achieved with your machine.
With respect to ramp, it aplies to each time you start the machine.
The only risk to the pressures I suggest is that you may not initially be comfortable with a a starting pressure of 9 or 10 and have trouble going to sleep. I use a minimum of 9.6 and it doesn't bother me at all. Even if the pressure goes to 20 it can't hurt you. The pressures are really quite low. If you want an idea of the pressure, insert a straw 8" into a glass of water and blow until you just get bubbles. That pressure is 20cm of H2O
RE: Last hour readings - Commodore - 07-31-2019
these data seem equally bad at the higher pressure settings.
RE: Last hour readings - Commodore - 07-31-2019
so here is data from nasal pillow - large leaks but maybe better overall? if I can trust the data.
RE: Last hour readings - Melman - 07-31-2019
The higher min pressure reduced your hypopnea, RERA, and flow limitations so I believe it was the correct move. Unfortunately, the higher max pressure induced some central apnea. Without those the AHI would have been a little over 6. Try reducing the max pressure to 16. I'm sure the higher min pressure is not a problem. In every chart you posted the pressure has risen to 13-15 almost immediately and remained in that range.
What I didn't note yesterday is that your obstructive events are clustered suggesting a positional issue. You are probably tucking your chin to your chest which restricts the airway. That is best prevented by the use of a soft cervical collar. I had the same issue and wear one. It is commonly recommended in the forum. I see no clustering of events in the last chart with the nasal pillows. It may be that there was no chin tucking that night. You can believe the data for the periods in which there were no large leaks. You will note that even with the nasal pillows the pressure rose to over 13and stayed there.
Your machine has a setting for mask type. Be sure to select the correct setting for the type of mask you are using. I suspect you may need a higher min pressure but try the soft cervical collar first. You can get them at any pharmacy, big box store, or amazon.
EDIT: I just noted that you had a previous thread in which the positional issue was identified and a cervical collar was recommended. As Sleeprider pointed out, you should keep your posts in the same thread. It preserves continuity and helps those who are trying to advise you. I'm going to recommend to the moderators that the two threads be merged.
RE: Last hour readings - Commodore - 07-31-2019
Thank you
I feel better generally with the nasal
Would your suggestion be up min on that approach too?
Also, I’ll drop the ramp regardless
RE: Last hour readings - Melman - 07-31-2019
Given that the pressure increases almost immediately I think the increase in min pressure makes sense.
RE: poor results [Please Advise] - Commodore - 08-09-2019
I have not posted because I have a new Mac and just learning. I am still using nasal pillows and cpap with the basic information seeming decent and feel pretty good. My wife says no snoring at all. So, I did just have an overnight in hospital study. They now say the cpap pressures not treating effectively and ahi need Bipap or surgery.
They want me to see ENT. Very reluctant. Any insight into BiPap from an ease of use, compliance standpoint? Are nasal pillows completely unusable? I was fine,key getting comfortable with my setup.
I’ll try to post data from CPAP tomorrow. It really doesn’t seem that bad from a symptom standpoint. If it matters, I am non drinker or smoker. Very athletic and fit. I know apnea can effect anyone but the appearant severity of mine is surprising to me. Any stories about surgical successes , or earnings?
RE: poor results [Please Advise] - Commodore - 08-09-2019
Warnings...not earnings.