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RE: Pressure Support Question - MrIvanDrago - 11-21-2023
I saw this in a post from the past, "Far from getting expiration relief, the patient is actually getting LESS than his prescribed EPAP pressure (7 instead of 10) and a healthy dose of pressure support (3.0) that he may not need and which may actually cause him problems."
Why would a pressure support of 3.0 cause problems? What type of problem would you typically experience with unneeded pressure support?
RE: Pressure Support Question - WhyMe - 11-21-2023
EPR and pressure support are different, but often confused, terms. If you set your APAP machine for a minimum pressure of 10 (with an EPR of 0), you get 10cm h2o of pressure, both when you inhale and when you exhale. That is the pressure you have determined is the lowest needed to keep your airway open at all times. If you set the EPR to 3, you lower the pressure you are getting during exhale from 10 to 7, resulting in too low a pressure, and an increased chance for an event (this is, I think, the answer to your question).
On the other hand, with bilevel treatment, you set the minimum pressure (10 in the example), and the pressure support increases the pressure for inhalation (to 13 if you used a PS of 3), so your therapy never drops below the minimum you had determined you needed to keep your airways open.
If you use a regular APAP with EPR, you really need to raise the minimum pressure by the amount of EPR to make sure you get enough pressure. EPR lowers the minimum pressure to make exhalation easier, while PS (which I think you only get in bilevel machines or ventilators) increases the pressure higher than the minimum to increase tidal volume, encourage inhalation or get past flow limitations making inhalation easier.
Sleeprider described the benefits and drawbacks in an earlier post.
RE: Pressure Support Question - PeaceLoveAndPizza - 11-21-2023
(11-21-2023, 02:29 PM)MrIvanDrago Wrote: Why would a pressure support of 3.0 cause problems? What type of problem would you typically experience with unneeded pressure support?
Too much (or little) pressure support, whether EPR or PS on Vauto, can create different issues for people. For me, if I have PS < 4 I get CA’s, but if I have it > 4 I get CA’s. For others, there is no end of problems too little or too much PS can cause, like too little or too much pressure.
Everyone’s pressure needs are different. We need to see as much data as is available to help them find what works as best it can.
RE: Pressure Support Question - MrIvanDrago - 11-21-2023
(11-21-2023, 06:38 PM)PeaceLoveAndPizza Wrote: Too much (or little) pressure support, whether EPR or PS on Vauto, can create different issues for people. For me, if I have PS < 4 I get CA’s, but if I have it > 4 I get CA’s. For others, there is no end of problems too little or too much PS can cause, like too little or too much pressure.
Everyone’s pressure needs are different. We need to see as much data as is available to help them find what works as best it can.
So you use trigger settings to high? Very high? Or normal?
RE: Pressure Support Question - PeaceLoveAndPizza - 11-21-2023
I currently have it on very high. When I wear the Evora FFM and use medium my AHI is 2-3, high is 1-2, very high < 1.
With pillows it is almost the same, although I do drop my pressure from 8-12 to 7-11 as I seem to need less pressure with them. No idea why…
RE: Pressure Support Question - CPAPfriend - 11-21-2023
There's a subtle detectable difference in FL between the two nights, where the higher PS resulted in less FL. That said, in both cases it's n=1 data, so we can't exactly slam the gavel. FL is a bit of an enigma, and there is even a measurable degree of FL within the general population (no SDB, no complaints, no symptoms people). The most common cohort is FL for about 5% of the night, and some researchers have suggested that FL beyond 30% of the night could be used as a threshold for screening for SDB patients. So, to your question whether the flow limitation or residual obstruction is still disturbing your sleep, the answer is that we cannot know but also that both suggestions are reasonable: that is, it could be contributing or it could not. Arousal threshold between patients is something often overlooked but now well-established, and so the question is whether or not even a little bit of airway resistance is problematic for you. Once patients start getting woken up around 15 times per hour, they start to get really sleepy, though this is an average, and by "waking up" I mean EEG arousal signatures.
REM Sleep - MrIvanDrago - 11-22-2023
Hello friends, I had a question about REM sleep and looking at my attached OSCAR chart from last night, is the time between 1:00am-2:20am REM sleep, or does it look like it is REM sleep? I am trying to learn if these are arousals or REM sleep when I know the flow rate can become a bit 'erratic'. Any thought are welcome, thank you.
November 21st 2023 (Full Night)
[attachment=56368]
November 21st 2023 (1:00am-2:20am)
[attachment=56369]
RE: REM Sleep - PeaceLoveAndPizza - 11-22-2023
Interesting question. OSCAR does not currently have sufficient data to determine sleeps states. If you want to know when you enter the various sleep stages, an Apple Watch or other smart watch would give a rough approximation.
Here is an earlier thread on the same topic…
https://www.apneaboard.com/forums/Thread-REM-Sleep
RE: REM Sleep - BoxcarPete - 11-22-2023
If you want to see REM sleep disordered breathing, look at post #7 in my thread:
https://www.apneaboard.com/forums/Thread-Auto-Titrating-Machine-Recommendation-REM-dominated-OA?pid=492261#pid492261
That's an excerpt from my chart, and those REM chunks are 20 minutes long, which is typical. People who are really starved for REM sleep can have sections up to 40 minutes long, which pretty much only happens when they start a new therapy which is working well after suffering for a long time. I think it's really unlikely that you had a segment of REM that long, or multiple segments so close together that early in the night.
RE: REM Sleep - MrIvanDrago - 11-22-2023
(11-22-2023, 09:30 AM)PeaceLoveAndPizza Wrote: Interesting question. OSCAR does not currently have sufficient data to determine sleeps states. If you want to know when you enter the various sleep stages, an Apple Watch or other smart watch would give a rough approximation.
Here is an earlier thread on the same topic…
https://www.apneaboard.com/forums/Thread-REM-Sleep
Interesting thread. I know some folks sometimes can look at the flow rate chart and see the nuances that tells them if it is REM sleep or not. I talked to one sleep tech and he explained you can sometimes tell by the respiration rate and the up and down breathing patterns for REM. I personally cannot tell anything and to me I was thinking it was arousals happening.
Folks on this board often surprise me with the amount of information they may have on a subject like this.