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+--- Thread: Oscar Data. No events flagged but weird flow rate pattern during REM (/Thread-Oscar-Data-No-events-flagged-but-weird-flow-rate-pattern-during-REM)
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Ynot - 01-29-2024
Just went to the sleep clinic. It went as expected tbh.
The therapist genuinely tried to help, but she insisted that bilevel is exclusively for patients suffering from central apnea, that there is no link between epr and ps in bilevel, disregarded FLs, suggested that disordered breathing must result in an apnea, hypopnea, CA or desaturation which disregards RERAs, and reminded me that I am technically not supposed to change my settings. It is my understanding that all I outlined above is untrue.
Getting insurance to pay for the Bilevel in Canada would take a lot of time, lots of opinions, lots of expensive appointments and tests, and a lot of luck, since I want a bilevel to facilitate breathing and decrease resistance, which is not the typical use of it. I am probably better off just buying it.
It might be that I have minimal resistance, but we sleep every night, and I guess a small improvement in sleep quality in a person with disordered breathing results in a great improvement in health.
Let me know what you guys think.
thanks
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Ynot - 01-29-2024
Is it possible to buy a bilevel without a prescription?
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - BoxcarPete - 01-29-2024
Your understanding is the same as mine, that everything you listed in your post is untrue.
It does unfortunately sound like you may be out of luck with the normal options in your health system. You can start looking for a bilevel machine second hand, or start making calls to docs across the river for a private consultation, which will likely end up costing more but if you find a good US doctor you'll be able to get a new machine and get it quickly, and/or get an evaluation for an elective procedure if you have significant obstructions that can be easily corrected.
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Fixit50 - 01-29-2024
I glanced at your Flow Rate waveforms and you seem to have something similar to what I have but mine look quite a bit worse with resp rates that are above 50bpm for protracted periods of time. Yes, the bilevel helped with this and cut down flow limits quite a bit so I don’t think your therapist provided any reasonable advice. Bilevels are widely known to decrease flow limits and just like you, my problem with APAP was not reflected in excessive events.
In my case, wearing a chin strap or mouthguard on APAP was enough to clean up my waveform and keep me from waking up multiple times in one night and notably improve how I felt during the day. You might try one of those devices to see if you can get a similar improvement in sleep quality/waveform. This might provide some clues as to what you can expect on BiPAP. Of course, if the chin strap or mouth piece don’t help much, I wouldn’t conclude that BiPAP wouldn’t help.
That’s a shame that it’s so difficult to get a BiPAP in Canada. Some of the others have pointed out some good alternate paths for getting one. The BiPAP has helped me, but you can also attack the problem by using one of the accessories I mentioned or playing around with different masks or both. I’ve found the F20 used alone, tends to push my chin back a little and this aggravates flow limits which has a snow-ball effect forcing high pressures and well, you probably know where that goes.
I feel a lot better on BiPAP and realize I should have gotten one years ago.
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Dormeo - 01-29-2024
There is no question about the improvement you can expect to see in FLs with greater pressure support. I've attached typical graphs for my FLs with the ResMed Airsense 10 Autoset (EPR of 3) and the ResMed VAuto (PS of 5) to illustrate.
The question, though, is whether reducing the FLs will help you sleep better. I think there's really no way to tell except by trying out a bilevel machine.
In the U.S., any M.D., dentist, or Nurse Practitioner can write a prescription for a PAP machine. I don't know what the rules are in Canada, but you might see who could help you with a scrip, then buy your machine from an online provider.
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Ynot - 02-06-2024
For the time being, I know there is not much I can tweak, but I'm trying to maximize my settings on my cpap. Specially with autoset. Essentially, I have my range set at min:8.8, max: 13.2. Pressure typically peaks each rem cycle at around 12.5 and stays above 9.1 for most of the night. The issue with fixed pressure is that above like 9-10 of pressure, I start getting areophagia, to the point where I sometimes wake up with giant 3-5sec burps. That is why I use autoset, it greatly minimizes aerophagia compared to a high fixed pressure of 11-12. 8.8 is simply a cut off where I consciously do not remember waking up to burp. I do not know the sweet spot and how bad aerophagia affects my sleep. I guess low arousal threshold might also be affected by swallowing too much air.
I guess I'm wondering how i can reconcile the need for pressure and aerophagia in a manner that maximizes sleep quality by finding the ideal range and how accurate the 12.5 algorithm increase is.
What do you guys think?
Thanks
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Dormeo - 02-06-2024
I'm not sure what you mean by "the 12.5 algorithm increase." Could you clarify? Aside from that, I think you have a good general plan to get the most out of your current machine. You have EPR at 3, which is your main tool for addressing FLs, and you are finding the pressure settings that you can tolerate without aerophagia, which can be a real bear.
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Ynot - 02-07-2024
(02-06-2024, 07:59 PM)Dormeo Wrote: I'm not sure what you mean by "the 12.5 algorithm increase." Could you clarify? Aside from that, I think you have a good general plan to get the most out of your current machine. You have EPR at 3, which is your main tool for addressing FLs, and you are finding the pressure settings that you can tolerate without aerophagia, which can be a real bear.
I'm referring to the machine increasing the pressure up to around 12.5 to deal with obstruction in autoset. If the algorithm is correct, then I guess I need a pressure of at least 12.5 during rem, but 12 fixed and up leads to bad aerophagia so It's hard to find the optimal autoset range with the least disruptive obstruction/aerophagia balance.
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Fixit50 - 02-07-2024
If you lower your max pressure down from 12.5 to the point where the aerophagia is not much of a problem what do your scores look like? Generally, AHI less than 5 is considered acceptable. If your AHI is below 5, or low enough at the lower max pressure that controls your aerophagia, then you should be good. You are correct that it is a balancing act.
RE: Oscar Data. No events flagged but weird flow rate pattern during REM - Dormeo - 02-07-2024
A footnote to Fixit: I’d say an AHI of even 3 can mess with sleep, though it’s too low for a diagnosis that will get you a machine. Ideally you can hit a sweet spot where your AHI is around 2 or less.